When Early Pumping Is Necessary

By Naiomi Catron, RNC-OB, IBCLC www.MilkDiva.com


When you have a new baby, a breast pump seems almost like a ‘must-have.’ It might have been an item on your shower registry, or perhaps you got one through your insurance company. But the pump doesn’t come with any instructions about when exactly to start using it. Some advice you’ll read says not for two months (or two weeks) and some parents are advised to start pumping in the hospital. Why all the different advice and how do you know what’s right for you?


When should you begin pumping, optimally?

It is optimal to learn to use the pump when you are not struggling with other challenges, but parenthood is often not optimal, right? If you receive your pump before you give birth, keep the user manual and other information with the pump and practice assembling the pieces. It is very useful if your partner also becomes familiar with the pump and pump parts.

If your baby is latching and transferring milk well, then you can begin pumping when you feel it’s time to get ready to return to work or when you want to start saving milk for other reasons. Have your #teamtuff help you with the pump (single pumping) while you nurse the baby on the other side and take your time.


It takes a bit to find the schedule that works best for you and to learn the settings on your pump that are most efficient for you, so don’t wait longer than about a couple of weeks before returning to work to begin pumping.

Knowing that this deadline is looming is very stressful for many parents so if you feel the pressure to start pumping and freezing, begin after a couple of weeks but give yourself a lot of space to learn and find the routine that works best for both you and your baby.


Why might you need to start pumping early?

If anything interrupts the natural start to breastfeeding after birth, then you may need to start pumping right away. The sooner after your baby’s birth you start, the sooner your milk will come in. The signal to your body that it’s time to start making milk happens when the placenta is delivered, but regular breast stimulation is necessary to bring in a robust milk supply.


Reasons to start pumping early include premature birth, late pre-term birth or induction before 38 weeks, a stay in the Neonatal Intensive Care Unit (NICU) or Special Care Nursery (SCN) for your baby, maternal illness (including preeclampsia, gestational diabetes, delivery complications, etc.), Cesarean birth, or simply if your baby is not latching for any reason.


When to start early pumping

While you are in the hospital, the nursing staff or a lactation consultant should be able to help get you started. Depending on your hospital, they may provide you with a hospital-grade pump and your own pump kit. You may be asked to bring your personal pump. Rumble Tuff pumps include a manual (hand) pump that you can use as well. Consider having your partner help with the manual pump while you focus on baby. You should ideally begin pumping within 1-2 hours after birth (barring any contraindications), but definitely start regular milk removal within 6 hours after birth (Flaherman & Lee 2013). Then continue regular pumping, at least every 2-3 hours, just as a baby would be cueing to eat if you were breastfeeding.


Short frequent pumping sessions are much better than long, widely-spaced ones. In fact, that will most closely match what your baby would be doing at the breast. The work you put in early will pay off in a stronger milk supply later on. Pump for about 15 minutes or until 2 minutes after milk flow stops. Play with the pump settings to find the highest level that is comfortable for you. Pumping, like breastfeeding, shouldn’t hurt. Experts recommend pumping both breasts at the same time (simultaneously) - this makes pumping sessions shorter overall (when compared to pumping each side on after the other or sequentially) and increases the milk most moms can get (Flaherman & Lee, 2013).


If you have had pain medications for labor or recovery, or if you were treated with magnesium sulfate for blood pressure issues during the birth, you may be groggy and need help actually using the breast pump. If you have had a surgical birth or if you have medical complications, you may have mobility issues and additional assistance from the nursing staff may be needed each time you need to pump.


Consider a manual pump and talk to your partner about helping you use the pump(s), especially if you will be going home more quickly after your birth because of COVID-19 restrictions. A manual pump can hold your nipple in the optimal position longer than an electric pump and can be easier to use and control if you have nipple tenderness.

Another option is hand expression of colostrum rather than using the breast pump, at least at first. A lactation consultant should be able to show you the most effective way to do this, but you can also find instructions and videos online. The benefit of hand expression is that you can capture more of the colostrum as less is lost sticking to the pump parts.

Once your milk comes in, though, using a double-electric pump is much more efficient for most women.


What to expect with early pumping

Don’t plan to get ounces of breastmilk at first. When a baby is breastfeeding directly, they need only small amounts of colostrum for the first couple of days until your milk ‘comes in.’ Think of colostrum in terms of teaspoons rather than ounces.

There’s a learning curve to pumping, too. After all, the mechanical, plastic pump parts are nothing like your soft, cuddly baby. And the stress of medical complications or worry about your baby’s health can add another layer of hormones working against effective milk production. Be sure you are warm enough, well supported and as relaxed as possible. Try massaging your breasts before turning the pump on and occasionally during the pumping session. Women who use this hands-on pumping technique tend to get more milk each time.


Maximizing production with the pump

You’ll also want to be sure your pump parts fit you correctly - while pump flanges come in standard sizes, every woman is not, in fact, the same size and shape. Some pump companies have IBCLC’s available to help properly size you such as Rumble Tuff who offers 15 different flange sizes. Because nipples are not one-size-fits-all – they also offer Pumpin’ Pals style flanges if you find your nipples are “elastic” and stretch a lot while pumping. These can improve the comfort of pumping and make it more productive (and less loathsome) overall.

Moms who pump regularly will sometimes use coconut or olive oil on the pump flange to improve comfort. Warm compresses, or a heating pad made specifically for pumping, are also helpful for some women. And many pumping moms will say some sort of pumping bra is essential if you are pumping regularly and long-term.

Visualization is also a helpful tool - try to image your baby at the breast or in your arms while pumping. Or listen to a recording of your baby crying or cooing. If your baby is with you, try having them skin-to-skin with you while pumping. If your baby is able to go to the breast, try pumping one side while nursing on the other (yes - this is often complicated at first and definitely takes assistance until you get the hang of it).

Guided meditation has been proven effective at increasing supply – download the Rumble Tuff guided meditations here.

By using a breast pump wisely, you can build a strong milk supply and keep your baby healthy and growing. While pumping is only a temporary tool for some moms, it’s more of a long-term commitment for other mother/baby dyads. Your baby’s doctor and your lactation consultant can help you come up with a plan for how often and how long to continue pumping based on your own personal situation.

If you have questions you can also consult (it’s free!) with our IBCLC here at Rumble Tuff.

In addition, Rumble Tuff has a basic pumping class for parents that can help with all the assembly and other questions. It’s free and you can sign up here. You do not have to be using a Rumble Tuff pump to attend the class.


References:

Becker GE, Smith HA, Cooney F. Methods of milk expression for lactating women. Cochrane Database of Systematic Reviews 2016, Issue 9. Art. No.: CD006170. https://www.cochrane.org/CD006170/PREG_methods-milk-expression-lactating-women

Flaherman, V. J., & Lee, H. C. (2013). "Breastfeeding" by feeding expressed mother's milk. Pediatric clinics of North America, 60(1), 227–246. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5332143/

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