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.

Finding Your Perfect Pump

The perfect pump is the one that helps you have a healthy breastfeeding experience. With all the brands and attachments on the market, how do you choose? Here is a breakdown of what’s out there, and what the label really means.

Manual vs. Electric

Manual breast pumps often pump one breast at a time using a squeeze or trigger device to create suction. The strength and speed of the suction is adjusted and regulated by the woman’s hand pressure on the pump device.

Electric breast pumps use an electric motor to create suction. These motors may have battery or plug-in power options. Electric pumps come in single and double, meaning they may pump only one breast or both breasts at the same time. Most of the pumps other mothers will recommend are double electric pumps. They are commonly used by mothers who work outside the home or have extended separations from their nursing baby. Electric pumps have speed and suction adjustment options that work in a variety of ways. Some have dials. Others have manual rhythm settings.

One of the first breast pumps pre-1900 made from glass and brass. Modern technology has come along way.

Open System vs. Closed System

Electric pumps use a motor to create suction. The motor system is either “open” or “closed.” An open system pump connects the pump flange to the motor directly with tubing. Air and fluid can be exchanged in the tubing.  A closed system pump has a membrane between the pump flange and the tubing. Air and fluid cannot be exchanged in the pump tubing. All hospital grade pumps are closed system pumps. The benefit of a closed system pump is that the membrane protects milk from being contaminated by fluid or particulates from the motor or tubing.

Closed system pumps are the only type of pump that can be approved for multiple users. Currently, only Hygeia makes a closed system pump that is FDA approved for multiple users AND is available commercially for purchase. Hospital grade closed system pumps are only available for rent.

Many top manufacturers sells open system pumps. These pumps generally work very well, have strong motors, and come with many features that make pumping on the go easier. The only caution is that there is a possibility of milk back-flowing through the tubing and into the motor housing. There is no way to sanitize the motor. Mold may grow in the motor housing. The tubing, flanges, and bottles can all be sanitized. This is one reason it is not recommended to buy a pump secondhand or use a friend’s pump that is not FDA approved for multiple users.

Pumping bras make hands-free pumping easier for working moms.

International Code for Marketing Breast-milk Substitutes

The US does not have laws in place to enforce the International Code for Marketing Breast-milk Substitutes. Companies may or may not voluntarily comply. Some pump manufacturers comply while others do not. You can read the full Code here to get a better understanding of how the Code seeks to support maternal and infant health. Mothers “vote with their dollars” when they purchase a breast pump, so choosing a company that truly supports breastfeeding is important to many mothers.

Hand Expression

All nursing mothers benefit from learning and practicing hand expression of their milk. Hand expression is safe, sanitary, does not require electricity, and is completely free. A mother just needs a bowl or bottle to collect her milk. Mothers can learn different expression techniques from taking a breastfeeding class, working with an LC, another breastfeeding mother, and educational films. Mothers who use hand expression can collect milk for their babies as effectively or more so than mothers using a pump, when they have mastered the technique.

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