To pump or not to pump? That is the question. And I hear it from just about every new parent as they begin their nursing journey with a new baby.
Over the last 20 years of providing birth and postpartum support to families throughout Puget Sound, I’ve heard from hundreds of parents and lactation experts regarding why, whether or when to pump breastmilk, which pump to buy for what purpose, how to get started with pumping without causing milk production problems and how to manage the up-and-down ride of nursing and pumping.
Good advice abounds
I’ve heard a lot of good advice rolled out to new moms:
“Get a pump before baby arrives but leave it in the box – you may not need it.”
“Take a breastfeeding class before the baby comes so you at least know how the plumbing works.”
So does bad advice
And, I’ve heard a lot of misinformation:
“You want to pump like crazy when your milk first comes in,” one well-meaning cousin told a client of mine during her baby shower. “You are going to want to get out of the house and let someone else feed her now and then.”
I sighed as I sat beside them, making a mental note to correct the cousin’s errant counsel at my next prenatal meeting with my pregnant client. She had the right intention, just the wrong approach.
So. Do you have to pump?
All that begs a question: Does every parent who plans to nurse a baby need a pump?
The answer to that is an unequivocal “NO!” lactation experts say.
Which begs another question: If not every nursing parent needs a pump, when should a pump come into play?
I turned to one of Washington state’s breastfeeding support pioneers and one of Seattle’s longest-term independent lactation consultants for answers.
When to consider a pump
Ginna Wall, RN, MN, IBCLC, retired former director of UW Medical Center’s lactation services, told me in an interview that a breastfeeding parent should consider a pump “only if she anticipates regular separations from her baby, separations of more than three to four hours.” Although retired from clinical practice, Wall remains a 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 breastmilk, such as babies with cleft palates, or premature babies struggling with the suck-swallow reflex, or other conditions that make it hard for a 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 said. “I consider mothers who can’t breastfeed but can provide breast milk by continuing to pump for many months to be heroic.”
Catherine Fenner, IBCLC, a longtime Seattle lactation consultant agrees with Wall. Pumping exclusively to feed a baby is “a gift for the baby who is getting their parent’s milk.”
But, she warns, it is a mistake to think pumping and bottle feeding is easier than feeding at the breast.
“Second-time parents who exclusively pumped with their first may seek out support to avoid needing to do that again,” Fenner says. “They are grateful they had the milk to provide, but underestimated how much time and effort it would take to sustain.”
That said, pumping willy-nilly or unnecessarily can cause real problems for a nursing parent’s milk supply, Wall stressed.
Problem 1: Decreased milk supply
“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 said. “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, pumping may decrease milk supply.”
When milk supply drops due to a parent pumping instead of putting a baby directly to the breast it can in turn result in an insufficient milk supply for a growing baby. Insufficient milk supply often leads to supplementation with formula.
Local lactation consultants do not discount the use of formula, especially when a parent’s supply is too low to meet a baby’s nutritional needs. But Wall and a mountain of research support the assertion that whenever possible, feeding from the breast directly is best for most babies.
They stress that a machine should be used cautiously so that it does not usurp the baby’s role in regulating how much milk a lactating parent makes.
Problem 2: Oversupply
At the other end of the spectrum, increasing the milk supply too much through pumping can lead to engorgement, blocked milk ducts, and increased risk of breast inflammation, or infection (mastitis).
Having too much milk can cause the nursing parent to become reliant on a pump — that is, needing to pump just to be comfortable when their baby cannot remove as much milk as their breasts are making. It’s easy to get trapped in a cycle of feeding, pumping to comfort and continuing to make more milk than is needed in response to both.
Pumping for a good night’s sleep?
Ironically, Wall noted 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 the nursing parent put the baby to the breast all day and all night – leads to more sleep for the nursing parent, not less.
Exclusive feeding at the breast leads to more sleep
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 can make for a more wakeful baby at night.
Even so, Fenner suggests most parents don’t need to worry about which half of the day milk was expressed and just put the date on the bottle or storage bag.
“In my experience it doesn’t matter that much,” she says. “I’d rather parents have one less thing to track.”
Making a habit of pumping by day so you can skip nursing at night can also lead to decreased supply over time. That’s because 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.
Fenner stresses that feeding when the baby says they are hungry is the most reliable way to maintain your milk supply.
“When your baby starts sleeping in longer stretches it’s usually an indication your body can maintain the milk supply,” says Fenner. “That communication between breast/chest and baby is key.”
Bottle-feeding and obesity connection
And, there is at least one other good reason to keep a baby on the breast rather than become reliant on a pump.
According to research being conducted by the U.S. Centers for Disease Control and Prevention, feeding at the breast 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 a breastfeeding session may act as a physiologic signal to stop eating.
“The same fat is mixed throughout a bottle feeding, rather than the different levels of milkfat being ingested in the right order when breastfeeding,” explains Fenner.
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. In fact, it can 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,” Wall said. “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 of a baby’s life, and wants to maintain their milk supply, should also consider expressing milk for her baby.
Got (too much) milk? Pump may be the culprit
For the mother who is a super breastmilk producer, however, a pump can become a perpetrator of chronic engorgement, increased risk for plugged ducts and mastitis. In this case, breastfeeding parents who feel full and uncomfortable even after a baby feeds well may be tempted to use a pump to empty the breast and relieve the discomfort.
Bad idea, lactation experts say.
Sit with the fullness
If possible it is better to try and tolerate the feeling of fullness, letting your body get the signal that it’s making too much milk.
If the full feeling becomes too much to bear, lactation expers recommend hand expressing just enough to “take the edge off” the discomfort.
Why hand express? 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.
Bottom line: take the edge off and no more
Critical, 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,” lactation consultant Diana West, BA, IBCLC writes in her book The Breastfeeding Mother’s Guide to Making More Milk.
Initiating that feedback inhibitor
West offers this advice on the Le Leche League International website:
“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 (FIL), 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.”
Conversely, most parents are wanting to increase milk production. Emptying the breast by nursing frequently (or pumping) prevents the FIL from sending the message to slow down production. This helps make more milk.
Do pumps cause breast infection?
Wall said 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 said she’s seen the association too often not to believe pumps may play a role in infection for some women.
To lower the risk, nursing parents should be fastidious about cleaning the pump parts that come in contact with the milk.
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 electric pump is the best way to go.
“A good quality pump just makes it faster and easier to empty both breasts and get back to work,” said 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,” said Wall, encouraging all moms to give hand expression a go. To learn how to hand express, she recommends moms watch this 10-minute video created at Stanford University.
Use hand pumps wisely
Fenner notes that there are several options available on the market today for hands-free pumps that fit in a bra, in addition to the hand pump. Both of these options are helpful for nursing parents with carpal tunnel syndrome, or just tired hands.
She noted that one popular hands-free pump should be used with caution: the Haakaa silicone pump.
“These were originally intended to catch milk leaking from the other breast while nursing,” Fenner explained. “This can be helpful, however, it’s not completely passive. Always nurse the baby on both sides before using the Haakaa.” Many parents nurse on the first side and use the Haakaa on the second side before their baby has nursed on that side.
“This takes the letdown milk, the “easy milk,” Fenner cautioned. “If your baby needs the second side, you have just taken part of their meal. You will need to feed that back to the baby after nursing. That makes more work, not prevents work.”
Avoid stockpile syndrome
If you are planning to nurse, you will hear from at least one person along the way that breastmilk can be stored in the freezer for up to a year. The possibility of storing up lots of milk in order to save of for the return to work definitely sells a lot of breast pumps. But parents interested in pumping for this reason may want to consider holding off on the pump until close to the time nursing parent returns to work.
“Many women think they need to stockpile a freezer full of milk before going back to work,” said Wall. “Then they 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,” Wall said. “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.”
What’s your goal?
Still, Fenner recognizes that some parents may want a bigger cushion of milk stored in the freezer for “emergencies.”
Says Fenner: “Decide how much of a cushion you think you need: is it staying one day ahead of your baby’s needs? Is it the three or seven day emergency preparedness guidelines? That is all fine. Decide how many ounces you need and once you reach that number back off on the pumping.”
If you’re pumping, rest 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,” said 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.”
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