Exclusively Pumping Breastmilk

Most parents who exclusively pump started parenthood wanting to breastfeed, for a variety of reasons, breastfeeding could not be initiated or if it was, it could not be sustained. In reality, at this point many parents decide to feed their baby formula.

Some parents however, will pump to build and protect their milk production until their baby is well enough and able to latch to remove milk from the breast themselves. They pump in the hope that one day their baby will latch themselves and they can dump the pump.  Others, may have to come to terms with the fact that their baby will never be able to breastfeed themselves and will need to pump for as long as they decide to give their baby breastmilk. Non-gestational parents in LGBTQ+ families may decide to induce lactation so that they can co-nurse; adoptive or parents of surrogate babies may also decide to induce lactation. This process involves a lot of preparation with hormones and pumping.  Finally, parents may decide to exclusively pump until they decide to end the pumping because it suits their nature. They know they are providing optimal nutrition for their baby along with the other protective and developmental advantages of breastmilk, yet, they know exactly how much their baby is getting, there is a certain routine and predictability about the feeding.  

Regardless of the reason for pumping it is generally a time of huge emotion and transition. There are big feelings to handle alongside transitioning to motherhood and parenthood. It is hard work.  Sarah a former client of mine who unexpectedly had to pump to protect her production as her baby could not transfer milk effectively. She embraced the pump and milk production became her focus, along with the hope of her baby transferring to full breastfeeding. She was and is an amazing first-time parent during Covid, focused and determined and all the while grieving and hoping. I asked if she would give me her tips that saved her while she was pumping exclusively and thankfully, she agreed. Nothing better than to hear it from the voice of experience . She tells her story amongst the tips.

Equipment! consider getting a closed system pump, in the early days, it’s worth getting/renting a hospital grade pump to establish supply. I tried a few pumps, beware of all the marketing around certain pumps and celebrities! Find the one that’s suits you. I found Spectra suited me best, I also had a handsfree pump which was fine when I was stuck/working but would never fully empty. Get the right fitting flange, pumpinpals™, I found them brilliant for being able to sit up while pumping without milk leaking back on me. Also, Sonya at hipbaby.ie has an amazing range of equipment, she is so helpful if you have any questions and delivery is super-fast! Hands free bra for double pumping essential! I bought a few and made others from old sports bras, but I preferred the ones I bought.

Extra pump parts! - this would have helped a lot in early days to have second pair of parts, gives a bit of flexibility. Wish I had thought of it!! There are lots of hacks for this you can find on the online community e.g., fridge hack, but I never tried this myself. Also not forgetting to change the valves etc I didn’t realise how often you should do this especially if exclusively pumping , as it makes the pump less effective if they are worn and can cause supply to drop.

Lactation consultant -  If you can afford it, see a lactation consultant for a consult. I did and it made a world of difference - worth their weight in gold! I was so lucky to have Pauline, especially in those early days.  I knew nothing about pumps and pumping, didn’t realise that I needed to establish my supply as my daughter wasn’t latching. She listened to my worries, my loss, my hopes and all the time made me feel supported and normal! She also instilled hope in me when I really needed it. Only for her I would not have realised my dream of direct nursing.

Snacks and TV shows for MOTN pumps - those middle of the night pumps can be so bloody hard, it’s good to have a treat to look forward too! I got through a lot of Netflix 😂Also prepping your pump bits and put them in a little box before bed so that you don’t have to get up to wash to sterilise before next pump.

Enlist help!  As much as you can. Your partner, family, friends can help out.  Sometimes partners feel helpless and not sure what to do, agree on specific jobs so that you don’t have to think about them. Eventually what worked well for us for us e.g., my husband got up and fed baby at night, I pumped and went back to sleep! He helped with food preparation, washing pump parts. It’s trial and error. Accept offer of dinners for the freezer.

Find your community
- Instagram, Cuidiu Facebook
It can be and feel isolating in beginning, but lots of people exclusively pump by choice or by necessity. Some accounts I found helpful onewiththepump, bemybreastfriend, pumpmommapump
Also, Cuidiu put me in touch with someone who had exclusively pumped and it helped just knowing there was someone else out there.

Freezer- if you are lucky to establish a good supply, you may need to freeze any excess - if you do, make sure to rotate your freezer stash. If you have excess, it helps to have lots of freezer space (we ended up buying a freezer!) or consider donating to the milk bank. Consider feeding one defrosted milk per day and freezing freshly pumped milk. This helps to keep freezer milk moving and you don’t end up with a freezer full of out-dated milk. Check for high lipase (for fishy taste off milk after defrosting)- do this early as can avoid lots of heartache down the line when the baby won’t drink defrosted milk!

Paced feeding - good for any baby but especially if you hope to breastfeed alongside pumping or in the future. Do this from the start so baby does not get used to fast flow.

Feelings You are not crazy if you have feelings of upset/loss/grief! It’s a real thing breastfeeding grief! Check out Prof Amy Brown. For those who did not plan to pump but did it because direct nursing wasn’t possible - Allow feelings of loss/grief to be present. You can connect with baby other ways than nursing, skin to skin, baby massage, sling. 

Do. Not. Feel. Guilty. For. Stopping!! It is bloody hard; you are doing triple the work. It’s not all or nothing either -If it’s too much consider pulling back - combo feed etc. However, If you wish to breastfeed, do not give up hope!

We got there at 4months old, and fed until 20 months, so it’s never too late if you have your supply established!!

Sarah

Basics of Exclusive pumping, starting off.

This is a basic guide to pumping breastmilk, take your time. Pumping can sometimes feel it is all about milk production (and it is!)  it can feel mechanical, as a result, you may feel a bit disconnected.  It is important for you and your baby to stay connected emotionally and have time where you are bonding, connected and restful. Time for touch, time to smell your baby and kiss your baby or to feel their softness against your skin, a time for oxytocin to flow. When it flows you feel it in your body.

Here it goes …

Have an appropriate pump for what you intend to do. See Sarah tips.

Know the basics  milk production.

Before you start to pump, read the instructions and get to know the pump parts. Look at You Tube videos, try not to rush head first into using the pump even if it means having to use formula in the mean-time. It makes for less anxiety around initiating pumping. Obviously, the more you pump the more you learn about what works for you and what doesn’t.

Flange fit is very important and you may need help with sizing, wrong size flanges can cause friction pain or oversized flanges can lead to a lower yield of milk. Rubbing some coconut oil on inside of flanges helps protect against friction. You can also get silicone inserts for comfort too.

Suction is personal, higher suction won’t automatically bring more milk. You may need to play around with suction. Set to a highest setting that you can tolerate and then bring it down and see what happens in terms of flow and comfort. Have a read of this little pumping poem

2To get the milk to start to flow

Set the cycles high and the suction low

Once the milk starts to flow set the suction higher and cycles lower2

Sam Mahon

Set up a “pump place” in your home and have your pump out and ready, as opposed to having to take it out each time and then putting it away following a pump session. Saves time. Have a comfortable chair, cushions, blankie, whatever makes you feel relaxed.  Have your snacks, phone, water, all within easy reach.

At night have a little cool bag with freezer block to hold your milk until the morning, or use a cooler box to include your pump parts rather than getting up and washing them during the night, Place the pump and parts in a Ziploc and pop them in the cooler box along with the pumped milk.

Establishing the milk production is hard work, no less than 8 pumps in 24 hours. But preferably 8 to 10 pumps. Pump once between 12 and 4am as prolactin, the milk making hormone is highest in blood circulation at that time.

It is not always about the time spent pumping but the frequency is more important. It is probably better to pump for 15 to 20 minutes 10 times in 24 hours than 30 min of pumping 8 times in 24 hours. You will get a larger yield.

How much you get per pumping session will vary, depending on the time of day and also how old your baby is. If you start to pump when your baby is born, babies are probably taking 30 to 60ml per feed once you milk has come in between day 3 and 5. Babies will be feeding approximately 60 to 90 and then 90 to 120 mls per feeding in 24 hours by six weeks. Think of volume pumped in 24 hours as opposed to the amount pumped per feeding, as milk output can vary. You may even get a different output on different days of the week!

We all have a breast storage capacity and how much you produce in any one feeding will depend on storage capacity. It has nothing to do with the size of your breasts. Small breasts can make plenty of milk and big breasts don’t necessarily make more milk. That’s why some people have can pump 10 times to get 900mls in 24 hours and others may have to pump 12 times to get that amount. Both are normal scenarios.  

Massage your breasts gently, before a pump or warm your breast with little hand warmers in your bra, or a warm face cloth. Hand expressing or breast compressions during pumping will yield more milk.

A watched kettle never boils, same goes for pumping, for some people, if looking at what is being pumped, the flow appears to be slow. Cover your bottles with baby socks! look at some TV for distraction. There are lots of accounts for mindful relaxation during pumping. Soothing the nervous system by breathing in for 5 and out for 8 or in for 7 and out for 11, breathing in peace and breathing out stress.  

Production of milk should generally go in an upward trajectory toward 6 weeks and will then settle. However, there may be some days where you don’t produce as much milk as the previous day. It may be tiredness, stress, illness, infection or just one of those days. Rest, replenish yourself, have or do something that nourishes your soul. Some common times for dips are two weeks and five weeks.

Storage of your breast milk. Be aware of storage guidelines. Storage times of milk once thawed is different.

Feed your baby in a responsive way using paced bottle feeding,  if your partner or helpers are feeding your baby show them how to pace the feed.

It does get easier as you go, the first five to six weeks are the hardest as you establish your milk supply. Take one pump at a time. Any amount of breastmilk is good.

Thanks to Sarah for taking the time to write for this blog.

Pauline Mc Loughlin IBCLC 2022©