By far, baby does it best! Milk expression, just like breastfeeding, takes some practice and patience. Google Maximizing Milk Production for pumping and hand expression video.
Moms can choose to exclusively pump but please consider:
- No pump replicates a nursing baby
- Exclusive pumping often fails to get milk fully established
- It frequently leads to early weaning due to diminished supply or mom feeling overwhelmed – just ask the mom whose baby had a NICU stay
- Soley pumping creates double-duty work when you have to pump, feed, pump, feed, + make sure your equipment is clean.
Hand expression
- A learned skill but has many benefits
- The best way to express milk if needed the first few days
- It can increase milk volume
- Oten recommended for mom to use after electric pump sessions to help maintain supply when separated from baby
- There’s no extra equipment to clean or forget to take with you!
Which pump?
There are too many brands to cover here but the major types include:
<Manual pumps >
- Can usually only do one breast at a time
- Suction is operated/regulated by hand
- Best for occasional use
- Haaka is not recommended; it doesn’t have suction control; passively collected milk is too skim; and it can be left in place too long causing damage
<Double electric>
- Personal pumps are the ones you can buy or insurance pays for
- For moms returning to work or school and going to be pumping 3-4 times per day
- Best to look for are ones that have different speeds and you can control the suction level
- Hospital or rental grade is what you need if baby is not suckling at the breast at all
- You will need to be pumping 8 or more times in 24 hours to establish and maintain milk
<Wearables>
- Not recommended until milk is established
- Occasional use only
- Can be left in place too long, sometimes causing oversupply and mastitis
- Too shallow for proper movement of the nipple
- The motor placement does not give you the view to assess fit, which can decrease milk production over time.
What size?
- This is an area of debate
- Ultimately whatever works and isn’t causing pain!
- The smaller sizes and the recommendations to use them only came into existence a few years ago.
- If I don’t want a baby on the nipple tip, I don’t want a pump just pulling suction on the nipple. It causes too much pressure per square inch (psi).
- From my experience with thousands of moms, without using a measuring device, if a mom’s nipple was about the size of a standard pencil eraser, then 24mm was adequate.
- Many, many, moms’ nipples seem to be about the size of people’s pinky or ring fingers and would have fit a 24mm flange, but actually had increased comfort and better milk volumes with 27mm.
- For moms with nipples about thumb size, a 30mm did well. There are 36mm and special order 40mm available too.
- It’s important it doesn’t cause high pressure on the nipple alone
- It shouldn’t make the breast rub in such a way as to chafe
- The nipple does need to stretch some to trigger let down of milk.
How to pump?
- No matter the method, start with clean hands and equipment. The breasts aren’t sterile so it is not necessary or recommended to sterilize. Hot water and soap are sufficient (the pump, not your breasts).
- Apply the pump, making sure your nipple is cantered in the flange and not rubbing on the side.
- Increase the suction only to comfort. A short, rapid suck works best to generate let down.
- As soon as you see drops of milk, slow the cycle down to mimic closest to what your baby does when drinking.
- If single pumping, it tends to work better to pump one breast x 10 min, switch to the opposite breast x 10 min, then repeat, doing 5 min on each. If you are double pumping, 15-20 min max.
- Use hands-on pumping. See video Maximizing Milk Expression (google)
When to pump?
- If you are trying to increase milk supply or to store for return to work, pump after daytime feeds. That means nurse your baby on demand, and when your baby is satisfied, pump 10-15 min total.
- If you experience mother-baby separation and your baby is not able to nurse, pump every 2 hours during the day and every 3-4 hours at night.
- If you have already returned to work/school, pump every 2-3 hours while away from baby; try not to go over 4 hours without at least a few minutes of expression. When the breasts get very full, it sends the message to your body to make less milk. So it’s better to pump for 5 min than to wait 5 hours; but get to your full pumping as soon as possible.
How to store milk?
- You may have heard about the “pitcher method” but it is not safe when moms are storing milk from who knows what date together in one container.
- The milk from one pumping, left and right, can be combined, then refrigerated.
- Once it is all cold, all the milk pumped on one day can be combined and labeled with that date.
- Safer to keep milk separate by date so you know which to use.
- When it is time to feed, use in order, oldest milk first. Milk from different dates can be combined to feed as needed, not to store.
For return to work or school
- Freeze all pumped milk ahead of your return.
- On your first day back, baby gets milk taken from the freezer, start with the oldest date.
- Every day after that, baby gets the milk you pumped at work the day before, which is just refrigerated. So what you pump on Monday, baby eats on Tuesday and so forth. The milk you pump on Friday is what baby eats the next Monday.
- Don’t tap back into your frozen stash unless you need some extra, until the milk is about 5 months old, then you start using the frozen.
- While you are using the 5-month-old frozen milk, anything you pump at work you bring home and freeze. Once you have finished the 5-month dated milk, you return to using fresh pumped and now your freezer stash is good for another 5 months.
To feed
- All milk separates so don’t be alarmed at how it may look.
- Warm the milk by a bottle warmer or by placing the bottle in a bowl of hot tap water
- No microwave or boiling water on the stove.
- Swirl, don’t shake, to mix the fat back in and it will look like it’s supposed to.
- Milk color changes with infant growth too