How to Introduce PumpingIntroducing pumping after exclusively breastfeeding

Ask the IBCLC: Katie McGhee, Resident IBCLC, weighs in on how to introduce pumping to your breastfeeding relationship.

The vast majority of lactating mothers in the U.S. leave expressed milk with a caregiver within the first several months of the baby’s life. The ideal timing for pumping initiation is a frequent and early postpartum concern.  It is only natural to want to be sure your precious baby is well fed at all times – when you are together and when you’ll be apart.

If breastfeeding is going well in the first several weeks, there is no automatic reason to begin pumping. In fact, if your plan was exclusive breastfeeding, adding in regular pumping on top of frequent breastfeeding can open the door to otherwise avoidable lactation complications.

Just as you were for 40 weeks, after delivery, you and your baby remain a unit.  Frequent and effective nursing early and often (very often) sets the stage for an adequate or even abundant milk supply to meet the needs of your baby and your individual lactation goals. The first two weeks are a very critical period in lactation. Changes take place at the cellular level to help you make milk both short term and long term. Adding in pumping during lactation establishment sends a signal to your breasts to produce more than your baby is needing or removing.

For this reason, adding pumping early may be very beneficial to mothers with lactation risk factors for low milk supply, since the added stimulation and emptying may boost milk production. However, for mothers and babies for whom breastfeeding is going well, early pumping may be lead to the unnecessary challenge of oversupply.

You may ask, “Isn’t that a good thing?”  We know that almost universally, new mothers worry about adequate milk supply. Milk left behind in the breast after feeding is a risk factor for plugged ducts, mastitis. It can be frustrating to new mothers and babies if the nursing infant is always met with a heavy or fast flow of milk.

Note: If you have concerns or have struggled with supply in the past, meeting early, one on one with an IBCLC may help.

How do I introduce pumping without interrupting early breastfeeding?

Here’s a real-life scenario:

Newly delivered mom Amy has a personal goal of exclusive breastfeeding her baby Sam until she goes back to work full time in three months. Amy plans to leave bottles of expressed breast milk with the babysitter and will resume breastfeeding when they are together in the evenings, overnight, and on weekends.

Amy delivered Sam on April 1st

Amy goes back to work full-time July 1st

Since Amy’s goal is to exclusively breastfeed for three months, it is important to establish breastfeeding first. Amy has no risk factors for low supply. She enjoys nursing on demand in April and May, and breastfeeding is going well.

Toward the end of May, when Sam is about six weeks old, Amy sets up a trial run. She cleans, sets up and tries her pump for two days in a row after a morning breastfeeding and has enough to leave with a sitter.

She starts with a single pumping session per day. Ideally in the morning, when milk is usually plentiful after milk making hormones have risen overnight. Right after a morning nursing session, when Sam is satisfied, Amy double pumps. Since the baby has just nursed, 10 or 15 minutes is probably long enough.

Amy enjoys nursing on demand in June but repeats this pumping process about once every two weeks until she’s back to work full time. This gives trial and error time with bottle feeding so that there are no unexpected crises her first days back to work.

Around mid-June, Amy pumps once every morning and stores that milk. It may not be much, but after two weeks she’ll most likely have enough of a backup that she won’t panic if stuck by a train or called into a late meeting.

As long as Amy’s supply stays adequate, she is using an effective and efficient pump, she is given time to empty her breasts thoroughly and at regular intervals while away from Sam, on July 1st, she’ll pump what Sam will need on July 2nd and so on.

When I leave my baby with a caregiver, should I leave my fresh milk, from fridge, or frozen?

Fresh is best. It has the most protective live cells for your baby. Try to leave at least some fresh milk when you can.

Amy’s leaving for work at 6. She wakes at 5 to either nurse or pump. That milk she leaves on the counter knowing Sam will be up between 7 and 8 and want to eat. In the fridge, some live cells die off due to the temperature change but more are retained than in freezing.

Amy stores her milk pumped at work in her work fridge and brings it home in a cooler bag with frozen ice packs. She leaves that milk in the refrigerator at home on Monday night for Sam to drink while she’s at work on Tuesday. She leaves what she pumped on Tuesday for Sam to take on Wednesday.

It is Saturday night, Sam is nursing this weekend. Amy has milk she pumped last Monday that has been in the fridge for five days. She knows Sam will not be using this milk in the next two days, so she decides to freeze and store it longer term. Check out these storage guidelines from Medela.

Keep in touch with your caregiver as you commute home. Is the baby going to be ready to feed and you’re 10 minutes away? Coordinate your arrival to be able to nurse if possible.

When you are reunited with your baby, do you plan to resume nursing?

Some nursing for partially pump dependent mothers will likely help hang onto your milk supply longer and more fully. Looking into your baby’s eyes, the baby’s skin on your skin, the warmth of your baby’s body and his or her ability to remove your milk: These are things no pump can duplicate. The hormones that support lactation are heavily tied to touch only nursing can provide. Remember, when you are lactating, whether together or apart, you and your baby are a unit. Any time you are separated from your newborn for more than 2-3 hours, plan to pump.

If you are experiencing difficulties at any time during lactation, your plan may need to be adjusted. If you are experiencing breastfeeding sessions that provide inadequate breast stimulation and milk removal due to:

  • low supply
  • prematurity or late preterm/early term
  • an anatomic challenge with you
  • an anatomic challenge with the baby

In these and other cases, your pump is an invaluable tool to establish or maintain your full milk supply until the breastfeeding baby is able to take over. These are instances in which a high quality and effective pump is instrumental to your ability to continue to provide milk. Ashland Health provides hospital-grade rental pumps, in addition to free insurance covered breast pumps. We are on standby to make sure you have the equipment you need to continue a successful breastfeeding relationship with your baby. Don’t hesitate to contact us with any questions surrounding your breastfeeding journey.