Let's Talk About Pumping
By Jill Rabin
Julia’s Way surveyed mothers of babies with Down Syndrome (DS) and discovered that almost 70% of these mothers have to pump at some point during their baby’s breastfeeding journey for reasons other than returning to work (for example: until baby is strong enough to nurse; while waiting for heart surgery; or while baby is recovering from surgery). Pumping can be tiring and it may be challenging to establish your breast milk supply if your baby cannot nurse directly, but it can be done!
We’ve written this blog post with the input of professionals and moms who have “been there, done that” to help you have the most success. If your goal is to eventually get baby to breastfeed exclusively, you should know it is possible and that the moms who have contributed to this article have babies who breastfed successfully for a year and beyond. If you plan to exclusively pump for your baby we are cheering you on and we admire your dedication to your baby! Please remember, a lot of the tips below are “ideals.” This is what experts and best practice recommend. However, we all know that real life is often not ideal. We want you to be aware of what to do to have the best chance of being successful but we know plenty of moms who haven’t been able to follow these instructions perfectly and were able to provide milk to their babies anyway. The last thing we want to do is add more stress to what may already be a stressful time.
ESTABLISHING YOUR SUPPLY WHEN YOUR BABY CAN’T NURSE
Establishing a breast milk supply if your baby is not able to suck for whatever reason can be a challenge but it CAN be done! If your baby is not able to latch right away, ideally you will need to start pumping within six hours.
There is some debate about how long it takes to fully establish a breast milk supply but there is research that shows that milk levels at two weeks may be a good indicator of what future milk production will be. Pumping 8-10 times a day for those few weeks will help to ensure a full supply. Aim to pump every 2-3 hours around the clock, with some variation built in. For example, taking a 5-hour pumping break overnight to get some rest is beneficial for most moms. If you were not able to follow these guidelines perfectly at the start, take heart! It may be possible to increase your supply as late as 3-4 months postpartum by diligently pumping.
Research indicates that milk production is the highest in the morning and starts to fall throughout the day so it is very helpful to pump first thing in the morning if you are trying to build a “stash” of milk for your baby.
A hospital grade pump can help establish your supply in the first few weeks.
Looking at a picture, watching a video, or having a piece of clothing that smells like your baby while you pump can all encourage letdown.
Hand expression can be more effective at removing colostrum/milk in the first 24-48 hours. This Stanford video can help you learn how. Some women are more responsive to hand expression, in general, so experiment to see what works for your body.
GETTING THE MOST OUT OF YOUR PUMPING SESSIONS
To establish your supply, more frequent pumping is often more important than longer pumping sessions.
Massaging your breast for a few minutes before you start pumping can encourage letdown and increase output. This article has good tips on how to do this well.
It may seem counterintuitive (and may take longer) but research suggests that you may actually get more milk if you massage your breasts while pumping. This will sometimes mean you will need to pump one breast at a time. Read more.
Try the “milkshake”! Lean forward and let your breasts hang down and gently shake them back and forth. This is thought to stimulate the breasts and release the milk droplets from the walls of the milk ducts.
Stay hydrated and try to maintain a healthy diet (not always easy when you are eating out of a hospital cafeteria). Protein-dense foods are important for good milk supply.
It may be helpful to watch this video on maximizing your milk supply, from Stanford University.
MOM TIP I always tried to have a large glass of water or something else to drink within arm's reach when I sat down to pump. A straw helped me to drink more water more quickly.
As long as it does not cause you pain, consider turning up the vacuum pressure during the two-minute letdown cycle. This may help your milk start flowing. After the letdown cycle is over, you can turn down the pressure as needed.
Some moms find it helpful to cycle through the letdown phase twice during a pumping session. If you can elicit a second letdown, you can increase your output and supply. On most pumps, the initial letdown cycle lasts two minutes. Pump for 6-7 minutes after that and then push the button to go through the letdown cycle again and pump for another 6-7 minutes.
Check your flange size. Sometimes going up/down a size will stimulate the nerve systems behind your areola more efficiently, thereby allowing for a better and more productive letdown, which leads to more milk. This article can help you determine your flange size but it may also help to be assessed by a lactation consultant.
If you are having a difficult time with your milk output, try “power pumping” (pump for 20 minutes, rest for 10 minutes, and pump for 20 minutes. Repeat this cycle for an hour). This simulates “cluster feeding” and can help increase your output.
MOM TIP I was so hesitant to call a lactation consultant because I felt that pumping wasn’t really nursing. When my OB told me “pumping IS breastfeeding” I felt so empowered. Little did I know how much a lactation consultant could help me to increase my supply and maximize my pumping sessions. I was also concerned that any lactation consultant might be discouraging of my efforts because my daughter had Down syndrome. If you have this concern too, it might be helpful to ask your local DS community who they’ve used who has been supportive.
SAVING YOUR SANITY
We know that pumping can be challenging and exhausting, especially for those with the demands of older children, work, and/or medically complex babies. We hope these tips can help you save you some time, and maybe even some sanity, too.
Consider purchasing two pumping kits to cut down on washing parts as frequently. Make sure to read the CDC's guidelines for keeping your pumping parts clean.
We know it’s not always possible, but if it is, try to make pumping time “me time.” Use that time to unwind: bring a book, a favorite TV show, catch up on social media, or, meditate to the rhythmic sound of the pump.
Most instructions suggest pumping 20 minutes at a time but that’s not always necessary. As we’ve stated, more frequent pumping is often more important than longer pumping sessions. So, take note of how much milk you have pumped after 10 minutes and then how much you’ve pumped after 15 minutes. If it is not a significant amount, you may want to shorten your sessions and concentrate on hand expression for a few minutes after pumping.
Especially if your baby is very young (thus not yet into everything) it can be helpful to pump while you are feeding your baby from the bottle.
Store pumping parts in a ziplock bag or other sealed container in the refrigerator between pumping sessions so you don’t need to wash as frequently.
MOM TIP I had a pumping station set up upstairs and downstairs (and in the car!). I used to pack a little cooler to take upstairs overnight. It contained all of my pumping parts and bottles to store the milk in. That way I didn’t have to leave my bed to pump. I washed everything in the morning.
If you have it in the budget, consider these items that may make pumping a little easier:
a hands-free pumping bra
freemie cups, which allow you to pump discretely anywhere, even while driving
an AC adapter to allow you to pump in the car (helpful when driving to work or doctors appointments, which you may be doing frequently in the first few weeks)
a second set of pumping parts, so you don’t have to wash so often
lanolin or nipple butter that is safe for baby to decrease chaffing, which can cause discomfort in the beginning. Breast pads that you can freeze or heat up in the microwave can be helpful, too. Cold helps if your breasts are painful from pumping at the beginning and heat can help if you have a clogged duct.
SOME GREAT THINGS ABOUT PUMPING
If you have to go out with your baby, pump right before you leave and just carry your milk with you. It’s good for 6-8 hours at room temperature. See the CDC website for full guidelines.
Many moms have such a good supply when pumping that they actually donate milk to other babies who may need it. It is extremely rewarding to know that your milk has not only benefited your baby but other babies as well.
If you pump and give your baby breast milk through a bottle it means that other family members can help you with feeding time.
MOM TIP If you can’t nurse your baby and have to pump, this is the perfect time to recruit your partner or family member to help. Two nights a week my husband would take the night shift. I would pump right before bed, deliver a fresh bottle of milk to the bedside, and head off for my uninterrupted five hours of sleep. He would feed our daughter my expressed breast milk while I slept. I was bummed that I couldn’t nurse my daughter for the first several weeks of her life but I was really happy to have that sleep!
A NOTE ABOUT GALACTAGOGUES
A galactagogue is something that you eat or drink that is thought to increase your milk supply. Many cultures have special food or drink that is traditional for new mothers to consume immediately after birth and research is beginning to show that those traditional foods frequently have a positive impact on milk supply! Galactagogues can be very helpful in improving milk supply but it’s important to remember that they do not work on their own. They have to be coupled with increased demand for maximum effectiveness. They can help your body to make more milk. There are several different galactagogues available. Kelly Mom has a good article on the pros and cons of using herbs to help your milk supply. This is not an endorsement of any supplement or herb for this purpose and it is suggested that you consult your doctor or lactation consultant before using any herbal supplement, tea, etc., to increase your supply. It is important to note that different galactagogues respond to different hormones so if you do have a low milk supply it may take some experimentation to see what your body responds to.
MOM TIP I ate a ton of oatmeal, drank plenty of water, and recruited my sister to make me “lactation cookies.” They were DELICIOUS! I can’t say if I definitely noticed an increase in my supply but I seemed to notice a bump in supply when I had them around. Bonus: If you are lots of family around wanting to do something helpful, ask them to make lactation cookies! They'll be doing something useful and you'll get the benefit of a boost in milk supply!
We hope these tips will help you prepare in case you need to pump for your baby and will help you maximize your pumping sessions. Pumping is hard work! You should make it worth your efforts. Whether you need to pump for a week or a year or more, we are here to support and encourage you.
We are so thankful to Dana Paris Mahoney, BA, IBCLC, RLC of The Robin's Nest Lactation Services, Jill Rabin, M.S. CCC-SLP/L IBCLC and Sruthi Muralidharan of No BS about DS for their help on this piece.