What to Expect When Pumping

Expressing milk for your baby can be one of the most affirming or daunting tasks. Filling your pumping bottles to the max can be a real boost of confidence, but is that normal or optimal?

General recommendations for how to pump milk

1. A double electric pump is ideal for mothers who will be expressing milk frequently. (For more information on how to choose a pump, see Finding Your Perfect Pump)
2. A properly fitting flange (the horn or bell shaped piece that presses to the the breast) will be the most comfortable and ensure optimal milk expression
3. Pump both breast simultaneously for about 20 minutes.
4. Normal pump output is 2-4 ounces total from both breasts from one 20 minutes double pumping session.
5. Pump output is not an accurate gauge of milk production. Pumping is a developed skill that improves over time.

Getting a Good Fit

Fitting your pump flange can be a tricky process. Breasts change over time. It is completely normal for a mother to need to change flange sizes over the course of breastfeeding. Many pumps now come with a range of flange options or additional flanges that you can purchase separately. The best fitting flange at week 1 may not be as comfortable or effective at week 28. Human bodies are not symmetrical. It is normal to use different flange sizes for each breast.

Most women use trial and error for testing their flange fit. Learning to hand express milk can also help determine where on the areola the flange should rest for optimal pumping. The flange should be in contact with the same areas of the areola that a woman stimulates to hand express her milk. The flange should not rub the nipple. It should provide even pressure to the areola.

Tips for Double Pumping

Some women find it difficult to hold the pump flanges simultaneously. Pumping bras are easy to find at most baby product stores. They hold the pump flanges for you. This hands-free option means that working mothers may be able to do other tasks while pumping. A sports bra with holes cut in the cups can work in a pinch if you don’t have a pumping bra. Simply feed the flanges through small holes in the bra.

Normal Pump Output

The general understanding of pumped milk output is that 2-4 ounces is normal for both breasts combined. You may notice that one breast expresses significantly more milk than the other. You may notice that time of day influences how much milk you collect. It’s important to remember that pumping milk is not a predictable process, just like all things with parenting. Here is a list of common pumping experiences that cause mothers to worry about their milk supply though they are usually perfectly normal:

–¬† higher pump output in the mornings, lower pump output in the afternoons

– pump output that decreases over time as the baby ages (most women begin with oversupply that noramlizes between 6-12 weeks postpartum)

– one breast pumping a high volume, one breast pumping a low volume

– pump output decreases during menstruation and/or ovulation

– inability to pump the breast “empty,” milk continues to flow after the standard 20 minutes of pumping

– need for new flange sizes over time

– change in nipple shape over time

Blame the Pump First

Some women notice sudden changes in pump output. Always blame the machine before your breasts. Pumps have parts that are designed to be replaced during the course of time. Membranes and tubing are susceptible to small holes and degradation. If these parts are not at top shape, the pump will not work properly. Assembly errors (user errors) are also common. If your pump is not functioning, check  the pump first. Chances are mom is perfectly lactating and the pump needs a tune up. A good rule of thumb for open system breast pumps is to change the tubing every 2-3 months to avoid contamination and improve pump performance. The membranes on open systems pumps often function best when replaced monthly.

Top Tips for Improved Pump Output

1. Make sure the pump is in good working order, properly assembled, and properly fit to the breast

2. Pump in a relaxing environment to facilitate the strongest letdown response. Some mothers look at photos of their babies or watch films on their smart phone. Smelling an relaxing aromatherapy candle or even a “dirty” baby blanket can help some mothers.

3. Heat and massage the breasts before a pumping session. A microwave rice sock is easy to transport and can be tucked in your bra a few minutes before pumping. Rub the breasts all over in firm circular strokes.

4. Stimulate the nerves to the breasts. The thoracic spinal nerves that correspond to the breasts are T3, 4, and 5. They can be stimulated by rubbing your back against a door jamb. Think “bear scratching back on tree.” Or ask your partner to rub your spine a bit while you pump.

5. Drink a glass of water while you pump. It may help relax you and feel more in control of the process.

6. Hand express for about 5 minutes after pumping. Some women are able to express 50% more milk by hand after they pump. Remember, the breast is never truly empty until full weaning happens.

7. Make sure your baby is being fed appropriate amounts while you are away. 1-1.25 ounces is per hour of separation is the recommended amount. Many moms find their pump output is normal but the baby is being overfed. (more information see Bottle Feeding Human Milk)

8. Contact an LC to develop a pump routine that matches your pump output needs. Some mothers need an individualized plan because of workplace constraints or parenting demands.

Top Tips for Top Milk Supply

By far, the most common concern about breastfeeding is adequate milk supply. Here are the top evidence based recommendations for ensuring your short term and long term production.

OLYMPUS DIGITAL CAMERA1. Bring your baby to the breast as soon as possible after birth. Babies are born alert and ready to feed. Babies nursed in the first 2 hours after birth are more likely to be exclusively breastfed.

2. Feed often and on cue. Crying is a late sign of hunger. In the first weeks, babies nurse all the time. This establishes long term milk supply and helps the stomach grow. Expect your baby to nurse at least 12 times in 24 hours, often more. All health organizations recommend “on demand” infant feeding. No health organizations recommend scheduled feeds.

3. Hold your baby. Skin to skin contact is proven to facilitate better breastfeeding. You can’t “spoil” a baby. Holding your baby has other health benefits for non-breastfeeding families as well. Babies in close contact with an adult care provider are better able to regulate breathing, metabolism, heart rate, and temperature.

4. Sleep near your baby. The American Academy of Pediatrics recommends babies room-in with an adult care giver for the first 6 months of life as a protective measure against SIDS. Room sharing also facilitates easier night feeding. It’s normal for babies to nurse at night well beyond 6 months of age.

5. Do not introduce formula, water, juice, or other solids unless medically indicated before 6 months. Exclusive breastfeeding provides everything a full term healthy baby needs. Giving a formula supplement “just in case” can cause milk supply to drop. Combination feeding of breast and formula leads to decreased milk supply as well.

6. Ignore the clock. Allow your baby to nurse as long as he or she wants. Some babies will finish a feed in 7-10 minutes while others may take 40 or more. Just like adults sometimes want a full meal and other times just a snack, babies feel the same way. Put your baby to the breast and nurse until the baby comes off naturally. Offer the other breast. Your baby may or may not want both breasts per feed. Always follow the baby’s cue.

Bottle Feeding Human Milk

Storage

Guidelines for storing human milk vary slightly depending on the resource you use. This article cites the recommendations from La Leche League International (as posted in the web FAQ) and the Centers for Disease Control website on breastfeeding. Mothers should be encouraged to test their milk whenever they doubt its freshness by smell and taste. It’s impossible to discern freshness visually. Human milk has a wide range of normal colors. The separation of fat can vary greatly as well. When in doubt, throw it out.

On the counter: 4 hours according to LLLI, 6-8 hours according to CDC In a cooler on “blue ice” packs with packs in contact with milk containers: 24 hours according to CDC

In the refrigerator: 3-8 days according to LLLI, 5 days according to CDC
In the freezer (do not store milk in the freezer door. It will be exposed to more drastic temperature changes in the door compartment.): 6-12 months according to LLLI, 3-6 months according to CDC
In a sub zero “deep” freezer: 6-12 months according to CDC

For minimum waste, store milk in 2 ounce portions. Some mothers find storing in 1, 2, and 3 ounce portion gives them more flexibility and less waste.

Heating

Thaw frozen milk in the refrigerator or in a bowl of warm water. Do not microwave. Do not submerge in boiling water. Milk storage baggies are not designed to withstand high heat.

Milk that is thawed can be heated in the bottle in a bottle warmer or pan of warm water. Remember, the milk need only be heated to body temperature, not made hot.

Milk will naturally separate after expression. Swirl heated milk bottle gently to mix fat layer back into solution. Do not shake. Shaking puts bubbles in the milk making the flow out of the bottle less smooth. Bubbles may increase gas. Human milk contains fat chains of long and short lengths. Shaking may disrupt the fats.

 

Choosing a bottle and artificial nipple

A slow flow artificial nipple is ideal for the duration of breastfeeding. Babies who alternate between breast and bottle will continue with a slow flow nipple until they transition to a cup. Slow flow nipples will keep your baby bottle feeding on a pace more similar to the breast to make the transition back and forth easier.

No brand of artificial nipple creates a latch like breastfeeding despite marketing claims. In fact, advertising a teat this way is a violation of the World Health Organization’s international code of marketing breast-milk substitutes. There is no shape, material, or insert that is like a human breast. When choosing an artificial nipple, the one that is slow flow, able to be sanitized, non-allergenic, and agreeable to the baby is the right choice. What works for one family may not work for another.

Breastfed babies rarely have stomachs larger than 3-5 ounces, even at 6-9 months. When choosing a bottle, small bottles are sufficient. Large bottles of 6 ounce capacity or more are for formula feeding.

Many parents are concerned about chemicals in plastics. Many bottle companies now offer BPA free plastics. Glass bottles are also growing in popularity. Glass bottles now are on the market that have rubber sleeves to help prevent shattering. The type of bottle a family chooses is a personal decision.

Paced Bottle Feeding

1. Hold baby mostly upright. Babies cannot regulate the flow of a bottle when lying on their backs or reclined.
2. Hold bottle parallel to the floor. It’s okay if some air is in the tip of the nipple.
3. Place the tip of the nipple on the baby’s upper lip. Baby will open the mouth wide. Gently insert bottle nipple into the mouth completely. The baby’s lips should be flanged at the base of the nipple.
4. Let the baby drink 1 ounce. Gently tip the bottle down to give a rest break without breaking the latch. Babies are able to stop the flow of the breast easily. Gravity prevents babies from controlling the flow of a bottle the same way. These short breaks help the baby bottle feed more similarly to breastfeeding and give them a chance to cue fullness.
5. Feed a second ounce and provide a second break by removing the bottle nipple from the baby’s mouth.
6. If baby shows hunger cues, switch the baby to the other side of the body. Breastfed babies coordinate left-right because they are switched from side to side. The second half of the feed should be done with the care giver holding the baby on the opposite side.
7. Latch the baby to the bottle nipple and feed again just like instructions 1-4. Continue to feed ounce by ounce with breaks in between to allow baby to burp and cue fullness.
8. The baby should spend as much time at the bottle feed as he would at a breast feed.
9. Never encourage a baby to finish a bottle. Always follow cues of hunger and fullness. Scheduled feeds are not recommended by any health organization.

Why is pacing the feed so important?

Many mothers misjudge their milk supply due to incorrect bottle feeding. A baby held in a reclined position during a bottle feed will have milk flood the mouth due to gravity. Babies are smart. They will swallow the milk in order to protect their airway. They don’t want to aspirate the milk into their lungs. This is why many mothers report that their baby “sucked down” a bottle rapidly.

Babies bottle fed this way generally have an easier time feeding at both the breast and bottle. So called “nipple confusion” is decreased. Many babies will learn the flow differences of reclined bottle feeding and breastfeeding. These feeding methods use different facial muscles. Feeding at the breast is shown to provide optimal craniofacial development. Paced bottle feeding can help a baby enjoy the benefits of breastfeeding when mother and baby are together.

5 Things You Actually Need Before the Baby Comes

1. Water proof mattress pad
It’s not for the crib or bassinet. Get a mattress cover for your grown-up bed. During the first weeks postpartum, women lose a lot of fluid. Some experience night sweats, most of us leak milk, and everyone has an unpredictable flow of lochia. Let’s not forget the mess the baby makes. At some point, every new mom will hold and nurse her baby in her bed. Spit up, leaked milk, and explosive diapers happen in every room of your house. Keeping the mattress protected from liquids is a simple investment that will really improve your postpartum comfort.

nursingpillow2. A ring shaped nursing pillow
But it’s not for nursing! Most women have some degree of sensitivity when sitting the first several days postpartum. The ring shaped nursing pillow is a perfect sit-upon for mom as it cushions the tissue around the birth canal and allows the perineum to rest in the center, completely untouched. Truth: hemorrhoids happen in late pregnancy. You might be opening that ring pillow before the baby comes.
Most women don’t have enough torso length to fit both the ring pillow and the baby. Very rarely is the pillow helpful for newborn nursing. However, it can be a great help for positioning your baby for other things as they grow: Assisting with sitting up, cradling the baby while mom does a two-hands task, and offering low back support for mom after a long day of snuggling a heavy child.

chuxpads3. Chux pads or other disposable water proof pads
Motherhood is a wet condition. Your post birth body undergoes rapid changes in the first weeks as your organs realign and your uterus shrinks. Postpartum contractions speed the process but can also stimulate the bladder and flow of lochia. Sometimes, moms leak. Sitting on a chux pad when rocking in that new, expensive, pastel glider will really boost your confidence. Sit on one on the couch or in bed too.

sleepbra4. Nursing sleep bras
Your breasts will change rapidly in the first few weeks of nursing. Sleep bras are a better investment until you know what size you will be. They are sized small-xx large, taking a lot of guess work out.
These bras are not like bras at all. They hold breast pads to control leaking and do not cause pressure on the breasts. There are no plastic clips or wires to fiddle with. They are economical and make a good transitional bra option while nursing is just getting started.
Even if you don’t plan to breastfeed, you will make some milk and need something over the breasts to absorb leaking. Pressure is no longer recommended for mothers wishing to cease lactation.

5. A sling or wrap to hold the baby
At some point, you’ll need to do some two-handed tasks (like pulling back your new mommy ponytail). Babies are hard to put down. They like being held and moms like holding them. A sling or wrap can help you nurse hands-free as well. Evidence shows that babies are best able to regulate their breathing, heart rate, temperature, and metabolism when they are in close contact with an adult care giver. Skin-to-skin contact also promotes long term milk supply. Your local Baby Wearing International group may have a sling lending library.

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