All the most commonly answered questions about working and pumping.Pumping is one of the most commonly addressed issues by working and non-working mothers alike. So, let's talk about it. Warning: This subject has been tackled many times by those who have already written great articles about it, so there will be a lot of links. We don't need to rewrite the manual, just say where that information can be found. So think of this also as a good reference page.
Here we go. Below are some of the most common questions we see: Do I need a pump? And if so, what is the best kind? Well, let's break that down. Do you need a pump? If you are planning on being a stay at home mom, then the answer is, not really. If you would like to pump a bottle to go out on a date occasionally, then sure, go ahead and get yourself a decent hand pump, though some mothers get just as much as hand expressing, if they do it correctly. But if you aren't really going to be separated from the baby, then a pump can cost a lot of money (if you are looking for an electric one), and can cause a lot of extra stress that as new mothers, we really don't need. We may look to pump to try to 'measure' how much a the baby gets, but that is not actually an accurate measure, since a pump operates VERY differently than a baby. On average, what we pump is about 60-70% of what a baby may get when they nurse. No matter how wonderful your pump is, a baby who is feeding well is ALWAYS more efficient than any pump. Jack Newman has a great article on Hand Expression here: http://www.breastfeedinginc.ca/content.php?pagename=doc-EBM If you are planning on returning from work, or are separated from baby due to medical or personal reasons, then absolutely, get a pump. What kind can remain a debate, since mothers respond differently to different devices. The best kind of pump is the one that works. Some mothers who feel like a cyborg by being attached to a machine won't relax, therefore, their body won't respond well to an electric pump. LLL has a great article that breaks this all down right here: http://www.llli.org/llleaderweb/lv/lvjunjul04p51.html No matter what kind of pump you are using, it should NOT be painful! So, what do to if pumping hurts? Read this to find out: http://www.nancymohrbacher.com/blog/2010/8/30/ouch-what-if-pumping-hurts.html This invariably leads to the next question: Is it OK to buy a used pump? Again, LLLI has a great article on what to consider when looking at a used pump: http://www.llli.org/llleaderweb/lv/lvjunjul04p54.html They address Open Vs Closed Systems, Health and Hygiene Issues, and Legal and Liability Issues, as well as what if a used pump breaks. I highly encourage you to read this article if you are considering buying a used pump, or if someone gave one to you as a gift. How long can I store breastmilk? According to LLLI: This information is based on current research and applies to mothers who:
All milk should be dated before storing. Storing milk in 2-4 ounce amounts may reduce waste. Refrigerated milk has more anti-infective properties than frozen milk. Cool fresh milk in the refrigerator before adding it to previously frozen milk. Preferably, human milk should be refrigerated or chilled right after it is expressed. Acceptable guidelines for storing human milk are as follows. Store milk:
A really great suggestion was to freeze the milk in ice cube trays, which ammount to approx 1 oz per ice cube, then you could put the ice cubes in a food safe freezer container. This can help keep you from having to thaw a full 4 oz when your baby only drinks 2 of them, and you end up having to toss the rest (with many tears included, because it always hurts to see what we have worked so hard for tossed down the drain). Can I continue to breastfeed when I go back to work? Well, some of that depends on where you work. There are new laws in place to protect breastfeeding mothers at the workplace, but only companies with over 50 employees that have to ahdere to Labor Laws are required to comply. Basically, they are required by law to give you as many breaks as you need in order to pump (though they are not required to pay you for those breaks), and they are required to provide you with a clean, private place to pump that is NOT a bathroom. To get all the information on that to share with your employer, please go here: http://www.dol.gov/whd/regs/compliance/whdfs73.htm#.UO9ZDOSx9ic There are instances, of course, when the employer is required by law to do something that they don't want to do, or may dock you or not schedule you or give you a hard time. This is illegal. But what new mother wants to deal with getting fired or not scheduled and launching a complaint and dealing with all of that with a new baby? Not many. So use your advocates, such as WIC to fight for you if you need. There are resources to help you, use them. Another common issue is a willing employer, but a job that doesn't necessarily allow a lot of breaks, such as working in a restaurant. In these cases, we recommend taking shorter, more frequent type of breaks. Instead of taking a 20 minute break every 2-3 hours, take a 5 minute one at least once an hour. If nothing else, use a bathroom to do hand expression or use a hand pump for 5 minutes. Even this will stimulate milk flow and production even if you don't sit with an electric pump for 10 minutes. It will help and be better than nothing. As always, it helps to discuss your BF plans with your employer before you go on maternity leave, or before you go back to work so they have time to accomodate you. Springing it on them the day you get back does not really make them want to bend over backwards to help you. As far as how often you should pump, that sort of depends on how often the baby nurses. Nancy Mohrbacher wrote a great article on this, what she calls "The Magic Number". Basically, how many times a baby feeds in a 24 hour period will determine how many of those feedings you are going to miss, and therefore need to pump out. If the baby nurses 12 times in 24 hours, and you are going to miss 6 of them, then you would need to pump 6 times while you are away from baby. This will keep your production going at the same rate, so you don't start to make less because you are away from the baby. To read her whole article on it, go here: http://www.nancymohrbacher.com/blog/2010/8/13/the-magic-number-and-long-term-milk-production-part-1.html Here is one from LLLI on pumping frequency at work as well: https://www.llli.org/faq/pumpfreq.html And here is a great one about facts every working mother needs to know: http://www.nancymohrbacher.com/blog/2010/8/10/facts-every-employed-breastfeeding-mother-needs-to-know.html And a compilation of Working and Breastfeeding questions and articles: https://www.llli.org/nb/nbworking.html My baby seems hungry all the time, and when I pump, I only get out an ounce! Am I starving my baby? First, take a deep breath. Then let it out. Do it again a couple more times. This tackles a couple of different issues. The first one: Baby hungry "all the time". First of all, what is "all the time" to you? We all have different perceptions, especially when we are used to our bodies belonging only to ourselves, AND we are in a sleep deprived exhausted state. ANYTHING seems like "all the time" when you're exhausted and just want to sleep. And we are pretty much functioning with only the right side of our brain, BTW, which does not guage time well, or do anything logical, really. There is a biological reason for that, so just know that "mommy brain" is normal and serves a survival purpose. Get used to looking for your car keys in the refrigerator for the next year or so (or 5). It is normal for breastfed babies to want to nurse every 2 hours, or more often than that. It's not all about the food, either. Do YOU only eat when you are hungry? Or when you're bored, or upset, or need comfort, or just because it's sitting in front of you? What if it was the only thing on this earth you knew was safe and could make you feel better, even if you didn't know what was wrong? Yeah, you'd eat "all the time", too. If you are bottle feeding and nursing, and feel like your baby "still seems hungry" after taking a bottle or is at the breast, it's not necessarily that it is hunger driving them. When babies get a bottle, it seems as though they take more. Usually, this is true. But for different reasons than hunger. One reason is because the flow of a bottle is faster than a breast, and they do not have to work very hard to get it out. In fact, if they are laying down while taking a bottle, then they are being flooded and it's swallow or drown time, so of course they are going to gulp it down. Then they may also get lazy at the breast because they get used to this new 'fast flow', but that is a whole different topic that we can discuss at a different time. The other thing that happens with bottles is that is bypasses an important signal in the brain (sugar does this as well), that alerts them that they are "full", so they don't necessarily feel "full". If you have ever eaten a lot of sugar, you can probably relate to that feeling. ;) To get mroe information on the difference in how much a baby takes breast vs bottle, see this article here: http://www.nancymohrbacher.com/blog/2010/7/12/breast-versus-bottle-how-much-milk-should-baby-take.html And a great article explaining the whole: "It's Not Really About The Milk", check this out: http://www.normalfed.com/Why/notreally.html I loved what Jack Newman said once, which was that Breastfeeding was really 90% about brain development and only about 10% about the milk, and we all know how awesome the milk is. So much more happens at the breast than simply feeding that allows the brain (and we now know oral and facial) development, that it's really wonderful for babies to feed at the breasts as often as possible. Basically, if your baby has the energy to nurse all the time, is gaining weight, and peeing and pooping for just about every time they feed, you guys are good. And they are doing wonderful things for your milk production, so hang in there and know that their nursing behavior and patterns will change. Some sooner than others. However, IF your baby is NOT gaining weight, is constantly sleeping, isn't having many dirty diapers, seems otherwise lethargic when awake (not alert), and/or you have nipple trauma (cracked or bleeding nipples), then see an IBCLC right away. Do not pass go, do not collect $200, simply make an appointment and get help. Now. For more info on how to tell if your baby is getting enough milk, check out this article by Jack Newman: http://www.breastfeedinginc.ca/content.php?pagename=doc-IMB OK, now to tackle the pumping 1 ounce issue. Or not pumping as much as your friend, or getting as much as you think you should. READ THIS ARTICLE about how much you should really be EXPECTING to get, and why it varies from woman to woman: http://www.nancymohrbacher.com/blog/2012/11/27/how-much-milk-should-you-expect-to-pump.html It covers all the things that can expect milk supply:
How can I increase the amount that I am pumping? (and variations on the same question) First, are you doing Hands On Pumping? The absolute BEST video to watch on how to get the MOST out of your pumping session as well as HOW to do hand expression can be found here: http://newborns.stanford.edu/Breastfeeding/MaxProduction.html Women who practice HOP can get an average of 50% more when pumping and using this technique. Here are some other pumping tips: "Forget all the rules—Let comfort guide you.You do NOT need to pump on a set schedule (Forget “every 2 or 3 hours” or whatever).And you do not need to pump a set number of minutes, either! 1. Relax and enjoy! This is a break from all your housework and baby chores. Relax and enjoy it.Milk flow is hugely psychological. Love, laughter and pure pleasure in your baby are what make the milk flow best. Don’t watch the pump. (No love, laughter or pleasure there!) Don’t watch the clock. Take off your watch! 2. Interruptions help! No need to feel chained to the pump, or chained to the sofa! Anytime you want, set the pump aside, and go off and do something else.It’s time to take a break… As soon as you start wondering what time it is, or how much milk you have; Or you remember something you need to do; Or someone asks you to find something; Or your baby is squirming: Just put the pump aside, and go take care of whatever’s on your mind. Don’t put the milk in the fridge, or wash out the pump… Leave the milk right where it iso You might be gone 5 minutes or a half hour. The break SPEEDS your milk. Then come back, and pump right into the milk that’s been waiting there. 3. Hands on the breasts, before, during, and after pumping The pump only vacuums the milk out, so it can’t do a great job by itself. Your hands are crucial! BEFORE: No skill involved—just use your hands to push and mush on the breasts for a bit, a few seconds each, just to warm them up a bit, and get the milk moving. DURING: While pumping, use your hands to press and massage on any lumps or full areas. As the breast gets softer, continue massaging toward the pump. Hint: Sacrifice an old bra that’s too small—cut holes for the pump flanges (shields), to pump hands-free. AFTER: If your aim is increasing milk production:Your hands can press the milk out that the pump can’t vacuum. Getting a bit more milk out is especially important to increasing milk production. If you have plugged ducts:If you have plugged ducts, or a tendency to get them, use your hands to look for any lumps of milk the pump didn’t get. Which pump?Not everyone needs a pump. The hands often work better than a pump, once you get the hang of it.There is no one best pump that’s right for everyone. The best pump for you is the one you like-- milk flows best when you are comfortable. Many women prefer a manual pump over an electric pump. Good manual pumps are the Avent ISIS or Medela Harmony. For round-the-clock pumping, many women prefer an electric double pump (Ameda (Purely Yours), Bailey,or Medela (PumpNStyle or PumpNGo); Others prefer one of the manual pumps. If pumping hurts… Use electric pumps on the lowest pressure that just pulls comfortably on the breast. Hand pumps are always comfortable unless you pull the handle too far. You do NOT have to pull it all the way, only to the point of gentle pressure. Be sure you have a flange (shield) that fits comfortably. Ameda and Medela offer several sizes. If your baby isn’t nursing; If you are not nursing, and if you want to minimize or eliminate formula use, You can keep up with your baby’s needs if you pump about as often as the baby feeds, and in the same rhythm as your baby feeds. Easiest is after feeding, after your baby is asleep, so you aren’t pumping under pressure. At first, you will probably start out by pumping about 6 - 7 short (interrupted) times in the daytime, and once at night. You may be able to drop this to more like 5 or 6 times in the daytime, and once at night. At first, keep intervals between pumping no longer than about 3-4 hrs in the daytime with no longer than one 5 hour stretch at night. If you’re increasing your milk production: It’s helpful to pump after most of your baby’s feeds, whether the baby feeds at breast or bottle, at least 5-6 times a day, followed by hand expression. If you’re pumping for work: Pump both sides each morning, before or after the baby feeds. This helps maintain your milk production. Everyone has more milk in the morning, so it’s an easy time to pump. You don’t have to pump everything the baby needs while you’re at work. Pump during your work day often enough too keep your breasts comfortableo get enough milk for the next day. You do NOT have to pump on a set schedule at work. You can be quite regular, every 3 or 4 hours, if your work schedule allows/demands. But if your work routine is erratic, that’s OK—You might pump twice an hour apart when you have a chance, knowing that you might not get another chance for five hours! If your schedule is very unpredictable, and you get over-full, you may occasionally need to take a one minute break to hand express just enough off to prevent leaking or plugged ducts, until you have a chance to pump for real." -Brought to you by: .Christina M. Smillie, MD, IBCLCBreastfeeding Resources, 2505 Main Street, Stratford, CT 06615© 2010 Christina M. Smillie, MD. All rights reserved. OK, other suggestions. You may hear about galactogogues. These are things you can take to increase your milk supply, but they all only effect ONE of the hormones in milk production. The other is stimulated by emptying the breast, so the more you use, the more you will make. Jack Newman has a great article on Herbal Remedies for Milk Supply: http://www.breastfeedinginc.ca/content.php?pagename=doc-HRMS There are also a number of members of our own group who either make Lactation Cookies, or have helpful tincures or suggestions for herbal galctogogues as well. I will include them in the next section of "Members Advice and Suggestions". There are also non-herbal galactogogues, though the one that is used most widely around the globe has not been approved by OUR FDA, for some crazy reason. Jack Newman also actually addresses this if you want to read more about it: http://www.breastfeedinginc.ca/content.php?pagename=doc-OFDA. If you have more questions about galactogogues, you can find information on them on www.kellymom.com, www.llli.org, www.breastfeedinginc.ca, or please speak to an IBCLC, or maybe your doctor, though I can't promise they will know what you are talking about. :P Additional Pumping Information Links: http://www.llli.org/nb/nbpumping.html http://kellymom.com/?s=pumping http://www.normalfed.com/Starting/work.html http://www.normalfed.com/Starting/pumps.html http://www.normalfed.com/Starting/pumpinghints.pdf If you did not find your question or answer on this page, check out the File: Pumping Q&A by Members. There we have compiled any and all pumping questions and answers by the moms on this page. We spent time doing that so that mothers didn't need to spend their premium time repeating the same answers for the same questions that seem to always come up at different stages. If you STILL have questions after reading this file and that file, then please post, as we all love new situations to talk about. Or if you simply need support, because that is why we are all here! Happy Pumping!
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