Health & Development
To Pump or Not to Pump?
“Have you bought a breast pump yet?”
It used to be that when friends, colleagues, or excited relatives asked an expectant mom what was on her list of needed new baby supplies, they were inquiring about diapers, blankets and booties.
Over the last several years, however, I’ve noticed something else making its way up the list of must-have baby equipment: a breast pump. In fact, in the past six months, I have attended the baby showers of three clients, and at each party the expectant mom was pumped for information about her pump preferences, followed by a wider-ranging discussion of pump makes and models, renting versus owning, the emotional impacts of pumping (“Sometimes I feel like a one-woman dairy farm,” one new mom confessed to her pregnant friend), and how to store pumped milk.
“Take it from me, you want to pump like crazy when your milk first comes in,” another seasoned mom advised a mom-to-be. “You are going to want to get out of the house and let someone else feed her now and then.”
Does Every Woman Need a Pump?
Such declarations beg a few questions: Does every woman who plans to nurse her baby and have a date night now and then need a pump?
The answer is an unequivocal “no,” lactation experts say.
That answer begs a second question: Why, then, do 75 percent of nursing mothers use a mechanical pump to express breastmilk even if they are not planning to return to work?
When to Consider a Pump
A breastfeeding mother should consider a pump “only if she anticipates regular separations from her baby, separations of more than three to four hours,” says Ginna Wall, RN, MN, IBCLC, head of the UW Medical Center’s lactation services. Wall is a widely known and highly respected instructor in the art and science of nursing.
Of course, there are circumstances when pumping is absolutely necessary in order to give a baby breast milk, such as babies with cleft palates, or premature babies struggling with the suck-swallow reflex, or other conditions that make it hard for baby to take milk from the breast.
“In such cases it is definitely preferable to pump and give mother’s own milk instead of formula in a bottle,” Wall says. “I consider mothers who can’t breastfeed but can provide breast milk by continuing to pump for many months to be heroic.”
That said, pumping willy-nilly or unnecessarily can cause real problems for mom’s milk supply, Wall stresses.
Potential Problems in Using a Pump
“In most cases the baby ‘talks’ to the breasts by nursing as much as needed, and tells the breasts how much milk to make,” Wall explains. “Pumping increases milk production if a mother is pumping in addition to nursing her baby. But if she is pumping and then skipping breast feedings, the pumping will decrease her milk production.”
Increasing the milk supply too much through pumping can lead to engorgement, blocked milk ducts, and increased risk of breast infection (mastitis) – or worse, land the mother in a situation where she is reliant on the pump just to be comfortable because baby cannot remove as much milk as mom is making.
Decreased milk production caused by pumping in lieu of putting the baby directly to breast can lead to an insufficient supply for a growing baby and the need to supplement breastmilk with formula. Local lactation consultants do not discount use of formula, especially when a mom’s supply is too low to meet baby’s nutritional needs.
“First and foremost, we gotta feed the baby, whatever it takes,” says Seattle Lactation Consultant Renee Beebe, M.Ed, IBCLC, owner of www.second9months.com.
Still, Beebe and a mountain of research support Wall’s assertion that whenever possible, feeding from mom’s breast directly is best for baby. The stress that a machine should be used cautiously so that is does not usurp the baby’s role in regulating how much milk mom makes.
Pumping for a Good Night’s Sleep?
Ironically, in a presentation to colleagues, Wall notes that one of the most common reasons for pumping is misinformation from well-meaning health care providers. Often it is a nurse or other provider who first suggests that the best way to get a solid four hours of sleep with a newborn is to pump breast milk in the day so a partner can feed it to the baby at night. In fact, research shows that exclusive breastfeeding – having mom put the baby to the breast all day and all night – leads to more sleep for the new mom, not less.
Why? According to researcher Cristina Sánchez at Spain’s University of Extremadura, the chemicals in human breast milk that cause infant sleepiness are most concentrated in milk expressed at night, so breast milk pumped and bottled during the day make for a more wakeful baby at night!
Making a habit of pumping by day so you can skip nursing at night can also lead to decreased supply over time. Parents often don’t understand that when a baby nurses at the breast less frequently, they have essentially begun the process of weaning. Spacing out the times between emptying of the breasts causes the overall milk production to gradually go down.
There is at least one other other good reason to keep baby on the breast rather than become reliant on a pump: According to research being conducted by the U.S. Centers for Disease Control, it may help reduce the chances of obesity in late infancy or childhood, an issue reaching epic proportions in the U.S. The association of bottle feeding breastmilk and obesity are not yet clear to scientists. But one hypothesis is that bottle-feeding leads to poor self-regulation on the basis of internal cues of hunger and satiety. Another is that the higher fat content that occurs during the end of breastfeeding session may act as a physiologic signal to stop eating.
Low Milk Supply or Going Back to Work – Good Reasons to Pump
For mothers with low milk supply (which can usually be determined by three things: is baby peeing regularly, is she pooping, is he gaining weight) pumping can be a godsend and may be the key that increases production enough to allow mom to nurse exclusively. Mothers of premature babies may experience low milk supply because their not-quite-ready-for-the-world babies struggle to suck.
“When babies are born early (even a little bit early) they may nurse and nurse and nurse but not empty the breasts,” says Wall. “This would result in the mother losing her milk supply. Even some full-term babies need time to develop the suction strength needed to empty the breasts, so if the baby isn't gaining weight at the first check-up after birth – especially if the baby's health care provider recommends supplementing (offering extra milk in addition to breastfeeding) – then the mother definitely should start pumping.”
And of course any mother who goes back to work or school in the first year should also consider expressing milk for her baby.
Got (Too Much) Milk?
For the mother who is a super breast milk producer, however, a pump can become a perpetrator of chronic engorgement, increased risk for plugged ducts and mastitis. In this case, moms who feel full and uncomfortable even after baby feeds well may be tempted to use a pump to empty the breast and relieve the discomfort.
Bad idea, lactation experts say. Better to just tolerate the feeling of fullness, letting your body get the signal that it’s making too much milk. Or, hand express just enough to “take the edge off” the discomfort. Why? Babies generally leave about 25 percent of the breasts milk capacity untouched after they are sated. When you pump on top of nursing at the breast and empty the breasts completely, you signal your glands to produce that much more – to refill the lost supply. In this case, pumping can lead to a vicious case of constant oversupply.
The key, say lactation experts, is to pump or hand express just enough milk to relieve discomfort but not to empty breasts.
“There is a certain whey protein in the milk that needs to be allowed to build up high enough to trigger the breast to cut back milk production. By removing just barely enough milk to be comfortable, but still allowing the breast to be full enough to trigger the ‘cut back milk production’ message, most mothers can decrease milk production without risking plugged ducts or a breast infection,” writes lactation consultant Diana West, BA, IBCLC.
Initiating That Feedback Inhibitor
Lactation Consultant Diana West, BA, IBCLC, of The Breastfeeding Mother's Guide to Making More Milk offers this advice on the Le Leche League International website (http://www.llli.org):
“If you are uncomfortable on the breast that is not being used before you are ready to nurse on it again, you can hand express or pump for only a few moments (20-30 seconds or less), just enough to relieve some discomfort,” West writes. “There is a certain whey protein in the milk, called Feedback Inhibitor of Lactation, that begins to build up and concentrate when milk is not removed for a while. This protein needs to be allowed to build up high enough to trigger the breast to cut back milk production. By removing just barely enough milk to be comfortable, but still allowing the breast to be full enough to trigger the ‘cut back milk production’ message, most mothers can decrease milk production without risking plugged ducts or a breast infection.”
A Culprit in Breast Infection?
Wall says she has not found any documented evidence that pumping, other than in women who are super producers, leads to breast infection. Mastitis as this is called can be a serious issue, leading to intense nursing pain, maternal fever and, in rare cases, breast duct abscess. But Wall says she’s seen the association too often not to believe pumps may play a role in infection for some women.
“I have a hunch that it could,” she says. “I think I see it in clinical practice and it makes sense” To lower the risk, moms should be fastidious about cleaning the pump parts that come in contact with the milk.
The Other Problem with Pumping by Day to Bottle Feed at Night
Wall says this is a scenario she see frequently: a mother pumps during the day, then skips breastfeedings in the evening or at night to get a little more rest or to let her partner have special bonding time with the baby through bottle-feeding.
But making a habit if pumping by day so you can skip nursing at night can lead to decreased supply over time. Not only does nursing at the breast at night get mom more sleep but it also promotes a full milk supply. Parents often don’t understand is that when a baby nurses at the breast less frequently, they have essentially begun the process of weaning. Spacing out the time between breast-emptyings causes the overall milk production to gradually go down. They may not notice it right away, but after a month or two, mothers are calling with concerns about a dwindling milk supply, and sometimes it’s difficult to get it back.
Most women do not need a pump to express milk, although if a mom is heading back to work and needs to pump a fair amount in a short period of time during breaks, having a good pump is best way to go.
“A good quality pump just makes it faster and easier to empty both breasts and get back to work,” says Wall, who recognizes that many mothers are under pumping time constraints in the workplace.
But for women who want to express a bottle occasionally – or even once a day – they simply need to look down to find the right tool.
“They have hands to get the milk out if needed,” says Wall, encouraging all moms to give hand expression a go. To learn how to hand express, she recommends moms watch a 10-minute video created at Stanford University and found online at: http://newborns.stanford.edu/Breastfeeding/HandExpression.html.
Perhaps one of the biggest contributors – although, again anecdotal – to the current breast pumping craze is parents’ learning that breastmilk can be stored for up to a year in the freezer. The key word here is can. Parents interested in pumping for this reason may want to consider holding off on the pump until close to the time mom returns to work.
Avoid Stockpile Syndrome
Saving up a lot of breastmilk in the freezer may end up being a waste to time and milk.
“Many women think they need to stockpile a freezer full of milk before going back to work,” says Wall. “Then are disappointed when they go to thaw the milk and discover that the milk has changed taste because lipase enzyme activity continues breaking down the milk fats in the freezer. And sometimes the baby refuses to drink it!”
You’ll know you have a lipase problem if your baby accepts freshly expressed breast milk just fine, but refuses to drink milk that has been stored for a long time.
“What a waste of time and energy,” she advises. “Just wait until two to three weeks before you have to go back to work and start stockpiling then. Save up enough for the first day (usually about 8 eight ounces), and then just keep up with tomorrow’s demand by pumping at work today.”
If You Must Pump, Breast Assured . . .
Perhaps one of the biggest myths lactation consultants hear around the use of a breast pump is this: Pumps cause breast stretch marks and sagging.
“This is a common fear,” says Wall. “It’s funny, but no! This has been studied. Breastfeeding/pumping doesn't cause breasts to sag. Pregnancies, weight loss of over 50 pounds and cigarette smoking are associated with greater breast droop.
“Breastfeeding or pumping breast milk is not.”