Once I realized that breastfeeding wasn't going to work for Jacob & I without considerable amount of energy, patience & money (mostly from repeated lactation consultant visits since the 2 visits already costing $225 total didn't really improve things), I chose to preserve the last ounce of sanity I had left & threw myself into learning all I could about exclusive pumping (EP) or EPing. I was happy to learn that I would still be able to provide Jacob with precious breastmilk without him being attached to my breast. I've already had a hospital-grade double breast pump rented (Medela Symphony for about $76/month) so I simply had to learn about the mechanics of EP (I highly recommend having a pump rented PRIOR to going into labor, about 2 weeks before your due date). With help of the internet & mostly by trial & error (including multiple episodes of painful plugged ducts), I became sort of an expert about 3 months later.
The Basics
Unless the baby is nursing, it's important to start pumping within 6 hours after birth. A hospital-grade double breast pump is the best choice for maintaining & increasing milk supply.
During the first 1-2 days (before milk comes in), hand expression is often the most effective way to express colostrum (feed colostrum to your baby using a spoon). Double pump for another 10-15" per session to provide additional breast stimulation 8-10 times a day.
Pump for 20" (at least 15") per session & 2-5" AFTER the last drops of milk once the milk comes in. Even if you don't have milk flowing while pumping, you need to pump that long to get enough nipple stimulation. A woman's breasts will release over 75% of stored milk in the first 2 let-downs. I found that 20" was plenty of time to empty both of my breasts if it's been 3 or fewer hours since my last pumping session, however, it would take good 30-40" if 4-6 hours have passed since I last pumped (However, I don't recommend going > 3 hours without pumping for the first 6 weeks after birth). With time & practice, you will eventually get the feel for your breasts' milk storage capacity & the length of pumping sessions required for complete breast emptying (e.g., a small-breasted woman may need to pump more often than a woman with larger breasts). Breasts should feel soft & non-tender by the time you are finished.
It's helpful to do breast massage prior to pumping, however, it's ESSENTIAL (along with compressions) during pumping to empty breasts as much as possible. The idea of the hands free pumping bra sounded great, but I quickly got rid of it since it didn't allow for any breast massage/compression.
Until supply is well established, it's important to get at least 8 pumping sessions per day (10 is better), which means you should be pumping every 2-3 hours. I wanted to sleep for longer stretches at night, so pumping only every 4-5 hours then worked for me. The longest I've gone without pumping was 8 hours (due to severe exhaustion & sleep deprivation), which I don't recommend to avoid plugged ducts & significant decrease in milk supply. Generally, it's not a good idea to go longer than 5-6 hours without pumping. The pumping sessions don't have to be evenly spaced as long as you get your 8-10 pumping sessions per day. For example, if I needed to run some errands from 1 to 6 pm, I would pump every 2 hours for a few hours before & after my leave to still get my 8 pumping sessions/day. After about 3 months (when your supply is well established), you can experiment with decreasing the number of daily pumping sessions from 8-10 to 4-7 without seeing a decrease in milk output (BUT make sure to pump at least once between midnight & 4 am - see the tip #3 in My Pumping Tips). For example, I now can pump only 6 times a day for 5-6 days in a row. However, I closely monitor my daily output & add more pumping sessions if I see any decrease in the amount of pumped milk.
More is not better when it comes to the suction settings on the breast pump. Higher suction will NOT result in more milk being removed from your breasts. Most women keep the pump suction on lower setting for more comfort & to prevent nipple injury. I use Medela Symphony pump & keep the suction dial at 6 (rarely 7) bars.
According to the research, exclusively breastfed babies take in an average of 25 oz/day between the ages of 1-6 months, & breastmilk intake is quite constant after the 1st month & does not appreciably increase with age or weight of the baby. Different babies take in different amounts with typical range of milk intakes being 19-30 oz/day. After 6 months, breastmilk intake will continue at the same level until it begins to decrease gradually.
Aim for pumping 25-27 oz/day by 7-10 days post-partum. 11-17 oz/day is considered borderline & less than 11 oz/day is considered low supply so galactogogues (prescription meds or herbs to increase milk supply) & other interventions should be considered. I've been able to increase my pumping output from 17-19 oz/day to 25-28 oz/day while taking the Oasis Prolactation Tea & Motherlove More Milk Plus capsules. Over time I came to prefer the capsules to the tea due to not having to boil water & brew the herbs multiple times a day. The Earth Mama Angel Baby's Milkmaid Tea is helpful as well, however, take care to avoid the concurrent use of the tea & capsules to prevent oversupply of milk & plugged ducts (take only one or the other).
To increase breastmilk output, add more pumping sessions so the breasts are emptied more often & more thoroughly. To decrease breastmilk output, allow more milk retention. It takes 1-4 days for the breasts to respond to different "demands." Unfortunately, compared to a suckling baby, even a hospital-grade pump is still not as efficient at milk removal. When Jacob was about 5 months old, I learned to hand express. When I started to hand express after each pumping session, I increased my daily milk output to 30-31.5 oz/day (!) & did not experience any more plugged ducts. The skill of hand expression was a lifesaver for me when the electric pump provided by my employer broke down one day & when my own rental pump's suction mechanism became too weak. Even if you are lucky enough to exchange the faulty pump on the same day, you will likely experience a few hours when pumping may not be possible.
Feeding:
Just like with breastfeeding, feed your baby on cue & not on a rigid schedule. The amount baby takes in may vary from day to day. It's very easy to overfeed a baby during bottlefeeding so it's wise to use slow flow or "newborn" type nipples. The breastmilk should never be warmed in the microwave since it alters the composition of breastmilk damaging milk's nutrient content. I warm my breastmilk by putting it in hot (not boiling) water for 5-10" (warm up 1 cup of water in microwave for 30-35 seconds on High first). You want to make sure to dissolve all of the milk fat adhered to the bottle walls during refrigeration, so swirl the milk gently several times after warming it up (shaking breastmilk is also not recommended). Breastmilk digests in about 90", so baby needs to be fed anywhere from 1.5 to 3 hours apart.
My Pumping Tips
1) It's important to pump in a quiet & relaxing place. I could never relax enough for a let-down to happen when screaming toddlers were trying to climb on my back or jump on the bed I was sitting on, so I chose to lock myself in the bedroom & asked my family members not to disturb me during pumping.
2) Pumping can get boring quickly & you may even find yourself procrastinating your pumping sessions. All of a sudden you realize that it's been 4 hours since you've last pumped even though you were going to do it at least an hour ago. For that reason, it's imperative to create some positive pumping associations. I used to surf the internet while pumping, but then turned to reading. I've always liked to read & it felt great to have a legitimate excuse to do it regularly. I actually found myself looking forward to pumping so that I could finish that one exciting chapter or paragraph. Some of the books I've read for the past 4 months include Jewels of the Romanovs: Family & Court (fascinating history & photographs of some of the most magnificent jewels of the last Russian royal family); Dr. Gundry's Diet Evolution (unconventional advice for weight loss by former heart surgeon & the founder of the Center for Restorative Medicine in Palm Springs), Babyproofing Your Marriage: How to Laugh More and Argue Less as Your Family Grows & The Hunger Games. Of course, I could only do this because my Mom has moved in with us when Jacob was 1 month old. If you have older chidren, you may need to find fun ways of occupying them during your pumping sessions.
3) If you don't have your baby waking you up at night (for example, you are lucky enough to have your Mom & partner to take care of him/her once or twice a week to give you that much needed rest), use an alarm clock to make sure to get at least one pumping session between midnight & 4 am. Prolactin levels (the hormone that tells your body to make milk) are highest in the early morning hours so it's important to pump at least once during this time to sustain adequate milk production. If you really want to increase your supply, pump at least twice between the hours of 10 pm & 4 am.
4) If you had your baby in the fall or winter, you may want to sleep fully dressed in order to avoid getting chilled when getting out of bed to pump during the night (I slept in my fleece pants, cotton shirt, fleece jacket & wool socks for the first few months after Jacob's birth). I've also had to reset my thermostat to keep the house warmer than usual during the night (67 instead of 65 degrees F). Freezing to the point of goosebumps causes nipple constriction & inefficient milk removal.
5) Although I've read that what you eat or drink has little effect on milk volume & composition, I still believe it's important to eat a nutritious diet. In pregnancy, the body will take what is needed for baby's proper development, often at your expense. Similarly, your body will also take all of the nutrients required to create "perfect" milk composition, even if you happen to be already calcium or iron deficient. I aim for calcium-rich foods as well as getting 80-100 grams of iron-rich protein foods/day. Forget about 8 daily glasses of water - just drink to thirst & make sure your urine is light yellow to clear. Even though I wrote a post about Foods Beneficial to Increasing Breastmilk Supply, the single most important factor in determining milk supply is regular removal of milk rather than the consumption of particular foods or supplements (remember supply & demand).
6) Relax & rest as much as possible. Making the time for even a 30-minute nap here & there can make a big difference in milk production. I seemed to get a plugged duct every time I got 4 or fewer hours of sleep per day.
7) It is super helpful to keep a spreadsheet journal where you record pumping day, time & amount. I love kellymom's Breastfeeding Log! It's perfect for tracking your daily milk "output" & facilitates learning (by trial & error) of the EP process. You learn firsthand about the timing, number & length of pumping sessions required to maintain your milk supply.
Gerritt & Sophia playing the game of "pumping" during bath (creatively using plastic egg halves)
8) Breast lubrication PRIOR to pumping makes the process more efficient by reducing friction, improving the seal around your breast & reducing nipple discomfort. I found baby safe Medela Tender Care Lanolin perfectly suited for this purpose. Some women use olive oil, however, I found it too greasy & difficult to wash off the plastic completely each time. After a year of EPing, I decided not to buy Lanolin cream anymore & changed to coconut oil with great results.
9) Make it as convenient for youself as possible. I put the pump, pumping parts, nipple cream & a towel on the small TV table next to my bed allowing me just-get-up-and-pump approach during the night. You are already exhausted & can barely drag yourself out of bed for that night time pumping session, so the last thing you want to do is to turn on bright lights. However, I couldn't just pump in the dark since I needed to make sure the horns were in the right position & the milk was flowing as expected, so I found the solution by throwing a dark shirt (you can use a dark towel or a table cloth) over the lamp on my bedside table. It wasn't too bright & provided perfect amount of light to see what I needed to see.
10) Unless you baby has a compromised immune system, is battling some type of infection or was born premature it's not critical to sterilize your pump plastic parts after each pumping session. Rinsing them in hot soapy water is sufficient enough. I would sterilize the parts by microwaving them in the Medela Quick Clean Micro-Steam Bag for 3" or boiling them for 10" only once a day (don't boil the tubing - I ruined one of my sets that way). Since I only got 3 20-minute breaks while working, I had to get creative. For the sake of saving time, I pumped for 20 minutes & then put the still-connected plastic breastshields, milk collection bottles & tubing into the fridge (inside a plastic bag to prevent contamination) until the next pumping session. Breastmilk stays fresh in the fridge for up to 8 days, so I didn't see the need to wash the pumping parts every time.
11) Although not required, it's helpful to wear a nursing bra for the whole pumping period to allow quick & easy access to your breasts.
12) It's not unusual to experience chronic shoulder & neck pain while EPing, so if your health insurance has chiropractic & massage benefits, make a full use of them.
Freezer supply
13) Now the most amazing finding of all... Pumped breastmilk should be drunk at the same time of day that it was expressed. Apparently, in addition to a multitude of other wonderful properties, breastmilk contains nucleotides that regulate babies' sleep. The composition of breastmilk changes quite markedly throughout the day, with sleep-inducing nucleotide concentration being the highest from 8 pm to 8 am. Once I learned this, I started to label the bottles of expressed milk with AM & PM stickers.
14) Take the time to nurture yourself & find the support you need. I believe EPing is harder than breastfeeding for various reasons, & you often don't get the acknowledgement your deserve from your family members, friends or even health care providers who may mistakenly believe that EPing will never work long-term. EPing is a big round-the-clock commitment some of us choose to make because we want the best for our babies. Since most of the support groups & classes are geared toward breastfeeding, you may have to find your own supportive community via connecting with other EPing Moms online.
Additional Resources
1) Establishing & maintaining milk supply when baby is not breastfeeding by Kelly Bonyata, BS, IBCLC from kellymom.com
2) How much expressed milk will my baby need? by kellymom.com
3) Long-term pumping when direct breastfeeding doesn't work out by Linda Smith, IBCLC
4) Breast pumping articles & tips from Got Breast Pump!
5) Weaning from the pump by kellymom.com
6) Exclusive Pumping: Chris's Story from the Motherwear's Breastfeeding Blog
7) Hand Expression of Breastmilk video from Stanford School of Medicine
8) Breastmilk Should Be Drunk At The Same Time Of Day That It Is Expressed from Science Daily (October 1, 2009)
9) To Pump More Milk, Use Hands-on Pumping by Nancy Mohrbacher from Breastfeeding Reporter
10) 40 Ways to Support Pumping Moms (At Home and At Work) by Code Name: Mama
11) My Exclusive Pumping Jorney (9 months & going strong) by Chasity via the Badass Breastfeeder
12) Ensuring Plentiful Breastmilk Supply Starts Before Baby is Born by Kelly Brogan, MD
Support Groups
1) Exclusively Pumping on iVillage
2) Yahoo's PumpMoms Group
& EPers Group
For Fun
1) The Best...Expressed! t-shirts
2) Growing on Mommy's Milk onesies from CafePress
