Expert / 20 July, 2021 / Beth Graham
Elvie expert, midwife and lactation consultant Beth Graham answers all of your questions on breastfeeding and pumping.
I recommend waiting until breastfeeding is established to begin pumping. It is important that the baby gets the hang of breastfeeding before you introduce a bottle teat. Breastfeeding is a learned skill for baby so they need lots of practice! That said, I do recommend introducing a bottle between 3-6 weeks so the baby doesn’t refuse the bottle when introduced later.
If breastfeeding isn’t going very well (or you are separated from your baby, e.g. in NICU) then you can start with hand express to collect the colostrum. As soon as your milk comes in and you are managing to collect about 10mls (from each breast with hand expressing) you can begin to use a pump to collect the milk. If you use the pump before this time then the colostrum volume is so small it won’t make it into the collector and will be wasted in the pump mechanism.
Your breast is like a dripping tap – it is constantly refilling. Try to leave at least an hour between pumping and the next breastfeed for sufficient refilling, but the longer you leave it to fill, the more milk becomes available (not too long or the breast may become engorged which may in turn decrease your supply).
The breast is never empty as it is constantly refilling, but before a pump, the breast will feel firmer and sometimes tender. After the pump, it will feel much softer with no lumps or sore areas.
After a breastfeed, pump to drain the breast as much as possible – an emptier breast encourages a faster rate of milk production. Pumping also increases the nipple stimulation which increases the production of the hormone prolactin. This helps the breast produce more milk going forward. Don’t worry if you only get 15-30mls when you pump – this stimulation and extra milk removal will help to increase your supply over the next few days.
You can put a little nipple cream on the inside of the funnel part of the pump that will come in contact with your breast/areola. This will reduce the friction and enable you to turn the pump suction up a little. The more relaxed you are the better the oxytocin release will be and so more milk can be collected. Try to be calm and think happy thoughts while pumping.
You can relax more easily when using a hands-free pump like Elvie. You can also hold your baby, play with your toddler or get on with something else while pumping so it feels less like a chore and hopefully enables more milk collection.
You can pump wherever you want – at home relaxing, holding your baby or while getting on with chores. You can pump in a restaurant, in a taxi, at work – the options are unlimited – the Elvie pump is very discreet and quiet.
Your milk production steadily increases over the first six weeks of your baby’s life. Once you make it to six weeks your supply is usually at about 1000ml per 24 hours but the range can vary from woman to woman – possibly in the range 750ml – 1500ml per 24 hours.
Your milk at any stage is perfectly matched to meet your baby’s nutritional needs. Here is a basic analogy: think of the milk you produce at six weeks as skimmed milk and 1000ml volume – not low in quality but perfect nutrition for your 6-week old baby. At three months the nutritional content of your milk changes but is still the same volume – 1000ml. Think of this milk as semi-skimmed milk – nutritionally different to the milk at six weeks but perfect for this age baby. The baby doesn’t need more and more milk – just this nutritionally changed milk. At six months the milk is different again – think full-fat milk and 1000ml. Great quality and nutritionally perfect for your baby, but again still the same volume.
Foremilk is the milk produced by the breast at the beginning of the feed – it is more watery and full of antibodies. As the feed goes on, the fat content of the milk increases and this has been called the hindmilk. It is a gradual change, not a change like the flip of a light switch.
The milk at the beginning of the feed does contain fat and the milk, and the end of the feed does contain water but the proportions are different. When you pump, the milk will settle in the bottle and the fat will rise to the top. Before tipping this milk out make sure the fat mixes with the rest of the milk and doesn’t get left in the bottle. You can do this by holding the bottle in your hand which will warm the edges of the bottle. This will “melt” the fat from the edge of the bottle. Gently swirl the bottle and the fat will remix.
Breastmilk can be stored in the fridge for up to 5 days and then warmed up before giving to the baby at the feed. Warm the milk and drip some milk onto your wrist to make sure it’s the right temperature for the baby – it should not feel too hot or too cold on your wrist.
Adjust the pump strength or decrease the time you pump. Put nipple cream on the inside of the pump – where it comes in contact with the breast/areola – to reduce the friction burn. Make sure the flange is the correct size and your nipple is not catching on the edge of the pump.
Try to relax when pumping, this helps with the let-down – the production of the hormone oxytocin that releases the milk from the breast. Massage the breast while you are pumping to encourage milk release. Check the pump is assembled correctly and you have good suction and a good seal between the pump and the breast. Breastfeed or pump regularly to ensure the breast is drained well at the pumping session – if the breast is left full this can decrease the supply.
Blocked ducts are an indication that the breast isn’t being fully drained at a feed or pump, or that the breast is allowed to get too full due to irregular milk removal, e.g. missing a feed or pump. It presents with a sore area on the breast – and when the ares is pressed, it feels very sore.
To solve the problem, first put a hot wet compress (be careful not to burn yourself) on the breast for five minutes (regularly reheating the compress so it stays hot) or take a shower. Then breastfeed the baby and while feeding press the sore area in a deep circular motion – avoid dragging your fingers over the skin which may give a friction burn. This will help the trapped milk come out. If you can’t relieve the soreness or find you’re running a fever, please seek breastfeeding help quickly as this can turn into mastitis if not resolved.
Having a baby is an amazing experience but it can also cause anxiety – you are responsible for this tiny human and there isn’t much down-time! Try to get help from friends and family and keep up on your own food and sleep. If you feel overwhelmed there is lots of support available from health care providers so please contact them and ask for help.
Low milk supply can be frustrating as you are doing your best, but the baby can appear hungry/unsettled between feeds or isn’t gaining enough weight so you may be advised to supplement with formula. Try to consider offering expressed breastmilk before offering formula. Remember being a good parent is about nurturing as well as nutrition so you are still doing a really good job!
Seek breastfeeding support to discuss ways to increase your supply by making sure the baby is latching well and your pumping is draining the breast as fully as possible. You can also consider galactagogues – food and herbs – that might help increase your supply. Eating and drinking well and resting and staying positive are all factors – be kind to yourself.
Feeding your baby every three hours, or sometimes more frequently, can be very tiring especially following a long labour.
You are also constantly learning about parenting and looking after a new baby with interrupted sleep and this can result in exhaustion. Try to let family and friends help as much as possible. You can feed the baby and they can then cuddle, settle and supervise the baby while you go for a nap. The best time to have a nap is after lunch – have some lunch yourself, then feed the baby and then try to nap. This is working with your circadian rhythm.
In the evening go to bed early rather than stay up waiting for a late feed and in the morning go back to sleep for a few extra hours after the early morning feed. You can also consider pumping milk and leaving this for someone else to bottle feed your baby while you have some uninterrupted sleep.
Make sure you monitor your breasts for blocked ducts if you delay milk removal via pumping to extend your sleep. If you feel you are not recovering from the exhaustion please seek help from your health care provider as this can lead to postnatal depression.
Hands-free flexible discrete pumping whilst still giving your baby adequate nutrition but looking after your needs too. Happy Mummy; happy baby.
You can exclusively pump your breastmilk if you have a good milk supply, but it can be hard to pump enough breastmilk to match your baby’s needs. You may need to supplement with formula.
I recommended trying to combine breastfeeding with pumping to maximise your chances of exclusive breastmilk feeding.
Article by Beth Graham, BA PgCert RM IBCLC Midwife and Lactation Consultant
For competitions and offers from our favourite brands, click here.