Pumping Basics Part 1- What The Experts Say To Do To Get Started Pumping Your Breastmilk

by Jessica Martin-Weber with Rene Fisher, IBCLC

This article made possible by the generous support of Ameda.

Ameda Finesse Double Electric Breast pump

When my baby was 4 weeks old, it was time for me to get started pumping not only for my baby to be able to receive my milk when I had to be away from her for work, but also for me to donate my milk to other babies.

To help me get started pumping, I spoke with Rene Fisher, IBCLC from Ameda, Inc. She helped me pick out a pump, the new Ameda Finesse Double Electric, and got me all set up. Via video chat and live stream, Rene got me all ready to go and before I knew it, I was filling milk storage containers with my milk. Thanks to Rene’s help, for the first time ever, after pumping through 6 babies, I’m finally using the right size flanges and pumping pain-free. See what I learned in the video and points below.

Setting Up Your Pump

Carefully read your instruction manual and ensure you have all the parts you need. Follow the directions for preparing your pump and setting up. Wash each part that comes in contact with your breast and milk including the flanges, milk storage containers (unless you intend to pump directly into bags such as the Store and Pour Ameda breastmilk storage bags), valves, and diaphragms. Do NOT wash the tubing. Plug in your power adaptor or install batteries. Wash your hands and assemble the kit (tubing, flanges, diaphragms, valves, milk storage containers, etc.).

Determine Your Flange Size 

Flanges are the horn shaped pieces that hold the pump and storage containers to your breasts. Correct fit of the flanges can prevent tissue damage and improve the effectiveness of your pump. All nipples are different and dynamic and the size of your flange may determine how you respond to pumping. Too small may cause pain and stress, reducing your output to the pump. Too large may cause too much areola and breast tissue to be engaged and not enough stimulation for let down or may result in reduced output. If your nipple presses against the flange or rubs, you may need a larger size. If there is a significant amount of space around your nipple and additional breast tissue is entering the flange which may rub, you may need a smaller size. Because nipples are dynamic, they may change during pregnancy, breastfeeding, and pumping. You may even need a different size flange mid-pumping session. See this video below and the information here to help you determine correct flange size.

Beginning: Set Up

If possible, set up in a quiet, relaxing space. Have a drink and a snack. Get as comfortable as possible, having read the manual prior to beginning.

Beginning: Positioing

Position the flange centered over your nipple, pressing in lightly to create a seal. Without a seal there will be no suction. If you are double pumping you can use your arms to help hold the flanges to your breasts but you may want to use a hands-free-pumping support.

Beginning: Before You Start

Relax. Close your eyes. Take a few deep breaths. Think of your baby. Focus on why you’re pumping rather than the output itself. You may want to watch a video of your baby, look at a photo, or smell their clothing.

Beginning: Turn Your Pump On

To get started with pumping, if your pump has individualized speed and suction settings, set your pump on the highest speed and, following the instruction manual for your pump, turn your pump on at the lowest suction level. Gradually increase suction strength to the highest comfortable level. Pumping should never hurt. It is not necessary to go to the highest level if it is painful for you and doing so could interfere with the milk ejection reflex and let down and result in reduced milk output to the pump, potentially causing tissue damage.

Beginning: Let Down and Expression

Stimulate let down with a high speed and the highest comfortable suction. Once let down begins (marked by spraying or flowing milk), reduce speed. You may feel ready to increase the suction level but only do so the the highest comfortable level. When the flow of milk slows to drips or a trickle, return to a higher speed and the highest comfortable suction level to stimulate another let down. It is possible to get up to 9 let downs in a 20 minute pumping session by adjusting speed and suction levels. It may be helpful to observe your baby’s pattern at the breast and mimic it as closely as possible with the pump during your pumping sessions.

When To Pump

When you pump for the first time will greatly depend on why you are pumping. If your baby is in the NICU and there is clinical separation from birth, you will need to begin as soon as possible and plan to pump 8-12 times within a 24 hour period for exclusively pumping. If you are pumping to return to work at 6 weeks postpartum, it is advisable to wait until 3-4 weeks postpartum and your milk supply and breastfeeding are established to protect your supply. If possible, introduce pumping gradually for partial separation giving at least an hour before breastfeeding again after pumping (though let your baby feed at the breast whenever they want to!). Many breastfeeding parents find they get more milk pumping first thing in the morning. Pumping one side while baby is latched and feeds from the other can also lead to more let downs while pumping.

How Long To Pump

Many breastfeeding parents find that 15-20 minutes is adequate time to pump. Some may find it takes longer but with the right pump and proper flange fit, 15-20 minutes will be plenty for most. Utilizing hands on pumping or breast massage while you pump can help encourage your breasts to empty fully, signaling your breasts to produce more milk for your baby. When you pump will depend on your reasons for pumping, how long you are away from your baby, and the amount of milk you need. Every breastfeeding parent and baby are different, figure out what works for you. For more on when and how long to pump, see here.

 

Mother of 4, Rene Fisher has been an IBCLC since 1998. Rene has worked in private practice before going on to be a hospital Lactation consultant for 10 years where she was responsible for nurses and patient education and hands on assistance with breastfeeding mothers. Rene got started in lactation support as a La Leche League Leader 1993 and became a member of La Leche League Area Professional Liaison Department from 2000 -2010. Today, Rene supports families in reaching their baby feeding goals working with Ameda breastfeeding products.

 

 

Drawing from a diverse background in the performing arts and midwifery, Jessica Martin-Weber supports women and families, creating spaces for open dialogue. Writer and speaker, Jessica is the creator of TheLeakyBoob.com, co-creator of BeyondMoi.com, freelance writer, and co-founder of Milk: An Infant Feeding Conference. Jessica lives with her family in the Pacific Northwest and co-parents her 7 daughters with her husband of 21 years.
 
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Safely Express and Store Your Baby’s Breastmilk- Guidelines For Parents

by Jessica Martin-Weber

This post made possible by the generous partnership with Evenflo Feeding, every baby’s advocate and every parent’s ally.

Evenflo Feeding Every Parent

 

Whatever your reasons for expressing your milk, having your milk wasted in any way is like a punch in the gut. Whether it is spilled, left out, too much served and the extra thrown out, or it has spoiled, seeing breastmilk go to waste is enough to bring even the toughest Leaky mom to tears. While accidents happen there are ways to prevent such a tragedy with safe handling and proper storage practices. We’re here to help with that.

Breastfeeding moms cry over spilled milk.

It is bound to happen, for sure. Slippery bottles, floppy bags, too full containers, whatever it may be, if you express your milk long enough your going to have your fair share of spills and mishaps. I’d love to be able to wave a magic wand so no mom has to experience the agony of seeing her milk spilled on the counter but since we can’t do that, we’ll give you some tips and guidelines for avoiding other unnecessary causes to pouring liquid gold down the drain.

Below, find protocols and guidelines for breastmilk and tips for practical application plus some lessons learned the hard way. (Information gathered from the CDC; Human Milk Bank Association of North America; Office on Women’s Health, U.S. Department of Health and Human Services; and the Academy of Breastfeeding Medicine Clinical Protocol #8 Human Milk Storage Information for Home Use for Full-Term Infants.)

Breastmilk Expression and Storage Safe Handling

  • To prevent contamination, wash hands with soap and water before expressing or handling breastmilk. Unless you are aware that your breast has come into contact with some contaminates, it is not necessary to clean your breast prior to pumping as breasts are self-cleaning.
  • Collect and store milk in clean containers such as bottles with screw caps, double zip-style bags designed specifically for breastmilk (like these), or trays with a sealing lid. Bags not designed for breastmilk storage may easily spill or potentially contaminate the breastmilk.
  • Label all stored milk with the date, if sending to child care provider, include your child’s name to prevent mix-up.
  • Cool freshly expressed milk prior to adding to previously refrigerated expressed milk to prevent rewarming and potential bacteria growth.
  • Do not add milk to already frozen milk within a storage container.
  • Store milk in small amounts to prevent waste.
  • Leave room for milk to expand when freezing.
  • Breastmilk is safe to be frozen best if frozen fresh, optimally after up to 3 days in refrigerator, 12 hours in cooler bag with freezer pack, ok after 5 days in the refrigerator or 24 hours in cooler bag with freezer pack; smell milk to ensure freshness before freezing.
  • Store milk in the back of the freezer where temperatures are more consistent.
  • Milk that is partially defrosted but still has ice crystals can be refrozen.

Breastmilk Safe Temperature Storage Guidelines

  • Room temperature*: 3-4 hours optimal, 6-8 hours acceptable if very clean  *(60-77° F [some say up to 85° F], 16-25° C [some say up to 29° C])
  • Cooler bag*: 8 hours optimal, 24 hours acceptable if very clean (please note, some studies show that a freezer pack keeps an insulated cooler at food safe temperatures for no more than 2 hours)  *(up to 39° F, 4° C.)
  • Refrigerator*: 72 hours optimal, 5- 8 days acceptable if very clean  *(up to 39° F, 4° C.)
  • Freezer within refrigerator*: 2 weeks maximum.  *(up to 5° F, -15° C.)
  • Freezer attached to refrigerator*: 3-6 months optimal, 12 months acceptable.  *(up to 0°F, -18°C.)
  • Deep freeze*: 12 months.  *(up to -4°F, -20°C.)

how long can I freeze breastmilk

Tip: If you’re not sure your milk is still good, you can always smell and taste your milk for freshness. Spoiled milk has a very distinct odor and taste. Most of the guidelines are to minimize the degradation of milk. It is possible your milk may vary slightly from these guidelines or that your milk will have not spoiled but the composition may have begun breaking down. The simplest way to prevent feeding your baby spoiled milk is simply to smell and/or taste it.

Breastmilk Defrosting and Feeding Safe Handling

  • Defrost only amount needed
  • Fresh is best, use oldest milk in the freezer or refrigerator first to not let milk go to waste.
  • Safely defrost frozen milk in the refrigerator, running under warm water, or setting in a bowl of warm water. Do not microwave as this damages milk and creates dangerous hot spots due to heating inconsistencies.
  • Gently swirl or shake defrosted milk with the lowest amount of force possible to mix fat that likely separated (please note, shaking milk has been discouraged to prevent breaking down the protein molecules, however, this has been debunked, here.)
  • Do not save milk from a used bottle to use at another feeding more than 1-2 hours later, doing so risks the growth of bacteria from pathogens introduced by the baby during the feeding and the milk composition may be altered.
  • Milk that has been defrosted has a lessened ability to inhibit bacteria growth, milk that has been thawed for over 24 hours should not be left out at room temperature for more than a couple of hours.
  • Optimally, defrosted milk should be used within 24 hours of thawing, this may change based on when the milk was initially frozen after expression.

Additional Tips For Breastmilk Storage and Handling

My friend Amy Peterson, IBCLC and coauthor of Balancing Breast and Bottle, shared this golden nugget of a breastmilk storage tip with me. Before you start building your freezer stash, express some and put it in the fridge. After 24 hours, smell it. Then with freezing. Storage effects the smell of the milk if there are lipase or mineral oxidation issues. Before stockpiling, perform smell tests after refrigeration, and after freezing/defrosting. There are options for milk storage if there is high lipase or mineral oxidation issues but you need to know them before freezing to avoid having to toss a freezer full of milk due to such problems. *Note: high lipase or mineral oxidation is different than spoiled. Spoiled has a very sour odor and taste, high lipase is usually described as soapy tasting, and mineral oxidation as metallic or astringent. 

How much you need in the freezer depends on your needs and why you’re freezing your milk. Your “freezer stash” doesn’t need to be huge, having just what you need at least lowers the risk of crying over milk defrosted due to the freezer becoming unplugged, power outage, or just a tragic freezer death. See this article to determine what you need in your freezer stash and why.

Get comfortable and familiar with your pump before baby comes if you can and check out these tips for maximizing breastmilk production with pumping.

Take your time when handling breastmilk. That can be challenging to do with a hungry or demanding baby but most mistakes that lead to spills are caused because we’re hurrying. Slow down, this free-flowing precious commodity takes handling with care. Don’t lose a single drop.

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What are your tips for safe handling and maximizing your breastmilk expression?

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Jessica Martin-Weber Drawing from a diverse background in the performing arts and midwifery, Jessica Martin-Weber supports women and families, creating spaces for open dialogue. Writer and speaker, Jessica is the creator of TheLeakyBoob.com, co-creator of BeyondMoi.com, and co-creator of OurStableTable.com, supporter of A Girl With A View, and co-founder of Milk: An Infant Feeding Conference. She co-parents her 6 daughters with her husband of 19 years and is currently writing her first creative non-fiction book and a children’s book.
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Healing Power of Breastmilk Donation After Loss- In Memory of Maya; a #MyStoryMatters Leaky Share

 by Ulrike K. Ingram

***Please note, this piece covers infant loss in detail and may be triggering for some.

infant and pregnancy loss

My daughter Maya was stillborn at 35 weeks gestation. It was a sudden and devastating loss to find out that after an easy, uncomplicated pregnancy, she had died due to a cord accident. While still being in shock after her death and birth, I started to think about what to do once my milk came in. I knew early on that I wanted to try to pump for donation purposes, but wasn’t sure if I could really do it, physically and emotionally. I planned to just take it one pumping session at a time. I didn’t want to make a long term commitment and then fail. My milk came in when I woke up on the Friday after she died on Wednesday. I started pumping that day and collected maybe 2 ounces of milk during the first session.

I have two older children who I breastfed. When they were younger, I was working part-time and I only had to pump occasionally. Pumping exclusively after Maya’s birth was a challenge. I tried to pump 6- 7 times in a 24 hour period. Three weeks later, I was consistently getting about 5 ounces of milk per session. I was still taking it one session at a time, always worried that my supply was decreasing, or that I was just too tired to get up in the middle of the night to pump. I was very close to stopping maybe five weeks after Maya was born. I struggled for several days with whether to continue or stop. After talking to my husband and praying about it for several days, I felt a piece in my heart about continuing on this journey. It felt like a God given guidance that it was good to pump and good to continue for longer.

Three months went by and I was still pumping, though not as frequently, probably only about four times per day. I didn’t plan how long I would continue to pump because it my only connection to Maya.

Sometimes when I pumped during the day, one or both of my sons would sit with me, or play on the floor next to me. My younger son would ask, “Mommy, why do you have to pump?” or when I’m done, “Mommy, why are you stopping?” I have explained to them why I pump. Although I wasn’t sure they really understood, I recognized that it was okay. Once my younger son told my husband that he likes to play in our guest bedroom because that’s where mommy pumps.

Almost five months went by and I stopped pumping at the end of July – 4 1⁄2 months after Maya was born. I decreased my pumping frequently from four times to three times per day. I then limited the remaining pumping sessions to 10 minutes, then 9 minutes two days later, then 8 minutes, and so forth. I was eventually able to stop pumping without feeling engorged. It was a slow process of letting go, physically and emotionally.

In total, I pumped for 131 days, and donated 470 breast milk bags, an estimation of 2300 ounces of milk. I donated the milk to local moms through a Facebook page, which matches milk donors with moms looking for milk, who for various reasons do not have enough milk for their baby, or want to provide breast milk to their adopted child.

guest post, leaky to leaky

It has been a privilege and an honor to use Maya’s milk in a meaningful way. It was one of the few things I was able to do in my daughter’s name. It’s part of her legacy. It’s her milk. It was made for her, and I was able to give it to somebody else who needed it. On the difficult days, when I was tired or emotionally drained, I sometimes wondered whether it was worth it. I suspect that the recipient cannot appreciate the value of this milk to the full extent. There is a lot more meaning and love in this milk and the act of pumping and the invested time than the recipients will ever know. I imagine that Maya has been watching over our family from heaven, seeing me pump, and understands that it was for her. It’s her legacy and her memory that is being carried forward and passed on to others.

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If you’d like to share your story with a larger audience, submit your story, photos, and your bio, with #MyStoryMatters in the subject to content @ theleakyboob.com (no spaces).

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Ulrike and her husband have two older boys and then got pregnant with their daughter Maya in 2013. After an easy pregnancy, they found out that she had passed away at 36 weeks gestation due to a blood clotting issue. Ulrike pumped and donated Maya’s milk for several months. It was a way to keep her memory alive in one tangible and physical way for Ulrike.
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Tips and Tricks for Exclusively Pumping Breastmilk

Gini and her daughter Claire.

We were happy to share a guest post by our friend Gini and her breastfeeding experience. Here are her tips and tricks for Exclusively Pumping breastmilk for your baby.

Tips and Tricks for EPing

1. Talk to a lactation consultant about supplements. I took 600mg of Fenugreek, three capsules- three times a day. It really boosted my milk supply, so much that when I was ready to stop pumping, I quit taking those and I experience very little discomfort weaning myself from the pump.

2. Find a comfortable place to pump. For me it was the bed. I would stack a ton of pillows between me and the headboard, watch tv, read my Bible, or just close my eyes. It was also nice that in the middle of the night I didn’t have to get up and go anywhere.

3. If you choose to EP, buy an extra set of pump parts. Pumping and washing seven times a day while caring for a newborn/ infant is hard enough. And use larger bottles rather than the 4-5 ounce ones that come with the pump.

4. You can store pump parts in the fridge between pumping sessions. When I learned this about three months into it, things became much easier. This was perfect for my middle of the night pumping. I would start with two clean sets of pump parts on my nightstand before I went to bed. I used the first at 1am, and when I was finished I put it in the fridge. I used the second set at 4am and put those in the fridge as well. Then, I would use the 1am pump parts (just clean breast shields) for the 9am pumping, and the 4am set from the noon pumping. This cut my washings down drastically.

Travelling with the Pump

1. Don’t be afraid to pack up the pump and take it with you places. When Claire was 8 weeks old, she and I flew to see my parents in New Orleans, and I successfully pumped in airport bathroom handicapped stall while feeding Claire, who was in her stroller. You can pump anywhere.

2. This brings me to… get a Hooter Hider, or an Udder Cover (www.uddercover.com). Whatever you want to call it, get one. It’s made for nursing mothers, but worked for me as well. I could pump in my car during the first few weeks back at work or in a room with my friends who aren’t quite close enough to see my ladies.

3. And pack lots of extra batteries in the pump. I could pump about two straight days worth on one set (of eight AA) batteries. Consider a car converter- one that allows you to plug in your A/C adapter in the car’s power outlet.

And pack the bag. They give you space there for a reason. Some of the things I kept in there were Lanolin wipes, Lanolin nipple cream, extra breast pads, spare white membranes (http://www.medelabreastfeedingus.com/products/pump-accessories/207/extra-membranes), spare breast milk storage bags, an old watch if you don’t wear one to keep up with your time, a little devotional book to help pass those fifteen minutes.

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