Breast Pumping Basics

Using a breast pump to express milk can be very intimidating to new and expectant mothers. Our team of Internationally Board Certified Lactation Consultants (“IBCLC”s) at the Pump Station and Nurtury field a variety of questions every day about breast pumping. The most common questions we hear include:

How do I choose a breast pump, and when should I start? How often and how long should I pump? How much milk can I expect to get, and when is the best time to pump? When is a good time to begin giving my baby a bottle, and how do I safely store my expressed breast milk?  

Below you’ll find some of our favorite breast pumping tips and suggestions that we’ve picked up or developed over the years from our clinical experience and hands-on support with so many new mamas.

We’ve seen that the reasons to use a pump to express breast milk vary widely from mother to mother and depend on how old her infant is, on her milk supply, how breastfeeding is going for both mom and baby, and on each individual mother’s own breastfeeding goals. Like breastfeeding, breast pumping can be challenging at first. We get it. But, we encourage you to stick with it, seek help if needed, and it will become easier with a bit of time and practice.

But first, a brief lesson in breastfeeding physiology

 It’s hormonal! There are hundreds of hormones involved in milk production, but the two we love to talk about most are prolactin and oxytocin. Prolactin is the hormone responsible for how much milk we make. Oxytocin, the feel-good hormone involved with bonding, also causes a gush of milk to be released from the milk producing cells in the breast, into the milk ducts to the nipple area, and into baby’s mouth.  Commonly referred to as the “milk let-down”, it’s also known as the “milk ejection reflex”. When a baby is latched and breastfeeding (or a mom is using a breast pump), both hormones are released into the blood stream.

The key to a good milk supply is frequent breast stimulation with effective removal of milk. The more often we nurse or pump, the higher our milk volume will go. 

BREAST PUMPING THROUGH THE STAGES

1. EARLY POSTPARTUM PERIOD-1^ST 2 WEEKS OF LIFE:

• If your baby is born prematurely, manual or hand breast milk expression should be initiated as soon as possible after birth and frequently for the first 48 hours. This has been found to be more effective in establishing a good milk supply than the immediate use of the breast pump. Following those first two days, a clinical/rental breast pump, commonly called a hospital grade breast pump, is the best choice for building and maintaining an excellent milk supply. This video can help you learn the important technique of using your hands to express those precious milk droplets for your new baby. firstdroplets.com
• You are separated from your term baby in the early postpartum period. Pump 8-10 times every 24 hours imitating a newborn feeding pattern. The clinical grade pump is again the recommended choice. Adding hand expression during the first days, before, after or between these pumping sessions as described above, has been shown to help bring in a good milk supply. Enjoy one 4-hour sleep stretch, making up for this by pumping every 2-3 hours at other times. Remember, it will be tiny amounts in the beginning.
• Your baby is unable to latch or nurse at the breast. Use the same plan as described above.
• You are concerned that your baby is not nursing well, is not making enough wet or soiled diapers, or has lost an excessive amount of weight. Pump after every feeding attempt to protect your milk supply until things improve. Feed your expressed breast milk to your baby.
• You are working to increase your milk supply. Pump after as many feedings per day as you can. Pumping while nursing on the second side (3^rd breast pumping) works well to save time (see description below). Try Power Pumping once a day: Pump for 15 minutes shortly after you breastfeed, rest 10 minutes, pump 10 minutes, rest 10 minutes, and pump 10 minutes. It may take a few days to see an increase.
• You are supplementing with formula, donor breast milk or your own expressed breast milk. You will need to triple feed: breastfeeding, followed by pumping and supplementing with formula or pumped milk.
• Get help! Schedule a lactation consultation with an IBCLC.

2. WHEN BREASTFEEDING IS WELL ESTABLISHED:

• You are breast pumping to bottle feed, and you want to protect your milk supply. Pump at roughly the same time a bottle is given.
• You are returning to work and/or would like to store some of your extra pumped milk. Add an extra pumping session 20-30 minutes after a breastfeed OR try “third breast” pumping several times a day. (see below for the how-to.)
• Always pump if a bottle is given—even at night. Remember, if you skip pumping when a bottle is given, your supply may decrease.

3. YOU HAVE RETURNED TO WORK OR WILL BE SEPARATED FROM YOUR BABY FOR LONGER STRETCHES DURING THE DAY

• Pump in place of the missed feeds if possible—Aim to pump every 3 hours.
• Nurse exclusively on days off when you’re with your baby.
• Pump on the way to work by using your hands-free pumping bra or an in-bra pump. Don’t get distracted—stay safe!
• Take our virtual Breastfeeding and Returning to Work class.

4. YOU HAVE A PLUGGED DUCT OR MASTITIS: 

• Pump the effected breast after every nursing session until symptoms have resolved.
• Please click on the link to find more help for this problem. https://www.pumpstation.com/blogs/articles/plugged-ducts-and-mastitis

5. YOU ARE EXCLUSIVELY BREAST PUMPING AND BOTTLE FEEDING “EP’ING”

• You have likely made this choice because breastfeeding has been difficult; yet you recognize the value in providing breastmilk for your baby. We commend you and are your cheerleaders—this isn’t easy. Call us for more support.
• Pump as often as needed to keep up with your baby’s need.
• If at-breast feeding is still what you really wish to do, make an appointment with an IBCLC.

WHICH BREAST PUMP IS BEST? 

• Types of pumps include: Single user double electric pump (“insurance pumps”), Hospital or clinical grade pumps, hand/manual pumps, silicone bulb pumps.
• If your pump is covered by insurance, you may have received a list of pump options from your insurer. Making a decision can feel daunting. Most women will do well with one of these pumps, but pump quality varies widely. We encourage you to reach out to pumping friends, attend a breastfeeding support group and a breastfeeding class before birth, book a prenatal visit with an IBCLC, or give us a call at 310-998-1981.
• There are some excellent new pumps on the market that because of their higher price point are not carried by insurance companies. Check to see if your insurance will give you a voucher towards a pump upgrade. Some of the features available are internal, rechargeable batteries and ability to sync via Bluetooth with a device.
• We recommend a double electric pump.
• We also recommend purchasing a manual pump and a one-piece silicone bulb pump. Moms love these inexpensive, small pumps for occasional convenience.
• The new, wearable wireless pumps are getting mixed reviews from moms. The pros: They can be very helpful at a time when you could not have otherwise pumped—they are quiet and discreet. The cons: They are expensive, bulky, and can be uncomfortable to use, and many moms feel they aren’t able to pump as much milk. We are excited by this new pumping technology, and expect to see vast improvement with each generation of these newer wearable pumps. We suggest that this type of pump is purchased in addition to your primary pump.
• A clinical/hospital grade pump, FDA approved for multiple users, is considered the “gold standard” for establishing, building and maintaining you milk supply.  These pumps are manufactured to a much higher standard, and are smoother, more effective and comfortable, more closely mimicking a baby’s suck pattern. If you need to pump in the hospital, after your baby is born, this is the pump you will use.  We strongly recommended this top-of-the-line pump for any mother who is separated from her hospitalized baby, has twins, is trying to increase a low milk supply, is coping with plugged ducts and mastitis, or who has a baby that isn’t latching or nursing well. (Check out our popular article on  Deep Latch)

Getting Started

• Learn how to use your pump: Read the directions carefully, or visit the pump company’s website for a how-to video. Learn how to change the pump from a single to a double, how to change the cycle/minute (speed) and the vacuum (suction), and how to assemble the pump correctly.
• There is no “right” way to pump: Most pumps have two modes—stimulation (massage) and expression. These modes are designed to replicate your baby’s sucking pattern at the breast, and to help achieve better milk flow. Some moms leave the pump on the stimulation mode the whole time while others go straight to the expression phase; still others toggle between the phases. Find what works best for you.
• Be patient: You may get only small amounts of milk as you begin. It takes several weeks to establish your milk supply. During the first week of life, a baby takes approximately one ounce of milk at each feeding. Research indicates that the amount taken by babies at three weeks of age averages 2.5-3 ounces/feeding. Your baby’s stomach will be very small and empties quickly.
• Turn up your pump’s suction: We find that moms often don’t know that this is an option and leave the pump on the default settings. Slowly increase the suction to a level you can tolerate without pain.
• Use the correct “flange” size: Flanges (breast shields) that are too small can cause nipple damage and may lower your milk supply. Purchase more than one size and see what works best for you. Try lubricating the tunnel of the flange with a non-tacky nipple cream, or coconut or olive oil for increased comfort. Check out this helpful article on flange sizing.
• If your baby is nursing well, there is no need to start pumping right away. Begin when you are ready to start offering your baby a bottle at about 2-4 weeks of age. Once you start bottle feeding, be consistent to avoid bottle refusal. Aim for at least 3 times per week, but not more than once per day to avoid a preference of the bottle over breastfeeding.  We’re huge fans of the Browns Options Bottle used with their preemie nipple. *If you don’t plan to bottle feed, you don't need to pump!
• Avoid oversupply: Even when breastfeeding is going well, some moms start pumping too early and too often leading to oversupply (making well more milk than your baby can eat). While it might sound tempting to have a high volume of milk, it can lead to breastfeeding issues like too fast a flow for the baby and plugged ducts.

PUMPING: TRICKS, TIPS AND HACKS

Trouble “letting down” for a pump?

• Distraction and relaxation are key. Binge your favorite show or listen to your favorite tunes. Try some hand expression and breast massage before pumping.
• Remember the old adage, “A watched pot never boils?” The same can be true for breast pumping.  Cover your collection bottles with baby socks or a nursing blanket and try not to watch.  You might find the volume you pump increases.
• Conversely, hand’s on pumping-breast massage and breast compressions during pumping helps some moms to increase output as much as 40% - Check out this link.

Milk volume varies throughout the day --Time of day can make a difference.

• Volume peaks after midnight and is lowest in the late afternoon/early evening. Lower milk volume late in the day allows the baby to suckle during the fussy/wakeful time of the day (the witching hours) without getting excessive amounts of milk.
• Morning pumping sessions usually produce the best results.

Time spent pumping varies – watch milk volume rather than the clock.

• An average pump session is 12-20 minute, but five minutes may be enough for some moms.
• Think about your pumping goals when timing pumps- Have you returned to work and are aiming to pump 3-5 oz? Stop the pump when you’ve reached that goal.
• Don’t rule out shorter sessions if that is all the time you have at the moment. Any extra stimulation is helpful while working on increasing milk supply.

Tap into Prolactin—increase your supply.

• Pumping both breasts simultaneously raises the milk producing hormone Prolactin, and increases milk supply.
• Pump while you are nursing. We’ve dubbed this time saving, multi-tasking trick “third breast” pumping. While your baby feeds on your second breast, pump the breast that was already nursed. Be sure your pump is set as a single; or use your silicone bulb pump.
• Get more milk in each pumping session by taking a short break when milk flow slows. Massage your breasts, have some water, then hop back on your pump for a few more minutes. You may get another milk ejection or “let down”.
• The amount of milk you pump does not necessarily equal what your baby drinks at each feeding. A baby is usually a better “pump” than a pump—but there are exceptions.
• Triple feeding can help to increase milk supply—Triple feeding is just what it sounds like: breastfeeding, followed by pumping and supplementing with formula or pumped milk.
• Making milk is a take and make situation. Your breasts will only make the amount of milk taken by the baby unless you request more with additional pumping. More Prolactin will be released in response to this extra stimulation, and more milk will be made. Be patient, it takes a few days to see the result of your efforts.

Hand pumps, silicone bulb pumps and passive in—bra milk collection devices

• Silicone bulb pumps are wonderful, but too many moms make the mistake of using these pumps BEFORE breastfeeding at breast. This can lead both to oversupply AND stalled weight gain. Make sure to use this pump AFTER you’ve fed from a breast.
• Since the let-down reflex happens in both breasts simultaneously, leaking from the opposite breast while nursing is quite common. Passive, in-bra milk collectors like Lacticups capture leaking milk. Tuck it inside your bra opposite the breast on which your baby feeds. We’ve seen many mothers capture 3-4 ounces of milk a day with this device.

Bottle feeding

• Babies receive more milk when bottle feeding than when feeding at the breast. Research has demonstrated that bottle fed babies are consistently overfed by about 20%. It is the nature of bottles—the flow is instant, constant, and fast--unlike the breast that releases milk in an ebb and flow, wave-like pattern.
• Some research suggests that the most a baby ever needs per feed is 3-5 ounces.
• We recommend slow flow nipples: If the baby finishes a 3-ounce bottle in under 10 minutes—the flow is too fast. A faster flow nipple is never necessary unless the baby is frustrated and taking longer than 20 minutes to get 3 ounces.  *Remember: Nipple flow rate is marketing—there is no standard.  If you’re having trouble picking a bottle, ask an IBCLC for a recommendation.

Pumping bras

• A well-fitting, hands-free nursing bra can be extremely helpful. Be sure your flanges fit snugly against the breast and are not dangling.
• Moms love the SUPER MOM bra that can be worn as a bra and allow you to pump or nurse without removing it. We really like that it makes it easy to pump while nursing.
• Remember, the more often you nurse or breast pump, the more milk you will eventually make.

Milk storage

The CDC’s recommendations for milk storage

• 4 hours at room temperature (77° or cooler)
• 4 days in the refrigerator
• 6 months is best; up to 12 months is acceptable

https://www.cdc.gov/breastfeeding/recommendations/handling_breastmilk.htm

Written by: Corky Harvey RN, MS, IBCLC and Allison Mahurin RN, BSN, IBCLC