If you are reading this, it probably means you are embarking on or considering exclusive pumping (EP). There many reasons women find themselves facing the prospect of EPing- latch issues, medical conditions of mother or baby, and personal preference are often cited by women as the reason they chose to EP. Although there are challenges to long term EPing, it is possible for women to pump for extended periods of time. This is a quick guide to help moms as they prepare for a long term EPing situation. As you start your pumping journey, we wish you and your “pumpling” the best of luck. It is a labor of love and we are here to cheer you on!
Pump Selection: It is important to arm yourself with the right equipment. Remember, most pumps are not designed with an EPer in mind. Even working moms who do multiple pumps a day on their high quality pumps are working with equipment that is not intended for constant use, especially for months on end. That said, the higher quality pumps have proven to work for EPers. Medela, Spectra, Hygeia, and Ameda all sell pumps that can work just fine for EPing. You may find that after 9 months to a year (or even longer) of using a pump so frequently, your engine shows sign of burning out. It may be necessary to replace your pump after so much wear on the engine, but many women find that their pumps can handle between 12 to 18 months of EPing use before they wear out.
While those higher quality pumps are solid options, many EPers find that hospital grade rental pumps are exceptionally good for the purposes of moms who only pump. By hospital grade, we mean true hospital grade pumps that are found in hospital NICUs, lactation departments, and labor and delivery departments. Medela and Ameda hospital grade pumps are the most common. These pumps have heavy duty engines and are designed for extensive and frequent use. You can usually rent one of these from your local hospital or Babies R Us; prices run around $50-75 a month and many women believe it is well worth the expense. Women who use these describe them as more effective at milk removal but also more gentle on their nipples. These are rather large and bulky pumps, so they are not necessarily a good choice for women who travel a lot or who plan to move their pump around regularly. Some EPers may choose to keep a rental at home and use a manual or double electric pump for work and travel. One option you may consider is renting one of these for those first few critical months, when you will be working to establish and maintain your supply.
Pump Maintenance: It is important for any woman pumping to keep her equipment well maintained, but this is absolutely crucial for EPers. You are relying on your machine and your pump parts to mimic the effective milk extraction of a good latch- this means you have to pay close attention to pump maintenance. This can include changing out membranes, keeping your tubing clear of moisture, protecting your pump while traveling with it, replacing the pieces that connect the tubing to the actual machine, and replacing or clipping tubing. Medela and Hygiea are known for good customer service; we recommend at the first sign of reduced suction that you contact customer support to trouble shoot. You should also plan to keep a manual pump or even a back-up electric pump in case of emergency.
Pump Schedule: If you are the mother of a newborn, it is important that you start a good pump schedule within about 24 hours of delivering baby. Remember, your pump schedule is mimicking the nursing schedule of a newborn, which includes cluster feeding and nursing extremely frequently. We advise that EPers pump every 2-2.5 hours around the clock for the first 8-10 weeks. After that point, you may find you can go a longer stretch between pumps at night. It is really important that you stick to that schedule as closely as possible- these are the months you are establishing your supply, so every pump sends a message to your body that it needs to produce more milk. Conversely, every pump you skip sends a message to your body that it does not need to produce milk. After about 3 months, you should expect to be able to go longer between pumps. Take it slowly- go from pumping every 2-2.5 to every 3-3.5 hours and settle on that new schedule for several weeks. If your production is still where you want it to be, move to a longer stretch of 3.5-4 between pumps. If your supply decreases, don’t panic! Just go back to pumping more frequently again and after a couple more months, try to lengthen your stretches again. Eventually, you may be able to do only 3 or 4 pumps a day, which feels great compared to those early days of 9 or 10 pumps a day!
Pump times can vary. Some EPers can finish a session in 15 minutes, others take 30. Don’t go crazy with long pumps- that can damage your nipples and is generally unpleasant, so stick to a 15-25 minute session. Many EPers choose to pump through a second let down and then stop. Figure out what works for you.
Supply Issues: EP moms deal with under supply and over supply issues, just like our nursing counterparts. Here are some tips on how to deal with these challenges:
Under supply: It is important to remember that pumping is simply not as effective as nursing, so don’t be discouraged if you find your supply lagging. Keep in mind that breastfed babies do not require as much as formula fed babies, so be clear on how much you should pump to meet your baby’s needs (DQ had good information about the volumes of milk babies need). Many EPers worry about filling their freezer; that may not be a realistic goal. Instead, work towards meeting your baby’s daily needs and don’t get caught up in feeding your freezer.
If you are not pumping as much as you need or want, make sure that your equipment has been regularly maintained. Some EPers find they forget to change out membranes and only realize it when they see diminished output. Equipment maintenance is an easy fix. Once you are sure your equipment is in tip top shape, scrutinize your pump schedule. Have you gotten to lax about your pumps? Are you pumping less frequently or for less time? Do you need to change your pump settings? Adding back an extra pump or two is probably the most effective way to work on building output. Some women are also more efficient pumpers if they do hand compressions or finish their pump sessions with a few minutes with a manual pump. Experiment and see if adding pumps back in and determine if a different setting on your pump or the use of hand compressions or a manual pump will help. Cluster feeding is one way that babies help stimulate milk production; since our pumplings can’t help us with that process, power pumping is a great way to mimic cluster feeding and may be a good way for under suppliers to increase output. Power pumping follows a cluster feeding schedule; alternate 10 minute pump sessions with 10 minute rest sessions and maintain that schedule for an hour. Finally, make sure your flanges fit properly. An LC or IBCLC will be able to help you determine the right size. This can make a huge difference in output.
Over supply: Some moms find they are over producers. As exciting as it is to build a stash and feel secure with your supply, over supply can cause a lot of problems for mom and pumpling, so don’t set this as a goal. If you find you are overproducing after the first few months, you should work at reducing that oversupply. Stretch out times between pumps- don’t do this too drastically as that can result in clogged ducts or even mastitis, but start adding time between each pump so that your body gets the message that it does not need to produce so much milk. If you find yourself engorged and uncomfortable, hand express to relieve pressure. Don’t pump for overly long sessions; cut yourself off around 15 minutes and hand express if you need to relieve more pressure. If you continue to over produce, work with an IBCLC to troubleshoot so you can get into a better schedule that helps normalize your supply.
Bottle-feeding: As previously mentioned, the volume of breastmilk needed for breastfed babies does not compare to that of formula fed babies. Many breastfed babies max out at 3-4 oz bottles per feed. Just like nursing babies, pumplings will take smaller amounts of milk over more frequent feeds. Pace feeding might be an important component of your bottle feeds, so become familiar with that method of feeding and consider using preemie flow or level 1 flow nipples. Many women who attempt to EP panic because they think they will need to produce enough milk for 7 or 8 oz bottles; that is not the case. Our milk changes in composition to meet the needs of our babies as they grow, so you will not need to be pumping 40+ oz a day to feed your baby.
Supplementation: There may come a time when you are not producing enough for your baby’s daily needs. If this happens, take a deep breath and stay calm! You are doing a great job pumping for your baby, and it is okay to supplement if necessary. Some women go through “pump slumps,” especially around 6 to 9 months post- partum, some women can’t keep up when their pumpling goes through a growth spurt, and women who are menstruating find short term dips in their supply. If you are struggling to keep up and need to use donor milk or formula, we advise that you pump during that missed feed so as to not lessen your supply further. If your baby will tolerate it, you can just replace a breastmilk bottle with formula. If you mix breastmilk with formula, you may find yourself throwing out any leftover since you can’t keep the mixed formula for too long, so only mix if your baby won’t take the formula by itself. If you do mix breastmilk with formula, you need to mix the formula with water according to directions and then add to the breastmilk. It is important to remember that until the age of one, babies need either breastmilk or formula, so don’t replace a feed with a milk alternative until your pumpling is over the age of one.
Introduction of Solids: Just like nursed babies and formula fed babies, your pumpling should not be introduced to solids until she or he is six months old. Once you do start introducing solids, remember that breastmilk or formula is still their main source of nutrition, so plan accordingly. Do not swap a bottle for a meal- these two things are not created equal. Infants who are between 6 and 12 months old will not take in enough calories, protein, and fat through solids to replace a bottle of breastmilk.
Weaning: Some women may find weaning is chosen for them; “pump slumps” can be hard to push through for some EPers. Other women may find they get to set their weaning schedule. Weaning is best done over a period of time, rather than rapidly. Plan to lengthen time between pumps so you are gradually dropping pumps. Once you are down to 1 or 2 pumps a day, you will find it easier to finally wean completely off the pump and should be able to avoid clogged ducts. You can start doing hand compressions to relieve pressure to speed up the process, and all the tips that work for nursing moms for weaning may be helpful to you (cabbage leaves, etc).
Tips: EPing is not a convenient choice for most moms. Here is a list of ways to ease the inconveniences and make it a manageable option for you and your family:
Family support: talk with your partner, family, and friends. Let them know your goals and ask for help. Many EPers have their partners do night time feeds so that mom is not up doing both pumps and feeds. Partners can support EPers by taking responsibility for the daily bottle and pump part washing. Be clear about the time you need to set aside for pumping so everyone understands the schedule you are following.
Pumping station: Many EPers set up a pump station for comfort and convenience. Choose a comfortable chair. Have a side table nearby for bottles, your phone, magazines, water, etc. You will be spending a lot of time there so make it a nice place to be!
Kiddie Corner: If your pumpling will be near you when you are pumping, try to set up a bouncy chair or swing and keep some little toys handy for entertainment. If you have older kids who will also be around when you are pumping, consider putting together a basket of items to help them stay entertained while you pump. Stickers, books, play doh, blocks, and puzzles will keep an older child distracted and are all things you can manage even while hooked up to a pump.
Hands-free Bras: Many EPers will list this is a must-have. In the first three months of EPing for a newborn, you will spend up to 5-7 hours a day tied to a pump. Let your hands be free during that time! It will make for an easier pump, you can multi task, and you can interact with your pumpling and/or older kids much more efficiently if your hands are free.
Pump Parts: If you can, buy multiple sets of your pump parts (flanges, connectors, tubing, etc) so that you have several sets to work with and don’t get bogged down in washing numerous times a day.
Refrigerator Trick: You can store your pump pieces in the fridge between uses. This is another way to cut down on washings.
Self-Kindness: Be proud of yourself for accepting the challenges that come with EPing. Don’t be upset if you need to supplement. Don’t agonize over a missed pump. Set short term goals to get you to your long term objective, and be flexible with those goals. In short, be kind to yourself during your EP journey.
