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When a mother meets all her baby’s nutritive needs via pumped milk it is known as exclusively pumping breast milk. Exclusive pumping may happen when a mother makes a choice to express her milk for her baby instead of breastfeeding or it may be a temporary situation if a baby can’t breastfeed straight away. Although there are lots of ways to help a baby back to the breast when they are ready,
sometimes, even with good help, a mother may find herself pumping her breast milk temporarily or long-term. This article answers frequently asked questions about exclusively pumping breast milk whether as a choice or because breastfeeding has not worked out. This is a companion article to How to Increase Milk Supply When
Pumping. Exclusively pumping: What controls breast milk production?Milk making tissue develops in the breasts during pregnancy. Colostrum (the first breast milk) is quite thick and sticky and low in volume and is present before baby is born. It is the delivery of the placenta, and the sudden drop in the hormone progesterone, that signals the body to start making a higher volume of breast milk. Effective milk removalThe production of colostrum and the triggering of full milk production happen automatically whether or not you put your baby to the breast or plan to breastfeed. Sometimes you may hear this referred to as driven by hormones (an endocrine process). Mothers usually feel their milk “come in” around the second or third day after birth. After this time, milk production is often said to be under local control in the breast (autocrine control), the hormones prolactin and oxytocin must still be present for milk production, but the main influence on milk volume is how quickly the breasts are emptied. If milk is not removed from the breasts, milk production shuts down. What does this mean for exclusively pumping mothers?Mothers will need to express their breast milk as often as a breastfed baby would normally feed. Pumping regularly throughout the day and at least once at night helps to maximise breast milk production and ensure a good breast milk supply. What is the best type of breast pump for exclusively pumping?Breast pumps vary a great deal in their efficiency, portability and cost and tend to fall into four groups:
For exclusively pumping, a double electric breast pump or ideally a hospital grade pump are usually the most effective breast pumps. Look for a pump with multiple settings for speed and suction, different sized flanges (the part of the pump that is held next to the breast) and good reviews online. Authors Lisa Marasco and Diana West highlight a selection of popular pumps and their individual features at lowmilksupply.org. For more tips including why a second hand pump is not usually a good idea, why flange fit is important and how to clean pump parts see How to Increase Milk Supply When Pumping. Some electric pumps come with different sized flanges and soft inserts Some pumps can be converted from a single to a double pumpWhen should I start pumping?It is important to start expressing colostrum as soon as possible after the birth if your baby can’t latch or you have chosen to pump. Research suggests within an hour is beneficial45 and certainly within six hours. Studies indicate hand expressing combined with pumping yields best results in the early days after birth6. How often should I express my milk?Eight to ten times per dayTry to pump at least eight to ten times in 24 hours in the first few weeks7. Frequent and thorough milk removal in these early days and weeks helps ensure a full milk supply later8. Frequent feeds also mimic a baby’s breastfeeding pattern—a baby can digest breast milk in an hour, has a small tummy and feeds very frequently. Pumping and/or hand expressing for 10-15 minutes every two to three hours around the clock is a good guide for the first few days after birth9 and then continuing on a similar schedule but pumping long enough to thoroughly empty the breasts after milk comes in (see below). Avoid any long stretches of five or six hours between expressing sessions (apart from one longer stretch at night if everyone is sleeping) and try to pump at least once during the night (Mohrbacher 2020). Storage capacity will affect pumping frequencyThe amount of breast milk a breast can store between feeds is known as the storage capacity and depends on the amount of glandular tissue (milk making tissue) in any particular breast. Breasts with a smaller storage capacity can make just as much milk in 24 hours as those with a larger capacity but will need to be emptied more frequently. Therefore a mother with a small storage capacity will need to pump more often. A mother can gauge her pumping frequency by her overall volume pumped. If she needs more breast milk she can try pumping more often, for less breast milk she can reduce her pumping frequency. Pumping patterns may changeStorage capacity may continue to increase in the first few months10 which may help explain why pumping patterns can change over time. Once a mother’s milk supply is well established she can often go longer between pumping sessions without affecting her overall milk volume. After milk supply is at full production, Nancy Mohrbacher, breastfeeding author and IBCLC lactation consultant, refers to the perfect number of pumping sessions for an individual mother as the “magic number”:
Do I need to pump at night?If you are exclusively pumping it is important to express breast milk at night in the first few months after your baby is born to stimulate a full milk supply. Prolactin is an important hormone involved in milk production and it has naturally high levels at night11 making this an ideal time to fit in a pumping session. Leaving breasts full all night is likely to slow down milk production. How much milk do I need to pump if I am exclusively pumping?After the first week or two, a baby’s average requirement for breast milk is around 750-1035 ml or 27-35 oz12 or an average 800 ml/day 13 and this volume remains fairly constant from months one to six. Aiming to pump a volume that just exceeds this average will provide a cushion for growth spurts. Mothers of twins will need to aim for double this volume. How long should I pump at one time?Pumping time will vary depending on the type of pump used, whether you’re pumping exclusively to build a milk supply or pumping occasionally alongside breastfeeding. A mother with a small breast storage capacity will need to pump for a shorter time more frequently compared to a mother who stores more milk at one time making the process very individual to each mother. Twenty minute starting pointNancy Mohrbacher suggests pumping for twenty minutes for a few sessions while observing milk flow and then adjusting the time pumped as required: simply pumping for a longer or shorter time as needed to remove all the milk (Mohrbacher, 2020. p 490). The goal is to establish a full milk supply (750-1035 ml per day) by 10-14 days after the birth. Once the goal is met, pumping length may return to 10-15 minutes for some mothers14. Watch milk flow rather than the clockIn their study, Morton et al found a double pumping session including all the steps in the next section averaged 25 minutes. However the authors point out that specifying an ideal time to pump may not be helpful as some mothers were pumping for 15 minutes and others for 45 minutes15. The Womanly Art of Breastfeeding suggests:
Total pumping?One resource states that a total of 120 minutes of pumping per day is a good rule of thumb16 while Morton et al refer to a daily pumping time of around 150 minutes albeit with the caveat mentioned above (Morton, 2009). However because of individual variation between breasts it is not really possible to specify a time limit. The total number of separate pumping sessions is more important than pumping length per session and sessions don’t need to be equally spaced throughout a day (Mohrbacher. 2020. p 502) Shorter, more frequent pumping sessions are likely to be more productive overall than fewer, longer sessions. How can I increase my milk supply when exclusively pumping?This section should be read in conjunction with How to Increase Milk Supply When Pumping. Getting startedOxytocin is the hormone needed to cause your milk to “let-down” (milk ejection reflex) to your baby or a pump. When breastfeeding, the let-down is triggered by sucking when a specific nerve alongside the nipple is stimulated in a neurohormonal reflex. Hearing your baby cry, holding your baby skin-to-skin or looking at your baby can also trigger this reflex. Tips to initiate the let-down when pumping include:
During pumping
Keeping a record of volumes of milk pumped per session and per day can be a good motivator to encourage you and see How to Increase Milk Supply When Pumping. Holding both flanges in place with an arm or a double pumping bra leaves a hand or two free for massageTroubleshootingNot enough milkIf after following all the steps and tips above your milk supply is still lower than your baby’s needs:
Too much breast milkSome engorgement when a mother’s milk first comes in around three days after the birth is quite normal and doesn’t necessarily indicate oversupply (too much breast milk). This engorgement is partly due to blood and tissue fluids in the area as well as breast milk. For more information on how to handle this early engorgement see Engorged Breasts. After the first couple of weeks, breast milk production will normally settle down to a volume that exactly balances the amount of milk removed from the breasts. Sometimes however, a mother might feel constantly full of milk, leak between pumping sessions and seem to pump over and above her baby’s needs until she has a freezer full of frozen milk. Some mothers will need to take steps to reduce their supply a little. The different strategies for reducing supply are described in Oversupply of Breast Milk and the principles can be applied to the exclusively pumping mother. Reducing a milk supply when pumpingA mother who is exclusively pumping can reduce the length of each pumping session to slowly regulate her supply, or begin to space the pumping sessions a little further apart. Some herbs and medications may also reduce a milk supply, see Too much milk: Sage and other herbs for decreasing milk supply by Kelly Bonyata for further reading. Whenever a breast is full, milk production will slow down so over time the strategy of having fuller breasts between sessions will down regulate the milk supply. However, go slowly, it is very important to always pump enough milk to remain comfortable to avoid blocked ducts or mastitis (breast inflammation). Sore nipplesPumping should be comfortable and not make a mother’s nipples sore. However a poorly fitted pump flange rubbing a nipple, a suction that is too high, not using lubrication or a poor quality breast pump could cause pain and friction during pumping leading to sore nipples. Whenever skin has been broken around the nipple or base of the nipple there is a higher chance of getting a fungal (thrush) or bacterial infection. For further reading see:
Rarely a mother could have a skin reaction to the plastic used in the pump flange 27 Blocked ducts and mastitisA mother who is pumping exclusively can run into a number of difficulties just as a breastfeeding mother can. Breast lumps due to engorgement or blocked ducts and mastitis are more likely when a pump is not draining all areas of the breast thoroughly. Breast massage and breast compressions during pumping can help with this and check whether your pump and nursing bras are a good fit for you. Massaging all areas of the breast while pumping helps milk volume and prevents blocked ductsHow long can I store breast milk?For much more information about storing breast milk see How Long Does Breast Milk Last? Premature baby?If you’re exclusively pumping for a premature baby see Breastfeeding a Premature Baby, and Kangaroo Care for Your Premature Baby for much more information. When can I drop pumping sessions?The number of pumping sessions needed to maintain the right volume of milk for a mother’s baby is individual to each mother and varies with breast storage capacity and a baby’s needs. In the early weeks frequent pumping throughout the day and not forgetting at least once at night are the key to a good long term supply. As time goes on however, after a full supply has been established, many exclusively pumping mothers find they can reduce the number of pumping sessions and still get the same volume of milk per day overall. In her book Exclusively Pumping Breast Milk author Stephanie Casemore offers the following tips:
How do I stop exclusively pumping?As with stoping breastfeeding this is best done slowly to give your breasts time to adjust and avoid getting blocked ducts or mastitis. Over a period of a few weeks to a month or so try gradually shortening each pumping session by a few minutes. Look out for any engorgement and express enough milk to stay comfortable if you do feel painfully engorged. SummaryExclusively pumping breast milk to feed a baby is a viable alternative to breastfeeding for some women. It is important to find both the right pump and the right pumping schedule for any individual mother to maximise her milk supply. Browse by CategoryNow Reading Exclusively Pumping Breast Milk 5 Feb, 2021 Does pumping exclusively reduce milk supply?Frequent pumping stimulates the production of breast milk. While your child is a newborn, try to pump every two to three hours. As your child grows, you can usually pump less often. However, if you're struggling with low milk supply, pumping more often can increase milk production.
How do you avoid oversupply when exclusively pumping?The bottom line is, the more you stimulate your nipples, with the baby's latch or a pump, the more milk you will produce. Skipping a pumping session, or putting extra time between feeding and/or pumping sessions can help prevent your body from creating an oversupply.
How do I deplete my milk supply?Medications to dry up breast milk. Anti-prolactin drugs. Drugs such as cabergoline and bromocriptine reduce prolactin levels , helping dry up breast milk supply. ... . Estrogen and birth control pills. Estrogen can help reduce breast milk supply. ... . Decongestants.. How long does it take to wean off exclusive pumping?In general, I would give yourself about a week for each session that you need to drop. If you've had issues with clogged ducts and mastitis during your pumping “career,” it might take you a little longer. I would give yourself a week and a half to two weeks per session.
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