Sunday, December 11, 2011

Pumping 411 - Getting the Most Milk

So what if you need to go back to work after your baby is born? What if you are needing to pump more than you already are because you can't keep up with baby's needs while s/he is away from you? What if you want to donate milk to a deserving family but don't want to risk decreasing your current supply? What if you have trouble emptying your breast while pumping?

Well, I just learned some new things in training that may be helpful to you.

Here's what I knew...I knew that you can pump just a few times a day after nursing your baby to increase demand and after a few days, you'll get a little more, a little more, and a little more. Usually. Obviously this is different for all women, and it can vary depending on how old your baby is and how effective a pumper you are. I also knew that mother's milk teas can help support this process. The few times I've tried this I've had a couple cups of the tea during the day whenever I thought of it, and pumped using a double pump maybe twice a day after nursing Chase. I found this very effective.

What I didn't know was that combining hand expression and hands on pumping can, on average, DOUBLE the yield from a single session. Now...this is more important that just having more milk...and empty breast makes milk faster than a full breast, so the emptier the breast, the faster it fills...the more milk it thinks it needs to make! So how do you do it?

Here is a great handout sheet from LLL about hand expression. This is a good guideline to start with, but pay attention to what works for you and modify how it works best. The research showed that if a mother starts her letdown with hand expression then begins using the pump, she will have more success, especially if she generally has a problem letting down to the pump. If you have 7.5 minutes and are interested in a video about it, this is very informative: http://newborns.stanford.edu/Breastfeeding/HandExpression.html

Pump until the milk slows to a drip or stops flowing, remove your pump flanges, massage and stroke the breasts, begin using the pump again in single mode, and do some massage and compressions WHILE pumping at your most efficient settings with your pump. Then massage and stroke the other breast, begin pumping and doing the massage and compressions to drain the breast a little more.

Now...hand express until you can't get anymore! Combine the milk, chill...done! Now...this sounds like a lot of work, and it can be, but you can pick and choose what works well enough for you. The mother's in the study who used this method took about 25 minutes total to express both breasts. Many moms don't have this kind of time to commit, so what should you do?

Get your breasts warmed up before putting your pump on a fast cycle and starting to pump. Once your milk begins to spray, slow the cycles down and turn the pump to your most efficient suction setting (where it is comfortable but removing milk). Your milk flow will slow, turn your pump back to the faster cycle and shake the girls around! Try turning it back to the slower cycle speed again to see if you get more, do compressions until you just can't get anymore and call it a day!



Some moms just do better, get more milk, and faster through straight hand expression, so maybe that's your ticket! Some moms also find a single hand pump just as effective for this situation, it's way less to set up, and you can control it easily by changing the speed of the suck and the pressure to your comfort. This can be very effective for achieving multiple letdowns...as the milk flow slows, increase the speed until another letdown comes through. A hand pump would also be easy to use while nursing baby on the other breast...what better way to get an excellent letdown that JUST KEEPS GIVING?! It's also easier and quieter to use while snuggling your baby (another excellent way to encourage a great letdown). So if you are pumping to build up a stash, slow and steady, to donate to a mom...this may just be the technique for you. In testing the pressure of the suction in many good manual pumps, it's equal to that in double electric pumps like Hygiea, Medela, and Ameda.



In order to ensure your highest comfort and your most efficient milk removal, make sure you are using the right size flange. A poor-fitting flange can cause endless problems, nipple trauma, pain, and decreased milk. Ameda has good images here of a good fitting flange and a too-tight one. On a too tight flange you will also notice blanching around the base of the nipple. A too-large fitting flange will result in too much areola getting pulled in and create quite a bit of discomfort. Both situations result in inefficient milk removal.

Not every woman needs a big, expensive, double electric pump. These pumps are best for moms who have to pump to return to work and thus must pump efficiently when they are away from their babies for an extended period of time. They are also a good fit for moms who are choosing to or NEED to pump exclusively for their babies whether they are home or not. Moms with babies in the NICU are better off using a hospital grade pump than a consumer grade double electric, but most moms do not need such a hearty pump. The rest of us can pretty much get away with a single electric or a manual pump.



It's important to spend. the. money. I'm sorry, I know it hurts, a good electric pump (again, Hygiea, Ameda, Medela) is going to cost a good solid chunk of change...but believe me when I say it will be worth it. The crappy box store pumps are just that: CRAPPY. It is unusual to find a mom who has success with these. Also, not all manual pumps are created equally. The Medela Harmony is probably the best bet for a manual pump. it's easy to use, simple, effective, and well designed. Not to mention, it allows you to get the correct flange size for you!

Milk collection and your health can be at risk if you don't properly care for your pump. This means inspecting and cleaning it regularly. When you are away from your baby AT LEAST rinse the pieces thoroughly so there is no milk build up in the nooks and crannies, and be sure to TAKE IT APART and wash the pieces every day at the end of your pumping day. When you take it apart inspect the tubing for moisture, mold, and milk. Inspect the membranes and valves for wear...the membranes and valves are soooo important to the function of the pump that even the smallest flaw can impact it's effectiveness...so replace worn bits and pieces regularly. Read your manual, learn the lingo, learn how it works, use it properly, and your pump will last a long time.

I hope something here helps you to pump more effectively. Ask more questions, I just finished an extensive training on breast pumps...I got more to give...you just gotta ask. ;)

7 comments:

  1. I EP'd for my first due to some not so breastfeeding friendly drs. I found this video from Stanford U on maximizing output so helpful http://newborns.stanford.edu/Breastfeeding/MaxProduction.html

    Also, a handsfree bra is a must if you are double pumping. I found my output increased when I started using it bc I could relax aznd do other things while pumping instead of watching the clock.
    :)

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  2. I always get an extra ounce or so when I use my hands. I use the hand expression techniques while the pump is still running once the milk has stopped dripping. Having the hands free pump allows me to do this efficiently. I love the Medela Freestyle!

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  3. A friend gave me that hand pump you have pictured here, but I don't know how to use it. Can you list instructions? There seems to be two ways to pump, but I'm not sure which to do and why. Also, I just tried the hand expression technique from the handout and I got squirted in the eye. It works well it seems :)

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  4. nurse and pump at same time! (when possible). works best for me.

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  5. Something else I learned while pumping is that you don't need to wash your pump stuff after each use. Just stick it in a ziploc bag and put it in the fridge. Just wash at the end of the day.
    And about flange sizes-I tried every single size until I found what worked. I ended up using one size for one breast and a different size for the other. And coating the flanges with olive oil reduces friction on your nipples.
    Thanks for putting this together. When I was EP'g for my first, it was hard to find everything in a central location.

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  6. Audrey, there ARE two ways to pump! you press the top of the lever to do a lower suction, faster speed and this will stimulate the letdown, then you can switch to the larger part of the lever, the lower part and you will pump slower here, you can set your suction to your comfort, you don't have to push the lever all the way down. It's designed to work like a nursing baby...when your baby nurses for the first minute or so (or less if you have a super letdown) the baby will suckle quickly and swallow infrequently...then the milk will release and the baby will suck much slower and swallow more frequently and regularly. :) I hope that helps!

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  7. Thanks. I will try it out when I get home. Also, just about every time I pump with my electric pump, milk collects along the flange. I have to stop several times to wipe it off as it seems to affect the suction. Why does this happen, and what can I do to prevent it? TIA

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