Demystifying Pumping: When, Why and How

Picture this: you just had your baby. Congratulations! The lactation consultant comes in the room and shares some newborn feeding education. Then they ask if you have any questions. You look over nervously at the shiny new pump you brought with you and ask, “So when should I start pumping?”

Wait, HOLD UP!

Pumping may or may not be something you’ve thought about, and it may or may not be needed for you, now or in the future. Let’s take a step back and look at how the pumping mindset has taken hold…

With the enactment of the Affordable Care Act (ACA) in 2010, pregnant parents everywhere are now able to secure a new breast pump at no out-of-pocket cost through their insurance. Working parents everywhere rejoice! Pumps are expensive, and vital to those who are returning to work and wish to continue providing breastmilk for their infants, so this move is huge.

However, this also means that those who may not need or want a pump likely receive one. It’s that whole thought of, “If it is provided then I must need it”. Don’t get me wrong, free breastmilk pumps are a game changer for so many parents, but just because you’re offered a pump does not necessarily mean you need one.

SO WHEN SHOULD I START PUMPING?

This is a GREAT question! Let’s break it down:

Firstly, let’s talk about how milk is made. Milk is made from the body by asking the breasts to make more. And asking the breasts to make more means putting baby to breast, using hand expression or pumping with an electric or manual pump more often. Milk removed = more milk made.

Since more milk removed will make more milk, it’s important to be choosy about when and if to pump so as not to create an oversupply. Oversupply can be complicated and cause many issues, so we want to avoid this if possible.

WHAT SITUATIONS WARRANT PUMPING?

With the exception of returning to work or school or the occasional night out, parents may not know they will need to pump after baby is born until the situation presents itself. There are four main times when you should be prepared to pump your breastmilk:

1 – When your baby is in the NICU

2 – For supplementation

3 – Date night or other short separations

4 – Returning to work or school

NICU BABY

When a baby is in the NICU and the mom or lactating person and baby are separated, this is an indication that pumping is necessary. Pumping from the very beginning of baby’s life helps to ensure that a full milk supply comes in. Since the baby can’t go to breast at all (or rarely) at this stage, the pump steps in to bring in a milk supply when the baby cannot.

In the first days, colostrum in small amounts is present (and I mean small). You may only see drops of colostrum during each pumping session for a couple days. Once your milk increases in volume (comes in), you will begin to see more milk. Pumping every 2-3 hours around the clock is crucial to telling your body you want the milk and building a supply. The NICU nursing staff and lactation consultant at your hospital will give you more guidance on when you can scale back how often to pump, but keep in mind that since pumping is mimicking what your baby cannot yet do, it won’t be until baby is going to breast and replacing pumping sessions with full feedings, and until you are about to head home with your baby.

SUPPLEMENTATION

When your goal is to exclusively feed from the breast, supplementation can make you feel inadequate, to say the least. Hear me when I say: you are not inadequate! You are doing the best for your baby. Sometimes, circumstances or situations warrant supplementation, and they are things we did not see or could see. Some reasons for supplementation include: weight gain issues, jaundice or blood sugar issues.

Jaundice and blood sugar issues usually occur in the first days after birth, often before you are discharged home from the hospital (if that is where you gave birth). If you gave birth at home or in a birthing center, you will be followed by your baby’s medical team to ensure that blood sugars and jaundice trend in the right direction. 

In the early days, hand expression is really the best way to get colostrum out for supplementation. This is because colostrum is thick, kind of like honey, and comes out easier with hand expression than with a pump. 

Once your milk increases in volume (comes in), a pump is a great choice for expressing milk for supplementation, especially if you are doing so for weight gain issues. The plan you follow will be based off of your baby’s specific situation and should be laid out by your medical team, including your pediatrician and lactation consultant. This team will follow you closely to monitor your baby’s weight gain and adjust supplementation amounts and schedules as needed.

SHORT AMOUNTS OF SEPARATION — DATE NIGHT OR A DAY AWAY

New parents know that a break away from baby is important for one’s mental health and for the relationship between the parents. It’s okay and should be encouraged for the feeding parent to have time away from the baby to reset and recharge. In this situation, some milk will need to be pumped.

If you can anticipate the separation (say, for a date night), then you can prepare ahead of time. In this case, you will only need 2-5oz for a bottle, so you can pump once or twice ahead of time to get this. The best time to pump for a little bit of extra is after the first feeding in the morning, because your body will most likely have the highest surplus of milk at this time. Feed your baby, then do one pumping session.

RETURNING TO WORK OR SCHOOL

So you’ve had your baby, breastfeeding is going great, and now you have to figure out how to leave your little babe for many hours a day to do the necessary thing — work or school. First let me say, you are a SUPERHERO! I won’t lie to you and say it’ll be easy at first, because it’s not. But it does get easier, and the times you spend with your babe when you’re reunited will be that much sweeter!

Okay, so let’s talk logistics. About 4 weeks before you have to return to work, you should begin pumping. Begin with pumping one time a day, after the first feed in the morning. Prolactin, the milk making hormone, spikes at night, leaving many milk makers with the most volume of milk first thing in the morning, which is why we do the pumping in the morning. Your goal is twofold: get acquainted with the pump and start making a small stockpile of milk for your first day of work or school.

Once you return to work, you will be pumping 3-4 times a day, depending on your schedule and how long you’re away from baby. You will get into a rhythm and know what you need in your pumping bag and find tricks that work for you, but here are some key things to keep in mind:

  • In the US, employers are required to give pumping parents a space to pump that is free from outside intrusion and not a bathroom.
  • Pumping breaks do not have to be paid, but employers are required to give them for the first 12 months of a baby’s life.
  • You should plan on leaving 1-1.5 ounces of milk per hour of separation for your baby. Example: this would be 15 ounces of milk for a 10 hour separation.
  • Keep in mind, milk intake should be viewed in a 24-hour lens. Babies take in an average of 25 ounces of milk over 24 hours, but the range falls between 19-30 ounces per 24 hours. For a calculator to help you better estimate how much milk to leave, click here. 

In a later post, I will go into more detail about pumping plans, methods to increase output and tips and tricks from my own working and pumping experience.

So there you have it: how to know when you need to pump. Keep in mind, everyone’s situation is different, so if you find yourself needing or wanting to express milk outside of these situations, it’s a good idea to consult with an IBCLC to discuss a plan to do so. Oversupply can happen fast, and can be a sticky situation — having guidance is important to help you navigate this. If you need a pumping consult, I provide those! Head over to my Services page for more info. BONUS: Your consult may be covered by insurance!

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