Exclusive Pumping

on February 12, 2014 in Breastfeeding, Exclusive Breastfeeding

Some mothers pump exclusively for their babies, sometimes by choice and other times because of breastfeeding difficulties.  I have helped hundreds of mothers who for various reasons, have exclusively pumped their milk for their babies, and some for quite a long time!

Occasionally, I meet a mother who simply dislikes the idea of putting a baby to her breast.  For her, she understands the importance of breast milk and is willing to do twice the work of both pumping and bottle feeding for her baby. While in some cases, I don’t always understand the reasons behind a mother’s decision to bottle feed expressed milk; I respect their decision and am as supportive as possible.

Other mothers find that they struggled with a breastfeeding issue early on like the failure of the baby to latch or latch effectively, and made the decision to simply feed their baby the milk by bottle.  Some mothers struggled with low milk supply and yet wanted their baby to get every drop of milk they could produce.  Some infants like those with cleft palates or other medical issues may not be able to latch and suck effectively. I have had mothers with very large nipples, larger than a half dollar, severely inverted nipples, or mothers with severe chest burns, may not be able to get their babies to latch and suck well enough to thrive.

Exclusively pumping mothers do have the choice of weaning and formula feeding but the option to exclusively pump, for whatever reason, is a special gift for their babies.  Mothers who exclusively pump often do not seem to get the respect and support of others.  They may often feel like they are excluded from other nursing mothers and sometimes even their healthcare providers.  It may seem to them that they need to explain why they are not breastfeeding.  Mothers who exclusively pump and bottle feed should feel proud of their decision and of course, of their efforts to provide the very best for their babies.

Mothers who exclusively pump may do quite well or may have difficulties keeping up their production.  There are certain things you will want to know.

Probably most important is having a great breast pump!  Yes, a good pump may be expensive, but it is always cheaper than infant formula.  While you may be eligible for a pump through your insurance company, these are typically not clinical grade pumps.  Personal use pumps are intended for mothers who are pumping part-time, like those mothers who are returning to work or school.  You may be offered a “Personal Use” pump, which you may be able to use after your milk supply is well established, so long as the pump has high suction capability and a double pumping option.

But to start, I recommend a fully automatic, clinical grade pump. Few insurances cover the cost of rental pumps, but you can certainly check with your insurance company to be sure.  These pumps can be rented from a local depot.  To find a rental station, you can call the major pump companies to find where you can rent one of their pumps or better yet, call around to local lactation consultants to see what pumps they offer for rent.  You can find the names of local lactation consultants by going on-line to ILCA.org and scrolling down to “Find a Lactation Consultant” where there are listings of lactation consultants by area.  When renting a pump, ask about long-term rental rates, which are typically much cheaper than daily rates.  You will also want to purchase a double collection kit for faster and more effective pumping.  Mothers at some point may do well using a “personal use” pump that they or their insurance covers for them, but some mothers do best with a clinical grade rental pump.  Mothers who are eligible for WIC may get a pump loaned to them for the purpose of exclusive pumping.

To establish and maintain high production, initially you will want to pump about as often as a baby nurses; about 8-10 times each 24 hours.  You can pump more frequently during the day and evening and pump only when the baby wakes in the night, but overall, try and get in at least 8 pumpings every day during the early months.  Middle of the night and early morning pumpings are very important, as this is when mothers have the highest prolactin levels, the hormone which drives milk production.  Pumping fewer than 7 times each 24 hours and/or skipping nighttime feedings can lead to a low milk supply.

You will want to try and get at least one feeding ahead, so that if your baby suddenly wakes and needs to be fed, you can bottle feed and then try to settle the baby so that you can then pump without having a hungry, fussing baby next to you while you are trying to pump.

You will do best by using a double collection kit to get the most milk in the shortest amount of time.  Most mothers will need to pump about 15-20 minutes at each session, but you will need to experiment with how long it takes you to get your breasts as completely drained as possible.  Some lactation consultants suggest pumping 5 minutes longer when the milk flow stops as some mothers will get a second or even a third milk let-down. You may not get complete drainage with a poor quality pump or if your pump flange is the wrong size.  Most mothers, about 75%, need a flange size of about 27 millimeters.  If you find that your nipples are swelling and filling the entire tunnel of the shield, you will need the next size larger flange.  Pumping may also be more comfortable if you use some lubricant, like lanolin, around the sides of your nipples prior to pumping.

You can also use the technique of “hands on pumping” to get your breasts as empty as possible.  This technique developed my Pediatrician, Dr. Jane Morton can be seen at Stanford University’s website at http://newborns.stanford.edu/Breastfeeding/FifteenMinuteHelper.html     Just click on “Maximizing Milk Production with Hands On Pumping”.

You may want to simplify pumping full-time by having two collection kits.  This will come in handy when you have not had the time to wash your pump pieces.  If you only have one kit, you can also place the pieces that come in contact with your milk in the refrigerator until you need them next.  Another handy item is a hands-free pumping bra.  My favorite is the “Simple Wishes” pumping bra that sells on their website, on-line or through some lactation centers.  By using a hands-free nursing bra, you can actually do something else while you are pumping!

How much to bottle feed your baby is another matter.  Most young babies drink about 3 to 4 ounces per feeding.  Formula fed infants often overfeed and perhaps that is the reason that so many formula fed infants are overweight as babies, toddlers, children and adults.  The average breastfed baby drinks about 25 ounces of milk per day.  Some may take a bit more, as much as around 30 ounces per day.  You can figure out the amount of milk per bottle by dividing 25 by the number of feedings per day as a rough guide.

Not many professionals discuss with exclusively pumping mothers how to feed babies using a bottle.  It is very common for babies to overfeed.  That is why it can be helpful to use a slow flow nipple.  Unfortunately, not all nipples marked as “slow flow” are actually slow flowing!  The baby should drink a bottle in about 5-15 minutes.  If the baby is taking longer than that to feed, then the nipple is probably too difficult for him. On the other hand, if the baby is drinking faster than that, you may want to find a slower bottle nipple or feed using the method called “paced” bottle feeding.

“Paced” bottle feeding can be very helpful in providing the baby’s milk in a similar way, as they would get if they were being breastfed and prevents overfeeding.  With paced feeding, the baby is able to latch onto the nipple and drink with pauses in a similar way as a breastfed infant.

Hold the baby in an upright angle instead of being laid flat. To get the baby latched onto the bottle, tickle his lips and wait until he opens his mouth to accept the nipple, rather than pushing the bottle in.  Encourage the baby to take in the wide portion of the nipple with his lips flanged out.  Hold the bottle horizontally, not vertically, and allow the baby to suck.  Don’t worry about any air being in the nipple; this will be released when the baby burps.  When he begins to pause, pull the bottle downward to allow the baby to have a brief break and lift it back up to the horizontal position when the baby begins sucking again.  Half way though the feeding, you may want to switch the arm you are using to the opposite side.  Switching sides improves a baby’s eye development as well as eye-hand coordination. This also mimics the way that breastfed babies are fed. Respect the baby when he stops sucking and see if he seems done eating even if there is a bit more left in the bottle.

If other people, especially child care providers feed your baby your milk, teach them this method too.  All too often, mothers who are leaving breastmilk for their babies, are led to believe that their milk supply in not enough when in fact, the babies are just overfeeding.  You can view a video on “Paced Bottle Feeding” at http://www.youtube.com/watch?v=UH4T70OSzGs which was created by Jessica Barton.

If you notice that your supply is dropping off, there are several things you can do.  Number one is increasing the number of pumpings to at least 7-8 times each 24 hours.  When pumpings fall below 7 in a 24 hour period, milk production often declines.  You can also use herbs to increase production.  Fenugreek capsules purchased from any health food store can help.  The typical lactation dose is 3 capsules three times a day.  I prefer More Milk Plus from Mother Love Herbals.  It contains fenugreek as well as three other milk stimulating herbs.  You can go to Mother Love’s website to find a local distributor or order it directly from them.  Teas are a very weak form of any herb and may be less effective.  But herbs may not help much if the number of nursings falls below 7 a day.  While commonly suggested, drinking beer does not help with milk supply and is not recommended for this purpose.

You may also want to be certain that the pump you are using is giving enough suction.  Pumps that don’t have a suction strength of -240 millimeters of mercury may not be effective enough.  Some mothers may get by with a low suctioning pump, but after time, this may be insufficient for you.  You can also return to a clinical grade rental pump for awhile if you are wondering if your pump may not be effective enough for you.  Also, some mothers may need to change the flange size over time.  If your nipples seem to be swelling in the tunnel, it may be that you need a larger size.  And lastly, be sure you are drinking plenty of fluids.  Not drinking enough or becoming dehydrated often lowers milk supply, especially if you have been sick.

Once your period has returned, you may find that your supply takes a dip from about the time of ovulation until your period starts.  You can help this by taking 1000 milligrams of magnesium and 500 milligrams of calcium per day can help.

Birth control pills containing estrogen dries up milk.  Another common medication, psuedoephedrine found in many cold remedies, often can dry up milk.  So if you are suffering with a head cold, use something like Afrin nasal spray is a better choice.

There are a few things to know about storing your breastmilk.  Feeding freshly refrigerated pumped milk is best, as your baby will receive the most immunity.  While many lactation specialists suggest refrigerating your milk for up to eight days, I suggest using it within 3 days.  If it is older than this, you can freeze it.  If you have frozen milk, you can defrost it using the oldest milk first to prevent losing outdated milk.  Placing it in the refrigerator and using it in the next 24 hours or placing frozen milk in a bowel of warm water can defrost milk.  Micro waving is not recommended because of the possibility of causing “hot spots” in the milk and changing the nutritional and immunologic composition of the milk.

Lastly, while bottle feeding is a bit of a chore, keeping your arms completely occupied, hold your baby for all of his feedings.  Devote your attention to the baby during feedings.  This is good for your baby’s emotional development.  Let the phone ring and turn the TV off. Let your baby fall asleep in your arms. Also, bottle propping is never recommended.  Breastfeeding allows for the important physical contact and bonding with your baby.  When your baby is older and can hold the bottle on his own, continue holding him for all of his feedings.  Dropped bottles and picking them back up for him increases his risk of infection and sickness from dirty floors.

You are special! Not only are you providing your baby the best milk on this earth, but also you are giving him the warmth of your arms and loving gazes that will help your baby thrive.