by Star Rodriguiz, IBCLC
Selecting a pump, fitting flanges, and how and when to pump.
I don’t know many mothers nowadays that go their entire breastfeeding relationship without ever pumping. For some, it’s a matter of being separated from their baby for things like work or school and needing to pump. Some moms exclusively pump (Note: I will never, ever disparage a mother’s choice, but as my own public service announcement, I do encourage all moms who can to try to put the baby to the breast before deciding to exclusively pump. I know there are a wide variety of reasons moms would rather pump, but, for many people, it does wind up being easier to nurse than pump all the time. Obviously, this isn’t true for everyone in every circumstance.) Some mothers would just like some time apart from their babies and want to pump milk to do that. Some elect to pump to donate their milk to other babies that may not be able to get all they need from their own mother for whatever reason.
Whatever your reasons, there is little more confusing to mothers than pumping. I mean, it sounds simple. Pump + breast = milk in bottle, right?
It appears to not be that easy for most women, though. A significant amount of the inquiries I receive have to do with pumping, and the whens and whys and hows. So this column is going to be a very general guide to pumping. There will be a part 2 that deals with specific situations, so if you’re wondering specifically about work or school or NICU, that will be addressed soon.
Also? If you already have a pump, or you know the differences, feel free to be all Choose Your Own Adventure and pop ahead to the rest of the article for some other basic pumping know how.
Choosing a pump:
There are a lot of pumps and brands and they can get very daunting. There are four main varieties that I see most often.
- Hospital grade electric pumps. You need one of these if you are separated from your baby or having a hard time breastfeeding. People will probably disagree with me on these, but I also think if you want to exclusively pump, or you have twins that you are pumping for, you are best served with this. That doesn’t mean that pumping won’t work for you in any other way, but this is the best for those purposes. These pumps are double sided (so you can do both breasts at once) and they are the top of the line. They are also certified for multiple users.
- Single user electric pumps. You probably need one of these if you are pumping on a regular basis (i.e. for work or school that is full time.) Some moms that exclusively pump or have twins use them, too. A very, very few are certified for multiple users. They are also double sided.
- One sided electric or battery powered pumps. These are good if you’re working on a part time basis (and I’m saying probably 25 hours or less a week) or just want to be able to pump and go out some times. They are for a single user, and the motors are typically a little weak. So, really, if you are pumping a lot, this is not for you. I am unaware of any of these that are certified for multiple women.
- Manual pumps. There are generally two types here: piston pumps and one handed pumps. I prefer one handed – piston pumps made me feel like I was doing some serious arm workouts. They can be used in the beginning to relieve engorgement (although I usually hand express first) or to begin building a store (I tell my clients to pump about once a day with one of these as soon as their milk is in, but many of my clients are going back to work really, really quickly. If you’re not, this may not be necessary for you.) Manuals are best if you are not going to be away from your baby often.
- Hand expression. Ok, it’s not a pump. But knowing hand expression can seriously help you. You can use it to express colostrum if you are separated from your baby; you can use it if you forget your pump at home one day; you can use it to relieve engorgement; you can use it if you just don’t like pumps. In basic hand expression, you put your fingers about two fingertip lengths back from the base of your nipple on opposite sides of your breast, gently press in towards the chest wall, and roll your fingers out towards your nipple. You may have to move your fingers slightly forward or backward to find the spot that works for your body, but when you find it, you will see milk come out easily. This video is an excellent demonstration of hand expression.
So, ok. I have a pump. Now what?
First of all, you need to make sure your flanges fit well. By flanges, I mean the plastic part that goes directly on to your breast. There are a million names for them. Each company has different ways that they size their flanges, but, typically, something around a 24mm comes with it, and sometimes there’s also something around a 27mm. I refer to these as the littler one and the bigger one. The 24 mm fits very, very few women in my experience. The 27 does a little better, but you may have to get an even larger size. Smaller ones are available, too, but it’s generally a very small percentage of women that need these.
Just like they all have different sizing, they also all have different preferred fits. Check with the pump’s manufacturer to see what they recommend, but, generally, the nipple should be pulled into the tunnel without a lot of surrounding areola tissue and it should not rub the sides of the tunnel. Keep in mind that your nipple will probably get a little bigger while pumping.
Another good tip is that if you are pumping a lot and the plastic from the flange is making your breast uncomfortable, you can coat the flange lightly with some expressed milk, nipple ointment, coconut oil, or olive oil. Please note: if you have a preemie or sick baby, check first with your pediatrician before using anything other than breastmilk. It’s usually not an issue, but it’s never bad to ask before introducing something new into an ill or tiny baby’s food, even in miniscule amounts.
Secondly, do some breast massages before you pump. It may feel silly to some, but massaging your breasts can help make your milk let down faster. It’s also helpful to do compressions while pumping; in breast compression, you will put your hand on your breast in a c-hold and gently squeeze it, moving your hand to different areas of the breast to help all of the ducts to release as much as they can.
It can also be beneficial to make sure your flanges are warm before putting them on your breast.
How long and how often?
So, once you’ve started pumping, how long do you do it?
I have heard estimates everywhere from five minutes to one hour, and while there’s some variation depending on why you’re pumping, with a decent electric pump, most women can get the majority of milk out in 8-15 minutes. It may take you longer than that with a manual, and with a single sided electric. I don’t usually recommend that my moms go longer than 20 minutes, though. They tend to have some soreness if they are regularly doing over 20 minutes of pumping at a time. If you’re pumping to relieve engorgement only, you probably just want to pump for a couple of minutes. And hand expression varies so much by mom that assigning time frames to it is downright impossible if your aim is to empty the breast.
And as for how often, that depends, too. If you are exclusively pumping or pumping for a preemie, recommendations are usually every 2-4 hours. This is round the clock, excepting a 4-5 hour stretch of sleep at night. As your baby gets bigger, you may be able to have a longer stretch of sleeping time at night; this varies per woman. For someone who is in work or school, every 2-4 hours probably also works. A good rule of thumb if you are nursing at the breast, too, is to count how many times your baby nurses in a day, and to be sure to make up that amount with a combined amount of nursings and pumpings (so if you nurse 9 times, and you nurse 5 times at home, you should pump 4 times at work.)
As always, every mom’s situation is a little different, and if things aren’t going as planned, seek out the help of a trained professional, like an IBCLC.