The World Health Organisation lists optimal infant feeding practices in the following order.
- Direct breastfeeding.
- Expressed breastmilk from the mother.
- Donor milk from a registered donor organization.
- Artificial infant milks.
And yet in most cases when breastfeeding is not working out mothers are quickly pushed from first option, to fourth with very little consideration for long term viability of option number 2, mothers own expressed breastmilk.
Breastfeeding is the biologically normal way to feed an infant, human breastmilk is made in the mothers blood and contains important nutrients, proteins, fats and immunological properties that are perfectly designed for growing human babies. Nursing at the breast provides far more than just nutrition, it provides comfort and a sense of security and is the perfect mothering tool to fix any and all complaints our tiny humans have, but due to certain circumstances, a mother may find herself unable to get baby latching.
A few of these circumstances are:
- Premature birth
- Cleft lip and palate
- Severe tongue and lip ties
- Birth defects
- Sensory disorders in either mother or baby
- Poor milk transfer / immature suckling reflex
- D-Mer (dysmorphic milk ejection reflex) or past sexual or traumatic experiences
- Working away from baby from early on for long periods.
Although several of these circumstances can be overcome with knowledgeable support from certified lactation specialists such as an internationally board certified lactation consultants or La Leche League leaders, some mothers are unable to overcome them and often turn to alternatives to formula, such as exclusive pumping or donor milk.
Well for starters, it demands extreme dedication, just like direct nursing, the same principles of breastmilk production apply. The more often milk is effectively removed from the breast, the more milk your body will produce. An exclusive pumper should aim to pump between 8 to 10 times within a 24 hour period in order to maintain supply, and while this seems extreme and undo able, it is actually quite easy to accomplish with the right equipment and techniques.
Understanding the basics of how breastmilk production works and how your milk is made within your body can give you the added confidence and knowledge to succeed with exclusive pumping.
Choosing the right pump
Choosing the correct pump for your personal needs is obviously a huge factor, there are so many options out there for mothers to choose from, but there is no one single type of pump that is better for exclusively pumping than another, I personally exclusively pumped for 4,5 years using a good quality manual pump, while other mothers have been able to master the marmet technique of hand expressing and exclusively pumped for well over a year using just their hands, many mothers however prefer double electric pumps to pump breastmilk, it is important to understand that choosing a breastpumps is a unique experience, not every pump is going to work for every mother.
Using your hands to help stimulate the breasts and milk ducts while pumping is a fantastic way to not only speed up the emptying process, but also to achieve a higher yield while pumping. This technique is aptly named the “hands on technique” and as an added bonus using this technique regularly also helps to cut down on blocked ducts.
Flange size and spares are foreign words to most new moms, but exclusive pumpers learn the importance of these words very quickly, the standard size flange, which is measured from the diameter of the nipple, not breast cup size, is 24 mm, this size only fits 45% of all mothers, flange size can greatly impact your ability to effectively pump breastmilk, it can cause friction burn, pain, and blocked ducts. Finding a pump which offers sized flanges is extremely important if the standard size does not fit you or causes pain.
Spares are the removable plastic pieces such as the diaphragm and duck bill, microscopic tears can drastically impact your pumps ability to function optimally so spares should be changed every 3 to 4 months or as soon as your pump begins to start feeling sluggish.
So does exclusively pumping mean that I will have to top up?
No, not at all. If a mother sticks to her schedule and maintains her pump correctly, she can successfully feed her infant well past the WHO recommended 2 years with only her breastmilk. Unlike artificial infant milks which are static in their ingredients, breastmilk is a living substance that is continually changing to meet your baby’s individual needs, therefore, unlike formula, the amount of breastmilk needed after the age of 6 months pretty much stays around 120 to 150mls per feed.
As I just mentioned, breastmilk is a living substance full of not only essential nutrients, fats, sugars and proteins, but also antibodies, stem cells and hormones, so storing and heating breastmilk are extremely Important.
Heating can also damage or denature the enzymes and nutrients found in breastmilk that can impact absorption of those nutrients. It is not recommended to heat breastmilk in a microwave or bottle warmer as the temperature rises above body temperature quickly, these methods can also cause dangerous hot spots within your milk, instead it is recommended to warm gently under warm water or in a bowl of warm water, some baby’s will happily take cooler milk while others are a bit more picky and prefer the perfect temperature of approximately 34 degrees.
Bottle feeding is something we have all witnessed in society, but bottle feeding breastmilk is best done using paced bottle feeding or respectful bottle feeding. Feeding your baby using paced bottle feeding can reduce choking hazard, gas, over feeding and stomach complaints in breastfed infants. The basic principles of paced feeding are to:
- Feed baby in an upright position
- Bottle should be parallel to the floor and not tipped up.
- Baby should be encouraged to actively suckle for milk.
- The bottle should never be forced into baby’s mouth.
- Baby leads the feed, baby should not be forced to finish the feed.
Often moms report baby guzzling down the milk and the crying for more, but more often than not those cries are misconstrued as hunger when they are more likely due to discomfort.
Because breastmilk is much thinner in consistency, a baby left lying down with a bottle is often overwhelmed by the flow from the teat, they are unable to regulate the flow so they gulp the milk down in an attempt to not choke and protect their airway, this gulping of milk can lead to painful tummies, gas and reflux symptoms which leads to crying after a feed, which is why it is so important to always use feeding time as bonding time and hold baby as upright as possible while bottle feeding breastmilk.
Using a number 1, slow flow teat is the only teat you will ever need as breastmilk does not change in consistency like formula.
Increasing supply is a popular topic in all breastfeeding circles, there are many supplements, foods and medications that mothers swear by to increase supply, however many only offer superficial boosts to supply, the most effective and safe way to boost supply is to empty your breasts frequently, regardless of how many galactagogues or medications you take, they will never have the desired effect if milk is not being removed. Power pumping is a good example of how to increase supply using frequent stimulation and removal of milk from the breast.
Lastly, I want to touch on support systems.
Support is such an important part of mothering in general, often finding a support system that understands and respects your choices can be challenging, and sometimes you need to become your own support system. If you are looking for support with breastfeeding or exclusively pumping, I cannot recommend La Leche League South Africa enough, alternatively for more specialised support specifically for exclusive pumpers you can join the Exclusive Pumpers South Africa group on Facebook.