How to start pumping, building a stockpile and how to make pumping a bit more enjoyable. Also includes safe milk storage and handling guidelines.
Expressing or pumping your breastmilk is one way of connecting to your baby. It provides him with your precious milk, along with all the antibodies and nutrition that is so important for his growth and development. But more than that, it also keeps your milk supply up, so you can breastfeed and remain close when you are together. However, pumping or expressing breastmilk is not a natural process; we are not meant to be hooked up to a machine! So it does take time and a bit of learning curve to get the hang of it and become successful. Follow the tips and suggestions on this page to get off to a good start with milk expression.
Getting Started with Pumping
One of the first questions military mothers ask is when they should start pumping while on convalescent leave. The first couple of weeks are the most important time for calibrating the breasts to the amount of milk they need to make for the long-haul. Because of your short convalescent leave, you’ll probably want to begin pumping within the first two weeks after birth. This will tell your breasts to make more milk than needed and will help to build up a superabundant milk supply. It will also help you begin to stockpile breastmilk for your return to work. Pump once or twice a day, just enough to practice and get the hang of it, at the beginning.
Pumping is a skill that must be learned, and it takes time to master this skill. Do NOT be alarmed if you get only drops or even nothing at all the first few times. The point of pumping in the early days is to tell your breasts to make more milk. But it will take time. Pumping is as much a physical process as it is a psychological process, so try not to become discouraged. Your body is used to letting-down to a warm, cuddly baby and must get used to letting-down to a cold, hard plastic pump instead. Effectiveness at pumping improves with practice! Practice in the morning when your supply is at it’s highest. You can pump after your baby has breastfed, or you can set your pump up to single-pump, and pump one side while your baby nurses on the other side. This is a great way to have a quick and strong let-down and boost your milk-making hormone levels.
Most mothers find that lightly massaging the breasts helps stimulate the let-down reflex. You may also want to put a warm cloth or heating pad against your breasts as well. Looking at your baby while you pump or smelling an article of his clothing can also be helpful. Once pumping becomes routine, your breasts will become used to the pump, your let-down will occur more easily, and you won’t need to do all this preparation.
Center your nipple in the breast flange (some mothers find that lubricating the flange with water or olive oil helps to create a stronger seal and reduces friction), and start the pump. If you are using an automatic pump, turn it to its lowest setting and gradually increase the speed. If you are using a manual pump, start with a gentle, slow rhythm. If pumping is painful at anytime, check that your nipple is positioned correctly and your flanges are the correct size (see below). You may also need to adjust the suction, as it might be too strong. Remember, pumping should not be painful. If it hurts, something is wrong.
- The flanges (or shields) are the part of the collection kit that fit over your nipple. All women’s nipples are different, some are small, some are large, but most pumps are packaged with a standard, one-size-fits-all sized flange. Your flanges need to be properly fitted to your anatomy. The way to tell if your flanges are properly fitted is to watch your nipples when you pump. After centering your nipple in the flange, you should see extra space around your nipple. During the suction phase, your nipple should move in and out of the “tunnel” without rubbing the sides. If pumping is painful or uncomfortable, your nipple fills the tunnel on the flange or seems to be stuck, you see a white ring at the base of the nipple where the tunnel opens into the flange, or your nipple turns a dusky, dark color, you may need larger flanges. Using too small of a flange will cause tenderness and can also lead to plugged milk ducts, mastitis, or a lowered milk supply. On the other hand, if the flange does not form an airtight seal or a large portion of your breast tissue is being pulled into the tunnel of the flange, you may need a smaller flange or a reducing insert. See an IBCLC for help in properly fitting yourself for flanges. If you can’t find flanges for your pump or you are having trouble finding flanges that fit properly, you may want to take a look at a company called Pumpin’ Pal. They make an insert called the “Super Shield Plus” that is angled and has a gradual slope from the flange to the tunnel. It is very forgiving when it comes to size and allows you to sit back, rather than lean forward, while pumping.
Continue pumping a few times a day while on convalescent leave. The milk that you pump can be saved for your stockpile when you return to duty (see below: Building a Stockpile). While it is important to calibrate your breasts to make more milk than needed in the first weeks, don’t pump so much that you end up with plugged ducts or mastitis when you return to work and you can’t pump as often. It is vitally important that you breastfeed your baby during the six weeks of your convalescent leave as it will fly by. Remember, your baby is your best pump, expressing milk is a bonus right now.
Tips for Expressing/Pumping Milk
These tips work for most mothers, use only what is helpful via trial and error:
- To establish milk production you need to pump at least 8-10 each day or 25-30 ounces in 24 hours
- Pump soon after or during feedings
- Use your hands: massage breasts before pumping, and do breast compressions during and at end of pumping. This helps to empty the breasts and increases the cream content of expressed milk.
- Adjust the pump pressure and cycling settings: use the lowest suction that effectively removes milk and vary during the pumping session. Also vary the cycling from fast to slow to mimic your baby’s suckling pattern.
- Avoid watching the pump
- Avoid looking at the clock
- Avoid long pump sessions
Building a Stockpile
Since you will be separated from your baby on a regular basis, it is a good idea to build up a supply for later use. A “stockpile” means to keep a large amount of frozen expressed milk in the freezer for later use. You can start to stockpile a reserve supply of frozen milk when you start practicing with the pump. Since you will be pumping after several feedings each day in order to calibrate the breasts to make more milk than needed, you will begin collecting a fair amount of milk. By creating an “oversupply” of milk, you will compensate for the dip in production upon your return to work, and your frozen stockpile can be a wonderful back-up for unexpected growth spurts, missed pumping sessions, or other variations in supply.
Decide how much milk to stockpile. Some mothers choose to keep a small reserve of about three days’ worth of milk for “just in case” reasons. Some women who start pumping and collecting their milk early on find that they can manage to stockpile enough to continue giving their babies frozen milk long after they have stopped pumping or even breastfeeding. But don’t become obsessive about how much milk you can or cannot stockpile. Some women let down easily to the pump or have an abundant supply, and find stockpiling easy. Other women may find it next to impossible to squeeze out even an extra ounce of milk for the freezer. It is important to remember that your extra store of frozen milk is for emergencies only. Don’t rely on your stockpile once you return to work. If you regularly use your stored milk, you’ll quickly deplete your stockpile, and every bottle that you give in place of breastfeeding or pumping reduces your milk supply.
Milk Storage and Handling Guidelines
Your expressed breastmilk is a unique fluid, a combination of both nutrition and antibodies, which protects your baby against illness and promotes proper growth and development. Expressed breastmilk can be thought of as a fresh, living substance; it is more than just a food. Therefore, you will need to take good care of the milk you pump, as how it is stored will affect how well the nutritional and anti-infective qualities are preserved. Follow these guidelines to safely collect and store your breastmilk:
Milk Storage Guidelines
- Hard-sided containers, glass or plastic, protect your milk, and are a one-time expense. However, they are bulky and can take up a lot of room to store. Research has shown that there is less fat loss with glass or plastic bottles. Look for BPA-free bottles. Any bottles you choose should have well-fitting, airtight, solid tops. Not all hard-sided containers are a universal fit for various breast pumps, so check carefully before buying. Expressing your breastmilk directly into the feeding container greatly decreases the likelihood of contamination.
- Plastic (polyethylene) milk storage bags, made for freezing and storing human milk, are convenient and take up less room for storage. However, they are a one-time use product and cannot be reused, and they are expensive. They can be attached directly to the breast pump for easier collection and storage in the same container. However, pouring milk out of them into a bottle can be awkward if they don’t have a pour spout. Moving the milk between storage and feeding containers also increases the possibility of contamination. Fat loss is higher in milk storage bags than hard-sided containers.
- Disposable plastic nurser bags or liners for bottles should not be used for storing expressed milk. They are not as durable, are prone to bursting or tearing, are not designed for freezer use, and are not designed for long-term storage. If you choose to use them, double-bagging can help prevent accidents. Never use plastic sandwich bags for storing breastmilk.
- Do not fill either hard-sided containers or milk storage bags more than three-fourths full to allow the milk to expand as it freezes. If you express into bottles, leave the cap loose before freezing, and then tighten once the milk is frozen. Squeeze out the air in milk storage bags before sealing. This also helps to prevent freezer burn and your milk from absorbing the odors from other foods.
- Label every container of milk with the date of expression and your baby’s name, using a sticky label or non-toxic marker. Labeling ensures that your baby gets your milk at childcare.
- Many mothers find a rack, such as the Mother’s Milk Mate Breast Milk Storage System® for storing bottles of milk (it dispenses bottles from oldest to freshest), or a plastic container, such as a bin or box to hold the bags of frozen milk (to prevent them sliding around and tearing), to be helpful. Make sure to mark the larger container with the month and year of milk collection (August 2010 #1, August 2010 #2).
- Store expressed breastmilk in ‘feeding sized’ quantities (two to four ounces) to minimize waste and make thawing easier. Some mothers use an ice-cube tray to freeze their milk. A new take on the old stand-by of using an ice-cube tray is MilkTrays®, a reusable, BPA-free, medical-grade plastic tray that freezes breastmilk in one ounce ‘sticks.’ It holds up to eight sticks (that fit in the mouth of bottles) and comes with a lid.
- It is fine to “layer” or combine milk from different pumping sessions on the same day. You can add freshly expressed milk to frozen milk after chilling it in the refrigerator (or cooler compartment) for at least 30 minutes. Avoid adding more freshly expressed milk than the amount already frozen in the container.
Milk Usage Guidelines
Your freshly expressed breastmilk should be given to your baby as soon as possible to have the maximum benefit. The vitamin content of expressed breastmilk degrades and the bacteria count increases the longer it is stored. Fortunately, breastmilk is full of immune properties that help to prevent bacteria from multiplying. Refrigeration of breastmilk preserves most of the immune properties, but not all of them. And freezing destroys the white blood cells that protect against illness, but preserves some of the other immune properties. No matter, expressed breastmilk that is properly collected and stored is still far superior to formula. Follow the guidelines below for best practices when storing your expressed breastmilk:
- Room Temperature - It is best if you can provide freshly expressed breastmilk to your baby. Antioxidant activity in breastmilk, important for fighting infection and mopping up free radicals, has been shown to decrease slightly with both refrigeration and freezing. If possible, pump once in the morning before work, and leave that bottle of freshly expressed breastmilk in the diaper bag for the first feeding at daycare. Should you forget and leave a bottle of freshly expressed breastmilk sitting on the counter or table, it will remain safe to use for four to six hours at temperatures up to 77°F or 25°C.
- Insulated Cooler - If you don’t have a refrigerator at work (or don’t feel comfortable leaving it in the workspace refrigerator), freshly expressed milk can be kept cool in an insulated container with freezer gel packs or ice packs when no refrigeration is available for up to 24 hours at 59°F or 15°C.
- Refrigerated - Refrigerated milk is next best, if at all possible. Always place your expressed milk in the coldest part of the refrigerator, usually at the back, away from the door. Freshly expressed milk can be refrigerated for three to eight days at 39°F or 4°C. If you do store your milk in a refrigerator at work during the day, or your childcare provider has questions about storing your milk around other food, you can let them know that the Centers for Disease Control and the U.S. Occupational Safety and Health Administration have both made statements that human milk is not a body fluid that requires special handling or storage in a separate refrigerator as a bio-hazardous material. It can be stored in a common refrigerator at work and childcare facilities.
- Frozen - If you know you won’t be using your refrigerated milk within three to eight days, it needs to be frozen as soon as possible after collecting. Place containers of breastmilk at least an inch away from the walls of a self-defrosting freezer to prevent defrosting and refreezing. Do not store containers in the door of a freezer where the temperature fluctuates. Always maintain a temperature of 0° F or -18°C. Frozen breastmilk will remain safe to use for three to six months in a self-contained refrigerator/freezer unit. You can store your milk in a deep freezer for 6-12 months at -4°F or -20°C. When using frozen breastmilk, always use the oldest stored breastmilk first. Try to rotate in a few frozen bags per week (two to four), along with your refrigerated supply, and freeze some of the freshly expressed milk to replace the milk you defrost. This ensures that your milk is rotated, and your baby still receives mostly fresh milk at feedings.