I am thrilled to feature an article by the one and only author of what is essentially the “Pumping Bible” within the EP community, Stephanie Casemore.
Stephanie Casemore is a mother, teacher, and writer living in eastern Ontario, Canada. She exclusively pumped for a year for her first child who was born at 31 weeks, and nursed her second child for three years. Turning the challenges and experience into an opportunity to support other mothers, Stephanie wrote Exclusively Pumping Breast Milk: A Guide to Providing Expressed Breast Milk for Your Baby and Breastfeeding, Take Two: Successful Breastfeeding the Second Time Around and also provides support to breastfeeding and pumping mothers both online and in person.
Both of Stephanie’s books are available in South Africa via Amazon.com and Kalahari.net.
An Exclusively Pumping Top 10—How to get off to a good start
1. Use the best breast pump you can afford.
When you need to rely solely on a breast pump to maintain (and possibly initiate) your milk supply, you need to go with the best one you can afford. What’s best won’t necessarily be the same for everyone, and your personal situation with regards to travel, work, and your baby’s birth experience will all come into play. Hospital-grade pumps are usually the best option in terms of efficient and durable breasts pumps that will withstand the rigors of pumping, while offering the most effective milk removal. But let’s face it, lugging around a larger breast pump might not work best for you if you need to return to work or if you travel a great deal. If supply is a concern, use a hospital-grade pump if possible—full stop! If you have a strong supply, then you might consider other quality double-electric pumps.
2. Frequency is key—early and often!
You simply can’t ignore the physiological basis of lactation. Early and often is a critical element to establishing a strong milk supply. If you need to exclusively pump starting immediately after the birth of your baby, then you need to pump starting as early as possible after your baby is born and continue pumping frequently (aim for a minimum of 8 times a day if possible) until your supply increases to a level that will meet your growing baby’s needs. Once supply increases, frequency will still be important to maintain supply, but many women are able to ease off their schedules a bit. Just how much you can shave off though depends on a number of factors including breast storage capacity and daily milk volumes. If your goal is to exclusively pump long-term, always err on the side of caution.
3. You have to remove the milk.
After lactation is initiated, it is largely maintained through a process of supply and demand. Removing milk from the breast signals your body to produce more milk. So, you have to remove milk. This in itself seems quite simple, but is often the biggest thing to trip women up. Reasons milk may not be removed? Here are some examples: skipping sessions, not pumping frequently enough, sleeping through the night early on, only pumping for the first let-down, going longer between sessions because you seem to get more if you do (but this won’t last long), not pumping long enough each session, a pump that isn’t effective for you (or is simply a crummy pump), and equipment that is not fitting you properly. We’ll discuss some of these points coming up.
4. Let-downs rule!
Milk isn’t simply “sucked” out of your breasts by the breast pump. Just like when breastfeeding, you need to trigger a let-down (or milk ejection) response. No let-down means little to no milk. And you will get more than one let-down per pumping session, so be cautious of that advice to stop pumping after milk stops flowing—you need to continue pumping for a second and maybe even third or fourth let-down. A let-down is initiated as a result of a wave of oxytocin being released from the pituitary gland and acting on the smooth muscle cells around the alveoli to “push out” or eject the milk. Pain, cold, embarrassment, and other such negative situations can affect milk let-down.
5. The importance of comfort can’t be dismissed.
Comfort is important to exclusively pumping moms. Comfort of the pump and flanges, comfort in your positioning, and perhaps even comfort with what you’re doing and the support you receive will help you provide milk for your baby. Pumping really shouldn’t be painful, so if you’re in pain, you need to try and find the cause and develop a solution. Frequently, nipple pain is caused by friction, a pump that isn’t effective, flanges that don’t fit properly, suction that is set too high, or pumping sessions that are too long. Some women may be predisposed to some discomfort—those with sensitive skin, for example—but it should never cause you extreme pain, sores, cracks, or bleeding. Using some type of lubrication is a good place to start, and many pumping moms like to use coconut oil. If you’re in pain, consider the list offered above and do some troubleshooting.
6. Get your hands working for you.
Whether breastfeeding or exclusively pumping, you want to get to know your “girls”! Use your hands when pumping, both before and during a session, to help elicit let-downs and remove milk. Breast massage prior to pumping—and perhaps coupled with a warm compress—can help start milk flowing and ease milk expression. Massage and breast compressions while you are pumping can also help with milk removal, but they are also important to feel for spots that aren’t emptying well and allow you to use your hands to help empty those ducts, avoiding the development of plugged ducts. Hand expression is also something to add into the mix. Try hand expressing for a few minutes after at least some of your sessions each day. This can help you establish a stronger supply in the early days, and also help you remove as much milk as possible once your supply is established. Here is a useful video on maximizing milk production with “hands on” techniques.
7. Flanges come in different sizes for a reason!
Thankfully we are not all the same, and neither are our breasts and nipples. Flanges come in a range of sizes for this reason. Flanges that are too small and those that are too large can equally affect the efficiency of milk removal and over the long term can reduce supply. Ill-fitting flanges can also cause some nasty sores and pain, so you own it to yourself to get the best fitting flange possible. Some pump companies offer a better range of sizes than others, and you might consider this when deciding on a pump. There are also some companies that offer flanges that can be used with numerous pumps. Big breasts do not mean big nipples though, so look at the diameter of your nipples and how they fit in the flange tunnel when determining what size will work best for you. Consider this graphic on how to fit your flanges.
8. Don’t look for the quick fix or the easy option.
No one said it would be easy! And the science of lactation can’t be cheated. Milk supply is regulated by supply and demand and there is no quick and easy way to pump less often but produce more milk. Some women with large breast storage capacities will be able to pump less and maintain their milk supply, but those without large storage capacities will, I’m afraid, need to keep pump, pump, pumping! If you do the hard work early on in the first days and weeks post-partum, you will have a better opportunity to drop a session or two—maybe even three or four—and still maintain your supply. Many moms are able to eventually drop down to only 5 or 6 sessions a day without seeing any significant decrease; however, there is no supplement, food, or magic pill that will make up for an infrequent schedule or inefficient pump. Keep the basics in mind, understand how lactation works, and do the early work of establishing your supply. This is what will give you the most flexibility.
9. Inform yourself.
And so this leads us to the importance of getting good information and applying that information to your own experience exclusively pumping. Sadly, there is a limited amount of good information available when it comes to exclusively pumping breast milk (of course there is my book, Exclusively Pumping Breast Milk!), and not all breastfeeding support professionals are knowledgeable or supportive of pumping moms, so to some extent, exclusively pumping moms need to become their own expert. Learning about how lactation is established and maintained is one of the best things you can do to help you along your journey. When you understand how milk is made, what regulates production, how production changes over time, and what things influence lactation, you’ll be better positioned to make choices relating to your own pumping schedule. The article on my website “Critical Factors in Milk Production” is a good place to start learning.
10. Support yourself—and in the process support others.
The importance of support can’t be overstated, and in some ways perhaps it should be number one on this list, but we’ll leave it as the final item on the list since the last point is often the one you’ll remember the best. Exclusively pumping can be a lonely journey, and almost every mother who travels this road believes she is a lone traveller—until she discovers a group of other women just like her! You are not alone, but you’ll find that travelling this road is much easier when you have others to talk to and lean on when you get tired and the destination seems a long way off. You’d be surprised at who is exclusively pumping. It tends not to be visible because most moms aren’t pumping in public—although some are! But they are out there. The internet has brought the community much closer together and you’ll find numerous discussion boards and Facebook groups specifically for exclusively pumping moms—like my group! Don’t go it alone. Support yourself by reaching out for support, connecting with other pumping moms, and in the process supporting other women. Having a group of women you can go to with concerns, a group of women who “get it” because they are doing the same thing, will make a world of difference and provide you with the strength to push on when you don’t have the strength, the courage to persevere when you’re feeling scared, and the kick in the butt you occasionally need when you’re having “one of those days.”
© Stephanie Casemore, 2014