Pumping 201- working, exclusively pumping, volume, and weaning

Breast pump, Hospital grade breastpump

Hygeia EnDeare

by Star Rodriguiz, IBCLC
Previously, in Pumping 101, we talked about some basic pumping tips.  In this article, we’ll look at pumping when you return to work or school and pumping exclusively, either by choice or for a health condition. Hopefully, these tips will help anyone facing these situations to successfully provide breastmilk for their child(ren).  Just like before, if a certain situation applies or doesn’t apply to you, feel free to skip to or past it.  

 

Working

This is probably the most common reason that I see for pumping.  Although we touched on it a little in the last article, we’ll go a bit more in-depth here.

First, know that federal law provides all overtime eligible workers (so, typically, anyone on an hourly salary) with the right to pump at work.  You are required to be given a private place that is not a bathroom to pump and reasonable amounts of time to do it until your baby is a year old.  If your state has a better law than the federal one (and you can find breastfeeding laws by state here) then employers have to go by that instead of the federal law.  Most moms should pump for 10-15 minutes every 2-3 hours.  To build up a store, I usually tell mothers that they can pump one time a day when their milk first comes in.  If moms do this fairly regularly in the beginning, even the mom returning to work at 2-4 weeks can have a decent store built up.

Most women pumping in the workforce should be utilizing at least an electric, double sided pump.  If you are pumping for twins, a hospital grade pump may be worth your while since you are pumping for two.  Pumping breaks aren’t usually very long, so you want to pump quickly and efficiently.  However, some women find that their schedule makes it difficult to take full 15-20 minute breaks at a time.  For those mothers, a swing pump or hand pump might work better, just because they can be taken out quickly without a lot of set up required.  For instance, some of my clients have been waitresses that have limited time some nights to pump, law or not.  Those clients sometimes find that using a hand pump for five minutes at a time can help.  Since this does not pump as efficiently and probably will not empty the breast, you will probably need to pump more often than every 2-3 hours, and I always advise that you do pump with a good electric pump at least once a shift.  If you are part time and working 4-5 hour shifts, you may be able to get away with just hand pumping as long as you are nursing often at home.

Many moms wonder how much milk to leave when they are away from their babies.  This can be a hard question to answer.  Some babies will eat as little as possible while separated from their mothers (and will make up for it when they are with their mommy by nursing more often), but some will want to eat more often – usually because they miss mommy and are comforted by her milk and sucking.  It’s good to remember that from 1 month to 6 months, your baby’s stomach is around the size of a strawberry and holds 2-3 ounces at a time.  Most babies will take in around 25 ounces a day until 6 months.  Therefore, store milk in 2-3 ounce increments, use slow flow nipples, and instruct your provider in baby led bottle feeding.  To get a rough estimate of the amount your baby will need, divide 25 by the number of times the baby nurses in a day, and consider about how many feedings your baby usually takes in during the time you will be apart. Most people will try to ensure that they have a couple of extra 2-3 ounces bags per day, too, just in case.

You may be thinking, “Well, MY baby eats/ate WAY more than 3 ounces at every feeding!”  And your baby may have been an exception.  However, a lot of babies are simply overfed by faster flowing bottles or are wanting more milk or to suck out of comfort.

 

Exclusively Pumping Moms/ Moms Separated from Babies

There are many reasons to exclusively pump.  Some moms have babies with issues that cannot latch. Some moms have a history of sexual abuse that makes latching difficult.  Other moms simply prefer to pump rather than latching.

In the colostral phase, when your body is producing small amounts, using hand expression can really help out.  Hygeia has some really awesome hand expression cups that I love (and a great article on hand expression), but you can also express into a small cup or spoon.  Babies take in a very small amount at birth (their stomach size is that of a marble) and colostrum is sticky and can cling to pump parts, making you feel like you’re not getting a lot.  Moms who are pumping should pump about 8-12 times a day (or the amount of times a baby typically nurses.)    You should pump for 15-20 minutes.  Some women can decrease their amount of pumps after awhile, but most have limited success when they pump under 7-8 times a day.

I prefer to have exclusively pumping moms use hospital grade pumps.  You can buy them, but they are quite expensive.  Renting is often a better option.  They can be found for rental in many drug stores, and many WICs also have them.  WIC can be a great pump resource, and lots of women are WIC eligible even if they aren’t aware of it.  Hospital grade pumps have the best control on suction and speed.  Do not assume that cranking up the suction and speed will get you the most milk.  You should start on a low to medium setting and play with it to see what your body responds to best.  Regardless, a double sided electric pump is pretty key to an EPing mom.

If you are pumping for a preemie or a baby with health conditions that might compromise immunity, be sure to ask your child’s provider how they prefer for you to store your breast milk.  Otherwise, many moms use reusable bottles, ice cube trays, or plain zippered storage bags to store their milk.  It can be less expensive than purchasing the breastmilk storage bags themselves.

Another good idea is to get, or make, a handsfree pumping bra.  You can buy some neat ones including PumpEase hands-free pumping bra or a Rumina Pump and Nurse tank or you can make your own by cutting slits into a sports bra.  The handsfree ones have the advantage of being able to be quickly snapped on and off.  They also tend to be prettier.  That sounds like a silly reason, but can be helpful, especially if you are pumping when you intended to actually nurse your baby.

Exclusively pumping moms can sometimes find that they have some chapping of the breasts.  Sometimes this is from the flanges sticking to the skin.  This can be alleviated by using something to lubricate the flanges.  My favorite thing to use is olive oil.  You can also apply lanolin to your nipples between pumpings to help the chapping.  The lanolin used in breastfeeding products will not need to be washed off of the breast when you pump.

 

Weaning Off Pumping

If you’ve been pumping for your baby for some time for any reason and you decide you want to stop, it can be confusing as to how.  Unless there is some medical reason, you never want to stop pumping “cold turkey.”  This can lead to engorgement and sometimes plugged ducts and/or mastitis.  There are a few ways you can stop pumping.  You can cut out a session at a time, every few days (usually, I say every 2-5 days.)  You can also decrease the time spent pumping in all of your sessions.  For instance, if you pumped for 15 minutes every session, you might decrease it to 12 minutes each time, and then, in another 2-5 days, decrease it further.

Please keep this is mind: not all of these time frames will work for all women.  Some may need to decrease more slowly; some can decrease more quickly.  Pay attention to how you feel.  You don’t want to compromise your health by trying to wean too fast.

Some women find that using cabbage leaves, peppermint, or taking over the counter cold or allergy medications can help to dry up their milk more quickly, if you are weaning altogether along with weaning from pumping.

 

 

 Star Rodriguiz, IBCLC, began her career helping women breastfeed as a breastfeeding peer counselor for a WIC in the Midwest.  Today she is a hospital based lactation consultant who also does private practice work through Lactastic Services.  She recently moved to the northern US with her two daughters and they are learning to cope with early October snowfalls (her Facebook page is here, go “like” for great support). 
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Unsupportive Support- is your milk good enough?

Continuing the series on unsupportive support come two more gems.  Hit the quality.  Please, if you have the opportunity to come into contact with a breastfeeding women and you can’t say anything supportive… maybe you shouldn’t say anything at all?

How not to support and how to avoid being unintentionally unsupportive- part 2.

Unsupportive support is…

Informing her that her baby must not be getting enough and that’s why her baby wants to eat all the time, saying she can/can’t eat/drink certain foods while breastfeeding, telling her breast milk turns to water after 6 months, that she needs to start them on solids, Sating her baby is too skinny/too fat and needs her diet needs to change, or pretty much anything else that puts down breast milk.

I’ll keep this one short: have you studied human lactation?  Are you well read in the latest scientific research and health care recommendations on infant nutrition?  Have you done anything more than read a couple news articles or listen to a radio personality/TV celebrity talk about breastfeeding?  Unless you can produce researched (as in legit, peer reviewed, scientific research) information backing these claims, don’t ever say anything questioning the quality of her milk or the validity of her feeding choices.  Ever. Are you even qualified to say this stuff?  Go do some research before you spout off ignorance and recite this until it sticks: “I must trust this mom to do what she feels is best and support her along the way.”

Telling a new mom “Isn’t formula just as good as breast milk?  My children were all formula fed and they turned out fine!”

While she’s probably quite happy for you that your children did fine on formula, that’s not the choice she has made for her child.  Her choosing something different isn’t a criticism of your choice, not even a little bit.  You may choose to wear pink yet she never would and that’s no reflection on you, just a difference in what each of you feel is right for yourselves.  She’s taken a lot of time in making her decision just as I’m sure you did in making yours.  You may not realize it, but in questioning her decision like this you are insulting her ability to make the right choices for her family.  And it is her family, her choice to make.  You already got to make your choices for your family or will some day.  If this thought runs through your head the most supportive act you can do is to button it and don’t dare bring it up to her or her partner.  Not even once.  If you’ve already done this, go out of your way to apologize and intentionally let her know you support her breastfeeding.  Put this on the inside of your front door to help you remember this: “I will support her even if she makes different choices than me.”

 

Pulling the quality card is exceptionally manipulative, most moms really want to give their child(ren) the best they can.  Taking a swipe at her for what she’s feeding her child and planting seeds of doubt that maybe, for some reason, her milk is inadequate isn’t supportive.  It becomes very difficult not to take it personally and she doesn’t need the worry you planted.  Breast milk quality is rarely an issue, in fact, breast milk is perfectly engineered to meet her growing child’s needs with a custom blend.  The quality couldn’t be better!  On the rare occasion that there could be an issue an expert on human lactation is better equipped to address it than the people that should be encouraging her in her parenting goals.  Your lack of understanding of normal human lactation and the normal needs of a breastfed child should not be what you draw from to show concern or support.  (A great place to start educating yourself is this post on normal behavior of the breastfed newborn.)

 

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Did some of your support people question if your milk could be any good?

How do you respond when people say unsupportive comments trying to tell you your milk isn’t any good or that formula is just good if not better? 

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