One of the most important tips for expressing is to have a good understanding of how milk production works. Breastmilk production is based on demand and supply, the more often you extract milk from the breast, the more milk your breasts will make, frequent pumping sessions (up to 10 to 12 times a day) in the first few weeks help to build and establish a healthy supply, these two links from Sutter Health and Kelly Mom explain how milk production works in more depth.
It is also important to ensure that you have the right breast pump based on your needs as well as the correct flange size. A top of the range double electric breast pump is not always essential in order to succeed at pumping breastmilk.
CHOOSING A PUMP:
There are so many breast pumps on the market today and they all vary in price, portability, single or double pumping, hospital grade vs. personal, and manual or electric.
It is important to decide which pump is best suited to your breast (nipple) size and needs.
Researching reviews of breast pumps can help give you some important insight into which pump will best suit you. You can find directions to EPSA collection of personal breast pump reviews here
The size of the breast shield is measured from the diameter of the funnel where the nipple is pulled into in order to remove the milk, you establish what size shield you would need based on the diameter of your nipple, not cup size of the breast itself.
For bigger breasted (nipple diameter) women it is recommend that you buy a pump from a manufacturer who offers different size sheilds, Medela, Spectra and Ameda all offer bigger flange sizes to suit your breast size.
Flange size is very important and can both positively or negatively impact your out put.
If you are buying a breast pump just for the occasional pumping session or for the sole purpose of donation then a cheaper manual pump will suit your needs perfectly. Majority of manual pumps are not designed for long term, constant use and many manufacturers do not offer replacement or spare parts for manual pumps.
Working moms tend to prefer both single and double electric and good quality manual breast pumps for quicker emptying and convenience while in the working environment.
Exclusive pumpers almost always rely on hospital grade double electric breast pumps, but they are not completely necessary as you are able to successfully EP with a good quality manual pump or small single / double electric as well.
If your baby is in NICU and you are using the hospitals pump, ask them to contact the lactation consultant to measure you for flange size, most hospitals will bring in sized flanges, or you may have to purchase your own milk collection kit directly from the manufacturer according to the size you need.
COMFORT AND SCHEDULES:
It is important to be relaxed and seated comfortably when starting your pumping sessions, sitting in a comfortable, supportive chair with a step or support under your feet, back straight and shoulders relaxed (don’t slouch), in a dimly lit, calm and quiet setting will help your body and mind to relax which in turn will help achieve a let down.
It is not necessary to lean forward.
For moms with babies in NICU it can be difficult to find a stress free environment to pump, but you can ask to sit next to baby while pumping which helps with letdown. Pump every 2 hours, day and night, pump until empty and then for a further 5 minutes.
Make sure that you have tended to baby and done any niggly tasks that may inhibit your ability to relax, keep a snack and fluids handy.
If baby becomes niggly during a session, remove the pump and tend to baby and then continue with your session once baby is settled, it can be tricky to feed baby and pump (for both EPers and breastfeeding moms) but with a little practice you will soon find a way that enables you to pump and care for your baby.
It is also vital to follow a pumping schedule, especially if you are pumping exclusively. It is recommended to pump as often as baby drinks while EPing as that helps to build a healthy supply and especially throughout the night as during the period of *midnight and 5am PROLACTIN levels are at their highest.
Pumping on average between 10 and 12 times a day within the first 12 weeks will ensure a healthy and well established supply.
For the breastfeeding moms, keeping to a schedule of pumping between feeds will help to get your breasts used to letting down for the pump for when you return to work. The amount you yield while pumping and feeding baby directly is NOT an indication of your supply and many breastfeeding moms will have difficulty letting down for the pump, this is something that may take time and with practice your body will learn to let down for the pump.
Remember not to skip feeds as a missed feed is a missed signal to your body to produce more milk, instead you can start to freeze the small amounts you manage to pump and start to build a small stash for emergencies and “low supply days” at the office or those hectic days when you just don’t get a chance to pump.
If you are able to, pumping on one side while baby feeds on the other will actually boost prolactin levels and help with supply.
Its important to remember that breastfeeding is based on demand and supply, the more milk you stimulate by creating the demand via extra nursing sessions or extra pumping sessions, the more milk your body will supply, even when supply is low, if you continue to stimulate the ducts then eventually supply will grow to meet those demands.
SUCTION SETTINGS AND BENEFITS OF LUBRICATION:
Start your pumping session on a slower suction setting (if using an electric) or with slow, steady squeezes (if using a manual) and gradually build up to a stronger suction. You may not need to get to the highest setting in order to achieve results.
Remember that a stronger setting will not draw more milk from your breast if you are in pain.
Pumping should not be painful.
If you do experience pain or friction, lubricate the flange with either olive, coconut or lanolin oil to help prevents pulling or friction.
Lubricating the flange also helps create a “seal” which enhances suction.
Hands on pumping technique can help stimulate and empty the breast more efficiently. It is especially helpful for mothers of preterm birth and mothers pumping in a NICU environment.
Using hands free can help achieve more yield and stimulate let downs.
HYDRATION AND NUTRITION:
Adequate hydration and nutrition are essential when breastfeeding, eating a healthy, well balanced diet and keeping your fluids up will help ensure that your supply does not dwindle.
Always make sure you have a glass of water or juice next to you while pumping or nursing.
It is also important to keep up with your prenatal vitamins to ensure that your body is getting ample vitamins and minerals for both you and baby.
Your body will always give the essential vitamins and minerals to baby first, which can leave you feeling tired, weak and out of sorts.
Having more frequent, shorter pumping sessions are far more beneficial than having longer intervals between sessions and longer sessions, for example pumping for 15 to 20 minutes every 2 hours will build and establish a supply better than pumping for 45 minutes to an hour every 6 hours.
Power Pumping mimics cluster feeding and are short, frequent sessions that help to boost supply, power pumping sessions can be done once a day or as many as 3 times a day for a day or 2 and results are often seen a few days after the sessions.
GALACTAGOGUES AND SUPPLEMENTS:
There are a few medications which are safe during breastfeeding that increase supply such as Eglynol, Esperide and Domperidone (Motilium), these medications should still be taken with caution and under the guidance of a medical practioner.
It is important to understand that no medication or supplement will increase supply if you are not removing the milk from the breast, taking a medication or supplement in the hopes of increasing supply but failing to empty the breast regularly will render the medication or supplement useless.
Natural supplements are great for boosting supply such as alfa alfa, brewers yeast, fenugreek and blessed thistle, as are foods which help increase milk supply such as oats, almonds, certain teas and electrolyte replenishing drinks. *likewise with medications, you should never take a supplement without consulting with your general practitioner or lactation consultant.
Be careful to avoid things like peppermint in large quantities as peppermint can cause milk supply to dry up.
ACHIEVING A LET DOWN
Breathing exercises (such as the ones you used for labour), relaxing your shoulders, meditation and being warm and comfortable all help to relax the mind and body, additionally having lots of skin to skin contact when with baby, having pictures or video clips of baby or smelling babys clothes or even being close to baby all help to elicit a let down.
Warmth also helps and placing a warm cloth or bean bag over or under breast can help trigger a let down, as can a warm pump flange.
Taking your mind off the milk and watching your favorite show, playing a game on the computer or reading a book can all relax you which helps milk flow. If you are having trouble letting down for the pump, you may just need more practice, try not to become overly stressed as it can hurt your ability to let down even further.
Regardless of your reasons for pumping, you are doing a wonderful thing for your child and your dedication and willingness to do what is best for your baby is admirable.