Introduction: How to Pump Enough Milk for Your Baby
So, you've managed to bring a cute wee person into the world, figured out a few basics, like how to change a diaper, and how to install a car seat, and suddenly, it's time to go back to work. I'm assuming 'You' are American here, since other countries tend to have less crappy maternity leave, but I digress.
If you've been following WHO guidelines, or have just been doing what comes naturally, and breastfeeding your baby, this is probably where you get nervous, and wonder how you're going to feed your kid now. Electric breast pumps have been on the market since the early nineties, and before then, many women hand expressed, or used manual pumps, but the whole prospect sounds rather intimidating, doesn't it? It doesn't have to be. With the right equipment, confidence, and some support, you can keep breastfeeding your baby, even if you can't always be with him.
This instructable is still being edited, so currently, it's published to allow mom-friends (or anyone else who wants rambling advice) access.
Step 1: Don't Pump and Dump
Breast pumps exist so your baby can have your milk even when you're elsewhere, not so you can pour your milk down the sink. It's really common to tell a nursing mother that she should pump her milk and then toss it because she's on medication, or even because she's had a drink, and it's typically bad advice.
If a medical professional ever advises you to do this, or to avoid nursing because of medication you've been given, ask that person to research their information, or look it up/get your friend with the shiny new iPhone to look it up online. Dr Thomas Hale's Medications and Mother's Milk has information on what levels of drugs pass into breast milk; what's safe, and what isn't. His Infant Risk Center has recently started a hotline, at . (806)-352-2519, Monday-Friday 8am-5pm CST. kellymom.com has lists, too. It IS alright to ask to be given an alternative drug if you're worried about how needed medication might affect your child.
Similarly, if you'd like a glass of wine with your dinner, or want to see if your neighbor's homemade beer is as good as he says it is, go ahead and have the drink. Alcohol isn't stored in breast milk, it's metabolized over time, so when you're sober, or very close to sober, your milk is too.
Well-meaning dads and relatives will sometimes suggest you express milk so you can sleep while they give your baby a bottle, or so they can bond with the baby through feeding. Sounds great, but skipping nursing sessions is one of the fastest ways to kill your milk supply. Why not have dad bring the baby to you in bed instead? Never give a baby a bottle when you could give her a boob.
Step 2: Take It Seriously
Feeding babies IS serious business. Buy a decent, double-electric pump, and scrimp and save elsewhere. Life is too short for single pumping, and you and your baby deserve decent equipment to work with. Likewise, if you forget your equipment at home, take time off work to go back and get it, or have a roommate or partner bring it to you. Pumping isn't optional, it's essential.
If your pump fails, get the manufacturer on the phone NOW, and let them know that the medical equipment you bought from them has stopped working, and they will need to ship a replacement to you overnight. You wouldn't write off a case of diapers that disintegrated when you put them on your baby's bottom, or do without for a few days because there wasn't a readily available substitute. This is one case where you really need to hold a manufacturer responsible for their product.
Coworkers and managers should respect your need to take pumping breaks, as well as your need to have a clean, private space (NOT a bathroom) to do so in. Communicate your needs matter-of-factly, and don't apologize for doing something you need to do. Check if there are laws that apply to pumping where you live. If you'd like to try to explain why pumping is important to someone who just doesn't get it, the US gov't offers a nice, free kit called The Business Case For Breastfeeding. You can order it online.
If your employer is hesitant to provide such a space, point out that all that is required is a room (even a large closet) with a locking door, or easily installed latch, a chair, and an electrical outlet. In extreme situations, you can pump in your car, in mild weather only.
Always remember that what matters here isn't your right to pump milk, it's your baby's right to eat. Unless a coworker regularly kicks puppies, that's not something they should feel comfortable arguing with.
Step 3: Stay on Schedule
Typically, you'll need to pump every three hours or so. With an older baby, you can usually pump less often. Try to stick to a regular schedule. It helps keep you producing milk, and if you're sharing a pumping room, it makes scheduling much easier. Make sure to communicate with management about the breaks you'll need to take, and when you'll be taking them, and let them know that for the sake of your health, and your baby's, it's important you do so. One of the women I work with split two fifteen minute breaks and a half-hour lunch into three 20 minute breaks. Set a cellphone alarm, or use something like ReminderFox (free Firefox addon) if you tend to forget to pump.
Step 4: Get Comfortable
Put on some soothing music, have a cup of tea, or find a snack. If you're able to, surf the net, or read something fluffy. I hacked a bra so I didn't have to hold the pump. Stress and discomfort make it harder to relax, and let your milk down. Don't multitask unless you're doing something you enjoy, and don't feel like you need to do something useful. Now is NOT the time to take phone calls from people who stress you out, either. Remember, you're already making food, and that's all you should be expected to do!
Try breast compressions (squeeze as the pump sucks), or simply lay a hand across your breasts while you pump. Looking at pictures of your baby, or watching a baby video on your cellphone can help too. Make sure the room you're in is warm, or put on a sweater.
The picture here gives a pretty good idea of what we did to relax while pumping. The room was full of books.
Step 5: Equip Yourself
Disclaimer: I'm not affiliated with any pump/baby supply manufacturer, nor do I stand to gain by recommending one brand over another.
The women I worked with had good successful with traditional Medela double-electric pumps (Pump In Style or Pump In Style Advanced), the Lansinoh/Ameda double electric (same pump, different colors), and an Avent double electric pump. We also had reasonable success with the Medela Freestyle (rechargeable, no-cord pump), and Playtex Embrace, which has good suction, but fragile flanges. The Playtex and Ameda flanges were interchangeable. The Lansinoh is the most reasonably priced pump, while the Medela PIS pumps were known to be sturdy, and a good choice for use with multiple kids.
Finding pumping uncomfortable? Invest in some bigger or softer flanges, or get a silicone insert for the ones you have. Medela makes hard and soft flanges, while Lansinoh/Ameda makes squishy inserts, as does Avent. Pumpin' Pals is a third-party company that sells big silicone inserts to allow you to recline while pumping. I've never tried these, but if they sound appealing, you might look up some reviews.
If you find your pump's suction has declined over time, give it a good clean, and get some new membranes! You can find Medela ones at Target or Babies R Us, and Lansinoh/Ameda/Playtex ones (yep, these are all the same) can be ordered online. Try to keep a spare with your pump, in case of emergencies.
If you'll be pumping in your car, make sure you have a power adapter that fits in the cigarette lighter (most manufacturers sell these, and some pumps come with them), a nursing cover, or stretchy shirt, so you can cover up, and an ice pack, to help keep the pump from getting too warm.
Spending too much on collection bottles and bags? Invest a couple of dollars on some standard baby bottles. These will fit Lansinoh/Ameda, Playtex, and Medela pumps. Avent bottles are extra-wide, so no interchanging here. You can get adapters to use wide-mouth bottles with standard-sized pumps. Dr Brown's makes storage caps that fit standard bottles, as well as teeny brushes that are great for cleaning pump parts. For the most part, you don't need to stick with one brand.
Considering a brand I didn't list here? Do some serious research on it. Some pumps are only available in some countries, so their exposure is limited, but other pumps just aren't very good. Please don't sabotage your milk supply by going for a sub-par pump, or trying to make do with a single pump, or manual one, though manual pumps are useful to keep around in case you're missing part of your electric one, or you have problems with it.
If you're eligible for WIC, ask about getting or renting a pump from them. I've got no personal experience there, but a friend got her pump from them.
Step 6: Save Some Time
Breast milk is a living fluid, and it's got some rather neat antibacterial properties. You can actually use it to treat minor infections and the blocked tear ducts that are so common in newborns. So it stands to reason that fresh human milk doesn't go bad as fast as pasteurized cows' milk. It's okay if your milk has to sit out for a couple of hours, and the same goes for your pump equipment. Of course, keeping it refrigerated, or in a cooler, is even better. Keeping your bottles and flanges chilled between sessions can save time you'd spend washing it, and helps you avoid having to clean it in a communal sink. ALL of the women I work with use this trick.
You can also put your milk and pumps parts in a cooler bag with ice pack after your last pumping session, so you don't need to go back to the pumping room, and possibly interrupt someone else's session.
Step 7: When You Get Home . . .
Put today's milk into 4 oz (or smaller) portions, with low-flow or preemie nipples, to help avoid overfeeding your baby. Breast milk should be sipped like single-malt whiskey, not guzzled like Gatorade. This will help your milk to last while you're away from your baby. There's no need to freeze milk unless it's not going to be used for several days, so it can sit in the fridge over the weekend, if you'd like. You'll save on storage bags, and keep it more nutritious this way.
If your baby has part of a bottle, it's fine to put that bottle back in the fridge, and offer it again within 24 hours. Breast milk isn't formula, and it doesn't go bad as easily.
It isn't unusual for a baby who's away from his mother during the day to nurse more at night. Cosleeping can be really helpful for handling this. Actually, I think that's the only way I managed to get any sleep for the first year of my son's life. There's a really good instructable on that here, with lots of information in the comments. You can also wear your baby in a sling or mei tai so you can do light chores, wander around outside the house, or play with other children, and nurse at the same time.
Step 8: Don't Give Up
Babies go through growth spurts, and your body's chemistry changes with time, too. It's totally normal to find that your baby's nursing a lot more than she used to, or that you're suddenly getting less milk than you expected. Typically, there's a slump in milk production around four months, just a month after going back to work, if you take the full US maternity leave. It doesn't mean your milk's dried up, or that you won't be able to make enough for your baby, just that supply has gone from being hormonally-driven to supply and demand driven. Keep pumping, keep nursing, and keep the faith. If you've been able to store milk in the freezer earlier, now is the time to use it. And remember, this stage should only last a month or two.
If your baby had problems latching, or you ended up having to pump instead of nursing (exclusive pumping), you're in a pretty special group of moms. Even if you're not able to pump all the milk your baby needs, know that trying at all means you're doing a good job. A baby doesn't need to have only breast milk or nurse directly to benefit.
Step 9: Have a Cookie
Seriously. A lot of women find that certain foods (galactogogues) help them produce more milk, and one of the easiest ones to find is oats. So, make some oatmeal cookies with some flax and brewer's yeast thrown in, or have oatmeal for breakfast. Fenugreek tea and tablets are also commonly used to help milk production. Staying hydrated is really important, too. If you're interested in the topic, there's much information to be had through a web search.
Step 10: Get Support
If you have other nursing mothers around you, they can be a huge source of help and support. La Leche League and online groups (I love LiveJournal's breastfeeding community) can be really helpful, too. Having someone who will encourage you to continue nursing and/or pumping even when things are tough can mean the difference between a successful breastfeeding relationship, and one that ends prematurely.
If a doctor, relative, or friend urges you to supplement with formula, or do something that otherwise doesn't feel right to you, get a second opinion. There's a lot of commonly spread and believed misinformation on breastfeeding out there -- and there's a lot of commercial motivation to get babies on breast milk substitutes. In the majority of cases, a mother can produce enough milk to feed her child.
If you're having a lot of difficulty, seek out a lactation consultant. When that's not an option, or you need immediate help, look for a website run by one, like kellymom.com.
Step 11: Share and Share Alike
Some women will get lucky and find that they're pumping a lot more milk than their babies need. This can be stored in little milk storage bags in the freezer, and it's great for growth spurts. At the same time, milk only lasts about three months in a standard fridge-freezer, and after awhile, you're going to start crowding out the peas and fish sticks.
Other women have problems pumping enough milk (even though they can usually get enough when nursing directly) , or experience supply drops after stresses like surgery or illness, or because of pregnancy. Some women have other problems that make it difficult to produce enough milk, and some babies don't live with their birth mothers, and don't have access to milk from the tap.
Any ideas where I'm going with this? It takes a little organization, but milk donation is a truly great thing. There are commercial milk banks, where the milk goes through a lot of screening, and is available at high cost to special needs babies. There are also less formal groups like MilkShare that help people in need of milk find women who have milk to give, and allow the individuals to work out their own screening arrangements. If you have milk to give, don't be shy about offering it to someone who could use it, and if you need help, don't be afraid to ask for it.
Step 12: Know That You Rock/Help Someone Else Rock Too
If you've breastfed your baby, you've given them a tremendous gift in terms of physical and emotional health. If you can keep it up, even after returning to work, you're adding to that benefit. If you learn how to successfully pump for your baby, and encourage a friend or coworker to do the same for her baby, you're passing that goodness on to another child.
If you know someone who's struggling with nursing or pumping, and you have any useful advice or encouragement to give, bring it on. Support can mean the difference between a baby getting to nurse as long as she needs to, or being weaned before she's ready, and mom and dad having to find money for formula. On a more selfish level, it can mean not having to cover for a coworker who's off work with a sick baby, since human milk benefits a baby's immune system in ways formula doesn't.
Step 13: Wean Slowly
Pump-wean, that is. At about a year, your milk supply should be well established, and it should be quite possible to go all day without pumping, and still have plenty of milk at night. The problem is that trying to stop pumping abruptly can lead to clogged ducts and mastitis (when the ducts get infected), both of which are pretty unpleasant, and the latter can be pretty dangerous. When you're ready to quit the pump, try shortening sessions, or cutting out one per day until you adjust. If you do start having pain, get over to Kellymom to find out how to handle it.
I failed pretty badly here, so after managing to clear clogged ducts, and possible mastitis, I just ended up pumping longer, and donated the milk. I got to hang out in a nice, private room, and read about vampires, so it really wasn't bad.