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Breastfeeding is a learned skill, and it is a different experience for each mom and each baby. Sometimes, babies can't get to the breast as soon as we would like them to. This can be the result of difficulties with latching, if mom or baby are ill/separated or for a variety of other reasons. In that case, Lactation Consultants will suggest mom hand express her milk and will also suggest that mom uses a pump to stimulate a breastmilk supply.

 

 

Pumping is an option for moms if the infant cannot go to the breast. In the early days (first three), it is often easier to hand express the thick colostrum. However, it is recommended that mom start expressing as soon as possible: 8-14 times in 24 hours, within the first six of hours of birth (if able).

Here are the things you need to know in regards to pumping breastmilk. The pump does not actually pump out milk as it sounds. Instead, it is a combination of differences in pressure gradients between mom and pump, compression and vacuum application that reduces the resistance to milk outflow. Many suggestions can help you to get a better milk yield. Most women will not get a lot of volume in the first attempts. It is important to continue to send the signals to her body that she intends to breastfeed, or at least provide breastmilk for her child.  Most moms worry about how much milk they will get, and how long it will take to pump. Typically, we suggest mom attempt to pump at least every 2-3hr for 10-15 minutes per side, including at night. There are two main hormones which help with milk production and letdown. The hormone prolactin is highest at night so it is beneficial to pump at this time. A woman with smaller breasts will be able to express the same amount of milk over 24 hours as a larger breasted mom. She will, however, have less storage capacity so she may need to pump more frequently.  Moms will have more difficulty expressing milk if they are rushed, uncomfortable or stressed. Any of these factors can reduce the amount pumped by half the volume.

Here are some suggestions to aid with getting the most milk available.

Anything that mom can do to help elicit the milk-ejection reflex (M.E.R.) will help. This reflex is the release of the hormone oxytocin which in turn, releases the milk to flow with stimulation of the nipple. The oxytocin is released every 5-15 minutes in bursts of 3-4 seconds. We refer to this as the letdown, and when it occurs, baby will be noted to increase their suckling and swallowing. If mom can elicit the M.E.R. first, baby will get the benefits sooner. Using heat to relax mom, such as a warm compress, a hot shower, or warming the flange of the pump will help. Massage of the breast while she pumps will help milk to flow. If mom is able to latch the baby on one side while she pumps, or simultaneously pump, this too, will have a positive effect. If mom doesn’t have baby near, she can look at a picture of her infant, or hold a piece clothing or blanket (that holds the infant's scent) for aid in eliciting the letdown. Mom should put the pump to a suction that feels slightly uncomfortable, and then back it down slightly, to find her maximum comfort vacuum. She should try to pump at least 10 minutes as most of the milk yield occurs in the first few letdowns. Most moms feel they get the most milk in the early morning pumping sessions and that the volume pumped gradually decreases throughout the day. It is very important that mom start pumping in the absence of the baby suckling. Prolactin is needed for milk synthesis to occur and is maintained by suckling/stimulation.  This stimulus establishes prolactin receptors which are necessary for a good supply of milk. If you are temporarily engorged, you may have to increase the frequency of pumping because mom’s body will actually start shutting down milk production if she becomes overfull.

 

    It is hard to maintain a supply of milk and keep up the regular routine of pumping. It requires dedication and perseverance. Some moms do not feel it is worth the effort involved to continue. Others wean earlier due to feelings of inadequacy over the amount they are pumping. We like to prepare the mothers ahead that these feelings are common, especially for moms who are facing many weeks of pumping to sustain a supply for a premature or ill infant. Some mothers may choose to pump versus latching their infants, for a variety of reasons. There are medications which can be taken that can augment a milk supply. However, they are ineffective if mom is not doing the part of expression while taking the medications.              

Let’s explore the different types of pumps.

There are three main types of pumps. Hand pumps are the cheapest but can tiring to use, can be ineffective or painful. Battery operated may be more affordable, but one must consider the cost of batteries. Then we have semi-automatic and automatic pumps. Too much pressure can risk damaging the nipples. Mom needs to make sure the flange accommodates her unique nipple size. Your health care worker can help you determine the right pump for your needs. Double pumping can increase milk yields and keep up hormone levels that are needed for an ongoing supply. You do cut your time needed to pump in half, but you cannot massage while pumping. It is not recommended to share pumps or borrow others. The hygienic reasons are obvious, but even with your own kit, the cleanliness of the pump itself cannot be assured. Pumps have a limited lifespan so you may not be getting a pump that is working at its optimum and that can affect your supply. As with most items, the more invested will probably result in a more efficient pump. Pump parts can be washed in hot soapy water, well rinsed and inverted to dry. The pump can be wiped down with a germicidal solution. Breast milk can be stored at room temperature for 4-6 hours, in the fridge for approximately six days, in a fridge freezer, 2-3 months, and deep freeze for 6 months. Most public health resources will have up-to-date storage guidelines. Fresh breastmilk is ideal. Pumping can be tiring and difficult to maintain for an infant that is not going to the breast. However by pumping, you can continue to provide your infant the precious breastmilk even if a separation occurs. 

Jennifer Harris is a Registered Nurse/International Board Certified Lactation Consultant that has a private practice "The Boob Lady" in Kawartha Lakes. She can be contacted at jmorris0090@rogers.com

 



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