For the first time in my mothering life, I’m heading back to work full time. Declan is 2.5 months old and while I’m excited to return to work I enjoy, I’m also sad that we have to be apart (I will save my rant about the deplorable state of maternity/paternity leave in the US for another day). Fortunately, technology – the breast pump – makes it possible for me to maintain my breastfeeding relationship despite being away for the work day. And thanks to the Affordable Care Act, I have a snazzy new Hygeia Q (the insurance branded version of the Hygeia EnJoye) with which to pump.
Breast pumps help mamas provide their babies with breast milk when they are apart, they help mamas maintain lactation when baby is unable to nurse due to illness or physical barriers, and they offer mamas an alternative way to provide breastmilk if for whatever reason they do not wish to nurse at the breast. So yay for breast pumps!!
But…as with most technology there is a downside to the breast pump. And I don’t just mean the odd feeling one gets when sitting hooked up to a whirring machine wondering if one’s co-workers can hear said whirring.
Rather, sometimes the very thing that makes breast pumps such a blessing – the ability to express milk efficiently without a baby involved – also makes them a bit of a curse. Let me explain.
“Do I have enough milk?” That concern in some iteration plagues many a breastfeeding mama. And for many women, pumping compounds the concern. Heck, I’m on baby #3, I’m an accredited breastfeeding counselor with Breastfeeding USA, and have read more about breastfeeding than most medical professionals and I still watch the drips into those bottles with an eagle eye as I try to still the voice in my head saying “you need more; you need more!”
Because we can pump, sometimes it feels like we have to. You’ve heard the advice to “pump now after every feeding to build that freezer stash!” Don’t do it!! (see below for why it’s a bad idea). And because we can pump, it feels like we need to pump more. I’m sure I’m not alone in that nagging feeling that no matter how much I pump, it’s not enough – even when it totally is.
Things don’t necessarily get easier even when we’ve been pumping for a while; in fact, often they get harder. Many pumping mamas experience drops in output, increasing stress over finding time to pump, and just burn out from being hooked up to a machine multiple times a day (thus the popularity of the “smash the pump” ritual at the end of one’s pumping career!).
I don’t mean to paint a bleak picture. Really, truly I’m so glad breast pumps exist! But I do think there are some fairly simple things pumping mamas can do to stay sane and have a more positive pumping experience. These come out of my breastfeeding education, working with other nursing/pumping mamas, and my personal experience.
- Don’t pump too early. Many mamas want to know when they should start pumping. For mama-baby pairs where breastfeeding can proceed normally, pumping prior to 4-6 weeks postpartum is not necessary and can be counter productive. If baby is unable to nurse at the breast (or if mama chooses to be an exclusive pumper), than of course pumping needs to happen right out of the gate. But if you are nursing at the breast, leave the pump in the box during those early weeks.
- Pumping on top of nursing is a lot of extra work. And if you’ve had a newborn, you know that’s not the time for extra work! Use your time to rest, to get a solid foundation for nursing at the breast, and to enjoy snuggling your baby.
- Pumping too much too early can also give you an oversupply. The early weeks of breastfeeding help to “establish your supply”; if you up the demand on your breasts by pumping, your body may think you are nursing multiple babies and will produce accordingly. While that may sound attractive (bonus milk! freezer stash!), those who have dealt with oversupply can tell you it’s not. Oversupply can cause trouble for your nursing newborn (including difficulty latching and gas and colic symptoms) and for you (including engorgement, clogged ducts, and mastitis).
- Use breastfeeding friendly bottle practices. Overfeeding baby at the bottle is probably the #1 pumping problem. What does baby’s intake have to do with pumping? Well, consider this…let’s say you are away from baby for 9 hours between your workday and commute. And let’s say your well intentioned care provider gives baby 3, 5 oz bottles in that time frame (because in her experience, that’s what formula fed babies generally take). So baby has had 15 oz in 9 hours; potentially 2/3 of her intake for the entire day (as the typical intake for a breastfed baby is 19-30 oz per day). So you’ll just pump 15 oz right? For some pumping mamas that’s no problem. But for many of us, that’s simply not a realistic pumping amount. So what to do??
- Remember that a breastfed baby’s intake does not increase after the first month (growth spurts excepted). A formula fed baby does start to take larger bottles; a breastfed baby does not. The typical breastfed baby will only ever take a 3-4 oz bottle.
- Babies, particularly young ones, are designed to eat frequently. Instead of forcing baby to stretch out feeds and take larger amounts, care providers should be attentive to baby’s feeding cues. That may mean baby is taking smaller amounts every 2 hours vs. larger bottles every 3-4 hours.
- Babies like to suck! And sucking is comforting! When at the breast, babies change their suck (those little flutter sucks) when they want comfort vs. food. That change in suck triggers a change in milk flow (smart breasts we have!). Babies will do the same at the bottle BUT bottles aren’t so smart and don’t change milk flow. Result…baby gets more milk than baby really wanted (which can lead to tummy upset and excess spitting). So…
- Paced bottle feeding is your friend. Make sure you care provider understands paced feeding (which I would argue is equally important for formula fed babies) and that your baby may not eat the same amount at every feeding (do you eat the same portion every meal??). Make sure to that your care provider is willing to distinguish baby’s different cries – is that a hungry fuss? A tired fuss? A want to suck fuss?
- Consider whether a pacifier might help. I don’t love pacifiers, primarily because I abhor the “baby is using me as a pacifier” line. But…when mama’s breasts aren’t available and baby truly isn’t hungry and just wants to suck, a pacifier can be a lifesaver.
- Send your milk in smaller increments. If you send a 5 oz bottle to your care provider, baby is likely going to get a 5 oz bottle. Consider storing your milk in 2-3 oz increments. Baby will get a more appropriate amount and you are less likely to end up with wasted milk.
- Know your equipment. Although each breast pump has its own “quirks,” they should all be used the same basic way to mimic baby’s action at the breast. Your pump should also fit you comfortably; an uncomfortable pump will yield less milk.
- Babies use a faster, gentler suck to trigger your milk letdown and then switch to a slower, slightly stronger suck for active nursing. Your pump has two variables – cycle rate and suction strength – that you can use to mimic this pattern. Use a fast cycle rate and comfortable suction to trigger your letdown; when the milk starts flowing (and only then!) slow the cycle rate and bump the suction just a touch (still should be comfortable). You can repeat this pattern to trigger a second let down. I prefer pumps such as the Spectra, Hygeiaor Ameda which allow you to independently control both cycle rate and suction. If you have a pump like the Medela that automatically switches after a set period of time, remember to use the letdown button as needed to continue the faster cycle rate until you let down. The amount of time you need to get a let down will vary from session to session.
- Make sure you have good flange fit. If your nipples are rubbing the sides of your flanges, you need to size up. If your areola is being drawn in with your nipple, you should probably size down. If you have a properly sized flange and are still feeling chaffed, try a little coconut or olive oil to lubricate before pumping.
- Pumping shouldn’t hurt! If you are having pain, or if you are having trouble getting a letdown with your pump, seek hands on help (see below).
- Have spare parts handy. Make sure you always have back up parts for your pump – flanges, valves, tubing, etc. Over time, you will need to replace some parts. Extra parts stashed at work can also save the day if you forget something. Some mamas like to keep a manual pump handy as well as a back up; learning to hand express is also a good idea.
- Use hands on pumping to maximize your output. When we nurse at the breast, our breasts get a lot of touching that the pump just doesn’t provide. Mimicking that touch can also help us relax – important for our milk ejection reflex.
- Be smart with your scheduling. Another hurdle many pumping mamas face is finding the time to pump. A busy workday and shared pumping spaces can make it challenging to maintain a regular pumping schedule. It is important to try to pump on a schedule that mimics how baby would eat. Although missing or delaying a scheduled pump every once in a while won’t cause huge problems, repeatedly doing so can easily lead to issues including a drop in output (less demand = less supply), engorgement, clogged ducts, or mastitis. So how to carve out pumping time?
- Know your rights! Employers must provide adequate time and a location for pumping. Have a conversation with your employer prior to your return to work to make sure that expectations and accommodations are clear.
- Use a hands-free bra to help you master multi-tasking. These are also great if you need to use your commute as pumping time. I’ve not tried them myself but many mamas love the Freemie Cups for hands free pumping.
- Know your “magic number”! The number of times you need to pump while away varies from mama to mama and has to do with storage capacity, not breast size.
- If you can nurse at the breast, do. Nursing baby right before you leave and right when you pick up can save you from needing to pump that extra 3-4 ounces. If you have the option of nursing on your lunch break, take it.
- Don’t compare yourself to others. We’ve all heard the stories of mamas who routinely get 12 oz per pump session or who have gallons of milk as back up. They are outliers! A “normal” pumping supply provides just what baby needs; anything extra is actually an oversupply. So great if you do have more milk – you can donate! But if you are “breaking even” – that’s ok! Your body is doing exactly what it should – producing just what baby needs.
- Use biology to your advantage. As noted above, babies are designed to eat small frequent meals. And babies of all ages (yes, all ages) often need to eat at night. If you continue to feed on demand, baby will most likely naturally space out feedings around the clock – meaning less you have to produce pumping. Many babies will also reverse cycle as a way to reconnect with mama after being apart. Those extra night nursing sessions not only offset ounces you would otherwise have to pump but are also great to keep your milk making hormones jumping. Many mamas find that bed sharing helps them to still get good rest while meeting the needs of a reverse cycling baby. If baby isn’t reverse cycling or if you aren’t comfortable with bed sharing, you can get in extra snuggles in other ways (for example by wearing baby during the dinner routine).
- Seek support. You are not alone on your pumping journey. Seek out other women who have been there or who are pumping along with you. If you are having trouble pumping or concerns about pumping, reach out. Breastfeeding USA counselors are available through local meetings but are also happy to work remotely with mamas. A good IBCLC can also help troubleshoot pumping and bottle feeding. As with any aspect of breastfeeding, hands on help is essential to overcoming challenges!