How do I provide emotional support to someone who pumps exclusively?

Listen to her. Pumping is hard and sometimes a pumping mother just needs to vent. The things that she may be venting about could seem trivial, but to the mother they are not trivial. When a woman is spending an average of three hours a day hooked up to a machine, those little things can start seeming really large. If you think about it, spending three hours a day hooked up to a machine is kind of like doing dialysis several times a day, seven days a week, with no days off, no holidays, no help and a target goal that seems so far away as to be potentially unattainable. YOU are the person this woman will come to when she feels like quitting. Give her empathy, sympathy and encouragement that she is doing something wonderful and amazing for her baby even when it’s difficult for her.

Be aware that you may be the mother’s sole source of support. Many women who do this are actively discouraged from continuing their pumping journey by spouses, family members, employers, coworkers, other mothers, and friends, and society at large.

Be understanding. You may hear the same problems, complaints and frustrations time and time again. That needs to be okay, since in many instances the mother will have the same problem(s) occurring over and over again. That these problems occur more than once frequently can make them more frustrating instead of less so.

There is a saying in the exclusively pumping community: “Never quit on a bad day.” Some women have very few bad days, and some women have a lot of bad days. But when they’re having a bad day they need to be told this. Remind them that they have chosen this path to give their little ones the best start possible, and that even though it’s harder than usual today, tomorrow is a new day that can bring a fresh outlook on things.

Remember that only the mother knows when it’s time to quit. It is true that one should not decide to quit on a bad day, but it is also true that when it’s time to hang up the flanges, it’s time. Most mothers find that they struggle tremendously with this decision whether they’ve pumped a week, a month, six months or even three years (yes – there is at least one mom out there who has been exclusively pumping three years!) and it is never a decision one arrives at lightly or without considerable deliberation. Despite having arrived at this decision, the mother may feel tremendous guilt about quitting, particularly if she has been feeding her baby breast milk for less than a year. Although you want to encourage and support continuing to pump, ideally for at least the first year of life, you also want to be mindful to be supportive of the mother when it’s time to stop. In our quest to see breastfeeding continue for at least the first year, is it very easy for encouragement to continue pumping to subtly shift into shaming the mother who is ready to stop. This consideration is present with mothers who nurse, also, but it is more damaging to the pumping mother than the nursing mother because she likely is already being shamed by others in her life and she also may be experiencing feelings of failure as a mother for being unable to nurse. Be mindful of this possibility so you do not inadvertently shame the mother. You may well be the only person in this mother’s life who does not shame her, either for pumping rather than nursing (or formula feeding) or for wishing to stop, so this needs to be in the back of your mind at all times so you may take steps to prevent it from happening with you.

Be aware that some mothers never stop trying to latch their baby. Whether it is likely the baby will latch or not is unimportant to the mother (she already knows if it’s not likely to succeed). It is important to recognize that some women will continue to try regardless of any negative emotional impact it may have on her. Be realistic but empathetic with the mother, and affirm for her that even though the baby may not latch, it is okay if the baby does not latch because the baby is still getting the wonderful benefits of breast milk due to all her hard work.

Always bear in mind that exclusive pumping is work. Hard work, in fact. Recognize this and verbalize that recognition to her. Praise her for being willing to do it. Women who exclusively pump are the unsung heroes of the breastfeeding world because they work harder than anyone else to feed their babies and are routinely criticized by everyone for doing so. You positive feedback and vocalized admiration are fundamental to her success, as well as her ability to experience positive feelings about the journey she is making.

Problems and Troubleshooting

Low supply and supplements

Low supply: some women have supply problems and cannot make as much milk as their baby drinks. This does not, however, mean that the mother needs to stop pumping and switch to formula. A woman may choose to exclusively pump and feed whatever milk she can, supplementing the remainder with either formula or donor milk. Donor milk may be requested (and is always free of charge) through organizations such as Eats on Feets or Human Milk 4 Human babies. Both of these systems use an honesty and full disclosure policy, and mothers who are registered as donors through banks but who also donate through these sites will specify that they and their milk meet the specifications required to donate to a bank. These mothers will probably need more support from you than any other exclusively pumping mothers, because they are working harder than anyone and are likely experiencing emotional pain that they cannot produce sufficient quantities of milk to meet their baby’s (or babies’) needs. They need your suggestions on how to increase milk supply, and many of the suggestions you would give to a nursing mother apply here. One suggestion you can give that is not part of standard nursing advice is to always pump for 5 or so minutes after the last drop of milk is expelled through the pump. This “tells” the breasts that more milk is needed than is being produced and can stimulate production. Rest, plenty of fluids (target of 96 ounces per day for a single birth mother), and low stress are essential for maintaining and increasing supply. Pumping often (8x/day) is often necessary, and the mother may wish to eat foods that are reputed to aid in milk production or take supplements (this will be covered below).
Encourage these women to keep pumping and remind them often that every drop counts, and that what they are doing is wonderful and amazing. It is highly discouraging to pump for 30-60 minutes and produce just a few ounces, but again, EVERY drop counts. Remind them that it’s okay they’re using donor milk or formula to supplement. Also be aware that many people in the low supply mom’s social network will tell her repeatedly that if she’s not producing enough, it’s not worth all the effort to keep pumping. This is not true, and you need to be the voice that counters this. Every drop counts.

Supplements: many women drink mother’s milk tea, take fenugreek capsules (this may make the woman smell like maple syrup), Oreo cookies, coconut water, sports drinks, nutritional yeast, flax seeds, chia seeds, and/or eat oatmeal. “Lactation cookies,” which contain oats, nutritional yeast and the like are a popular choice for helping to increase and maintain supply. There are a lot of recipes on the internet for these cookies and they should be given to people who have supply issues. In extreme cases of low supply, a mother may wish to consult with her physician as to whether a medication like Reglan might be helpful in her situation. Medications that help increase milk prescription should never be taken without first consulting a physician.

Common Problems

Clogged ducts: clogged ducts are a common problem for exclusively pumping mothers (this appears to be particularly common in users of Medela pumps). Warm baths are helpful, as is massaging (compressions while pumping) the breasts or applying a vibrating tool to the affected area. Pumping must continue while a clogged duct is present or the mother is at increased risk of developing mastitis. In some cases, women have sought assistance from their significant others by having them suckle to release the clog. Taking soy lecithin (or sunflower; alternately egg yolks have a tremendous amount of lecithin) supplements can help reduce the frequency and severity of clogged ducts, as well as help eliminate existing clogs.

Strawberry milk: if the mother’s milk comes out pink or red, it has blood in it. This is understandably upsetting to the mother and her first instinct may be to dump the milk. This is not necessary and may be fed normally to the baby, or allowed to settle before decanting the non-bloodied layer for the baby’s consumption. Remind the mother that if she were nursing she would never know the baby was consuming blood until she saw it in the baby’s stool. While this is frightening, it is not actually cause for alarm. If the woman has sores or lesions on her nipples that are not very severe, Lanisoh may be an effective treatment for the problem nipple. If the sore is severe she may wish to seek treatment from a physician. The mother should not stop pumping, however, as doing so until the nipple heals may cause her to lose her supply. If there is no visible tissue damage to the nipples, advise the mother to turn the setting of her pump lower, as it may be causing internal tissue damage. If pumping is painful, the setting is probably too high and can cause bleeding.

Mastitis: left untreated, clogged ducts may quickly turn into mastitis. It is safe for a woman to feed milk pumped during a round of mastitis to her baby. She does, however, need to see a physician for a course of antibiotics. This is very painful, but again, pumping still needs to be done on the effected breast.

Pain: if pumping is painful, there are a few things that may be causing the pain. The most common two are suction that is set too high, and flanges that are incorrectly sized. If the nipple is rubbing against the insides of the flanges, the flanges are too small and the mother should go up a size. If the pump is sucking the entirety of the mother’s areola and portions of her breast into them, the flange is too big and she should go down a size. Pumpin’ Pals brand flanges are a reasonable (although somewhat costly at $40 for a set of flanges in three sizes and a hands-free strap) alternative to traditional flanges, and the size of the flange needed is determined more by breast size than nipple size. These flanges can take a few days to grow accustomed to, so if the mother is attempting to use them, let her know it may be frustrating for a few days before it becomes easy again. Another potential source of pain is compressions. Compressions should be done gently. If it is painful to do compressions, too much force is being applied to the breasts.

Thrush: thrush needs to be treated immediately, and any breast milk that might normally be frozen should be scalded before the baby consumes it (scalding is fine for fresh milk as well). In addition to Western medical treatments, many women successfully treat thrush using homeopathic options such as gentian violet (though the milk may be blue in color if this is used).

Depression: exclusive pumping is lonely work; results in loss of time spent with the baby and the family at large; and dramatically affects a woman’s social life outside the home, as she must determine by her pumping schedule whether she may attend any out-of-the-home events. This is where you come in: be the mother’s cheerleader. If you know the mother is experiencing depression, call her once or twice a week to see how she’s doing and to have a chat. Having a baby to care for and keeping up with a rigorous pumping schedule can be emotionally taxing, before accounting for all the hormonal changes giving birth causes.

Lack of home and community support: this problem is the most insidious of all the problems the pumping mama may experience. Some mothers find the people around her to be very supportive, but in many cases, no one has heard of this method of breastfeeding before, and many of the people who should be the mother’s support system view the time spent pumping as inconvenient to them. Thusly, they actively discourage the mother from continuing to pump. This kind of pressure makes an already difficult task even more so and is probably the main reason women quit exclusively pumping as quickly as they often do. Alternately, people may pressure the mother to continue pumping when she has decided it is time to wean, which may be as damaging to the mother as discouraging her from continuing. You are the mother’s lifeline here. You are her cheerleader. You are the voice that validates her effort and her sacrifices, and who can help her meet her pumping goals (whether that’s three months, six months, a year, two years, or whatever the goal is). Be the angel on her shoulder who keeps her from listening to the devil on her other shoulder. Encourage her and support her. Remind her how good what she is doing is. Remind her that you admire her hard work. Rally behind her so she does not feel like the only person who cares that her baby is eating her breast milk. Without encouragement and support exclusive pumping is exceedingly difficult, at best. With encouragement and support, it is possible to succeed in continuing with breastfeeding for as long as she wishes to do so.

Problems with pumps: the selection of a pump can sometimes provide challenges to the pumping mother. Some women will respond very well to a specific type of pump while other women find that same model gives them a lot of trouble. Be aware that before determining the pump in question doesn’t work well for that woman’s breasts that trouble shooting to determine if there is a problem with the pump itself, incorrectly sized flanges, or whether spare parts need replacement, should occur. Some models of pumps work very well for the part-time pumping mother (hybrid feeder) but do not work well for the exclusively pumping mother. An exclusively pumping mother will either require a hospital-grade pump or a pump that is known to provide good suction. Exclusive pumping can be, and frequently is, done with a manual pump but most women find a manual pump to be an inefficient means of extracting her milk. If you know the mother will be exclusively pumping or later decides to exclusively pump, do not issue her a manual pump. Issuing a manual pump decreases the mother’s chance of success in providing her baby breast milk over in the long run. If your office supplies more than one type of electric pump it is possible you will need to trade out the pump you have released to her for a different brand or style for her to be successful. A good, efficient pump is key to her success.
Provide training on how to use the pump correctly, as well as how to determine when valves, membranes, diaphragms and tubing should be replaced. You must act here as the woman’s advocate to herself and ensure she knows exactly how to use the equipment provided as well as how to troubleshoot minor problems with the pump, such as loss of suction (change valves, membranes and diaphragms first). You should inform the mother that in instances where her pump is an open system model that she needs to run the pump for about 15 minutes after her session is finished to eradicate moisture from the system (otherwise the pump motor and tubing may develop a mold or mildew problem). You should inform the mother with an open system pump that when she washes her tubing (this is not needed with a closed system) to run rubbing alcohol through it to help dry it, and then attach the tubes and run the pump until all moisture is expelled from the tubes. Not knowing how to correctly use and care for a pump sets the mother up for failure as an exclusive pumper. Her pump is most likely to have problems when your office is closed and she cannot come see you to trade it out, so be sure to review with her basic troubleshooting procedures so she is less at risk of having a problem that could result in reduced breast milk supply.

Oversupply: an oversupply is technically categorized as any quantity of milk produced that exceeds the baby’s daily nutritive needs. Whether the mother produces one extra ounce per day, or fifty, she has an oversupply. Mild to moderate oversupply is frequently considered a good thing to pumping mothers, as it allows her to build up a freezer stash to use in emergencies, or to accumulate sufficient milk to see the baby through its first year while allowing the mother to dry her milk up early.
Extreme oversupply is as much of a problem for the mother as low supply is. Some mothers who experience extreme oversupply stock their freezers full of milk and then wish to donate milk to a bank or to individual mothers. Donating milk can be an rewarding experience that allows the mother to know that not only is she feeding her baby with the milk she produces, but she is also helping a mother-and-baby team fulfill their needs. Many women report that donating milk transforms the pumping experience into a more fulfilling experience because she knows she is contributing not only to the well-being of her own child, but to the well-being of other members of her community. If this is what the mother wishes to do, then at that time the oversupply is not problematic. If, however, the oversupply is a problem, counsel her to pump less frequently (consolidating or eliminating a pumping session from her schedule) and to avoid pumping until she is completely empty. Under no circumstances should the mother pump longer than the moment the last drop falls if she is attempting to reduce her supply.

Some foods and other substances that are reputed to help reduce supply are: mint (this includes Sleepy Time herbal tea), sage tea, cabbage leaves in the bra (this is a frequently utilized technique to reduce engorgement and pain but can actually affect supply), thyme, oregano, parsley, vitamin B6 and decongestants (not to be used without consulting a physician). Women with oversupplies may be encouraged to consume these foods, while women with low supply should be discouraged from consuming them. Although insufficient scientific research has been done to prove the veracity of claims that these foods decrease supply (this is the same with foods reputed to increase supply), enough women report efficacy to bear these tips in mind. Women with oversupplies may also be encouraged to wear tightly fitting sports bras to help reduce their supplies, and should be discouraged from massaging their breasts.

Boredom: boredom is a common problem for exclusively pumping mothers. Each mother is spending a considerable portion of her day pumping and should have other activities to perform while she pumps. Common activities include: watching television, surfing the Internet, reading, studying, participating in online support group discussions, eating, and chatting with a friend. Some women may wish to have “pumping dates” with others in their community and if you have more than one pumping mother you support this may be a good recommendation for them.

Crying baby: most women will experience times when their baby is crying while she pumps and there is no one around to help her with the baby. Let her know it is okay (albeit frustrating) to disconnect from the pump and go to her baby and then to resume pumping once the baby is settled. Women with younger babies may wish to allow their babies to nap beside them while they pump, and older babies should be encouraged to play independently while pumping occurs. Older babies may attempt to pull the flanges off the mother while she pumps. Those babies often do well with playing with a manual pump or spare flanges beside her while she pumps.

Work: the exclusive pumper experiences a set of challenges not present for those who do not work. Many employers offer resistance to giving the mother time to pump while at work, or a good place to pump. Know the legal rights of the woman in your state and inform her of them. In most states, employers are legally required to provide a secure, private space that has a chair, table and electrical outlets to pump in that is not a bathroom. Most states are also required to give breaks (paid or unpaid) to allow the mother to pump. Help the mother advocate for herself in her workplace to secure her right to pump. Encourage the mother to keep either a set of spare parts for her pump at work, or an extra pump to keep at work. This can help reduce pain and engorgement if the mother forgets her needed supplies.

Daily variance in production: many pumping mothers religiously track their output. This is normal behavior. However, there will be daily variance in the amount of milk produced. The mother should be encouraged to take a relaxed approach to days where she produces less milk than is expected. It is better to evaluate production over the course of a week or two than daily. Keep in mind that even an ounce or two less output than usual can be extraordinarily stressful for mothers (particularly those with low supply) and be encouraging. Increased stress over lower supply can lower supply further.

Period and pregnancy: Both menstruation and pregnancy can do considerable damage to a mother’s supply. If the mother’s output is reduced a few ounces per day for a few days, she may be about to start her period. Most mothers whose menses have returned report a reduction in supply in the days preceding the onset of their period. Remind the woman that once her period starts her supply should return to normal. Pregnancy can create a tremendous reduction in supply. If a woman’s supply reduces dramatically over the course of just a few days, she should take a pregnancy test to rule this out.

Spilled milk: sometimes a mother spills some of her milk. This experience is heartbreaking. Reassure the mother that she will make more, and that even though it’s a terrible loss of her liquid gold, that things are going to be okay.


About EP’er Allie:

I am a 36 year old, grad student studying literature (empire studies concentration) at University of Houston (did my undergrad there as well, though in mathematics), loves food and nerding out whenever possible. Married to a spectacularly awesome husband, with a very sweet 7-month old and an 8-ish year old persnickety cat.

My Journey: I started EPing when my daughter developed bottle preference. I didn’t know I was EPing, but I kept pumping while I tried to reattach her so I wouldn’t dry up. Eventually I had to accept I wasn’t going to be successful in reattaching her and I just kept pumping since I didn’t see a valid reason to switch her over to formula.

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