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Hedra's advanced course in 'pumping more'
By Heather Petit

Pumping is seldom the first choice of any mom. It takes extra time and effort, can be awkward, and is often difficult, annoying, or stressful. Sometimes women pump because their baby is struggling, sometimes they pump because they must work, and sometimes they pump because nursing didn't work out or was not a reasonable choice for them. These aren't usually fun options, though most women who pump will agree that they are glad they have the opportunity to do so, and hope they can make it work, at least for a while. But the pumping experience can be made worse by the fear, and sometimes the reality, of 'not getting enough from the pump.'

This list is for people who have already checked out the basics, but still don't feel they are getting enough milk, or feel they could possibly get more, from their pumping sessions. This assumes that they have a good quality pump (such as Medela or Avent or Ameda pump), the pump is in proper working order, they pump on a regular schedule, they pump frequently enough (matching to baby's feeding cycle), and they have a normal milk supply. If you don't have a good milk supply these tips may help you, too, but you may also need more help than just this (check out the articles on supply in the Breastfeeding Cubby). Check out the other topics in the Breastfeeding Cubby, as well.

Rather than just list the options, I felt that giving a little view of my 'increasing my output' pumping routine would be helpful. Here it is:

  1. Call in. Just before pumping time, I call the daycare provider to ask how my son is doing. This extra bit of connection helps with letdown.

  2. Go to as private a location as possible. If a supportive location is available, great, but if not, make the best of anything you have. I've pumped in bathrooms, the car, coworker's offices, conference rooms, a company 'privacy room', and even in an actual lactation room. Any of them can work.

  3. Set up with a standard pattern. It helps me keep from worrying about how long I'm away from my desk if I have a standard routine. Figure out what order works best for you, and then stick to it until you could do it in your sleep. I set up my pump in the same order each day, and put it away in the same order, too.

  4. Relax. I take a few breaths to shift gears from hectic to relaxed, roll my shoulders, and think about something cute my baby has done. I aim for something that will make me smile, so that I have a positive association going before I start.

  5. Pump. Get the pump started, make sure I'm not squashing any part of my breast or nipple in a bad way, and then relax again.

  6. Convert worry to curiosity. If it is taking a while for my milk to eject, I check the pump settings, and then focus on non-involved, positive curiosity - 'Huh. I wonder why it is doing that today? Aren't bodies interesting, some days starting with milk flowing right away, some days not right away.' I find this works better for keeping myself going, rather than approaching possible worries with personal anxiety or defeat - 'It isn't working, what is wrong with my body? Is something wrong with my pump? It won't work, I can't do this.' (etc.) I use the same approach when I get less (or more) one day or another.

  7. Encourage gratitude toward your body. Even if you only get an ounce, that's an ounce full of good things. It is amazing that your body creates this stuff, and even more amazing that it will let you take it out without even using your baby to do so. A positive feedback system generates more production than a negative one does.

  8. Observe. I observe the sensations of letdown (which are extremely subtle for me this time, so much so that I often don't feel anything unless I'm REALLY focusing on my body sensations), observe which ducts are working (and when), what color the milk is, and what sound my milk makes when it dribbles and splashes into the bottle. Observe what things happen before more milk comes out, and what things happen before less comes out. Anything I observe in a positive way allows me to train my body to do more of that, a kind of biofeedback system. Allow yourself to be awed by the amazing, cool, wonderful ability to produce food for another human being.

  9. Massage. Once the first gushes are done, I use my fingertips, thumbs, and the heels of my hands to massage my breasts, like using the gentle compression techniques to eject milk into a sleepy baby's mouth. After a bit of practice, I could do this without letting go of one pump collection horn or the other, and without interrupting the flow of milk.

    I learned this technique from my first son, actually. He used to poke me in certain places while he was nursing. I ended up with little nicks and scratches from his fingernails, marking the spots where he'd poke me. One day, while pumping, I decided to see what happened when I poked where he poked. I used the nicks as a guide, and poked. GUSH! He was poking the ducts to get more milk faster. Clever boy. Learn what kind of massage and compression work on different areas of your breasts, and use that. If I stopped when my milk was down to a trickle, before doing this, I'd go home with about half the milk I usually pump. Be gentle, though - you don't want to irritate things and cause a blocked duct.

  10. Change position. I curl forward and watch the milk flow out, then a few minutes later, I sit up straight and press my shoulders back and down. I'll lift my breasts up with the hands holding the collection horns, or let them drop (slowly) as far as they go comfortably. Every position change usually gets me more milk, especially the change from curled forward to upright.

  11. Pause. If I haven't got much hindmilk out in a particular session, I turn off the pump and let my breasts rest for a minute, and just let my mind drift. Then I start up again. This lets the milk drain down into the forward part of the breast. You can lean forward and shake your breasts while you do this, too.

  12. Visualize. What you visualize is up to you. I never found that visualizing my son actually nursing helped me, but it might help you. I did find that visualizing his smile, or him acting excited (as he does just before he nurses), or actively replaying anything he's done that made me smile or laugh helped a LOT. You can also try remembering how warm and heavy he feels when he's asleep in your arms, or the softness of his skin, or the sound of his laugh, or any other strong sensory memory. You can also visualize milk pouring out of you like a waterfall or river, or even like a stream of light.

  13. Adjust the settings. If I'm not getting as much as usual, or as much as I want, I check the settings on my pump. With the Medela Pump in Style, I have to set it between medium and high pressure. High is too high for me, and my milk ducts swell closed. Medium is a touch too low. You can vary the settings during a single session, or try different settings and then just leave it on the one that works best for you most of the time. But don't be afraid to change it around if you are having a rough pumping day, or even change it during every session.

  14. Try all the options. If your pump has inserts or other options, try them out. They might just work better for you, even if you didn't think they were designed for you. If you are already using the optional setup, try the standard setup. You can vary the options during one pumping session, too. And if your pump doesn't have inserts, you can readjust your nipple position within the collection horn, shifting it (slightly) off-center, then shifting it again and again (moving around in a circle) so that you press on different ducts in different ways. Be careful not to jam your nipple hard against the side of the collection horn - I did that once and had a bruise for a week. OUCH.

  15. Give it an extra few minutes. If I am trying to increase my supply, I will either pump an extra time during the day, or pump an extra 3 minutes, to see if I can get an additional letdown. Not everyone gets multiple letdowns, and sometimes it can take more than a few minutes to get a second letdown even if you do get them, so vary this as works with your body.

  16. Decide when to stop. You can pump forever and still get a trickle, because your body produces milk constantly. If my collected milk looks like I had a good letdown (it is opaque and white or cream colored instead of translucent and bluish or greenish), I generally stop after milk is no longer jetting out of any ducts and is down to a small trickle (including with compression). I also do not pump past 18 minutes, max (and seldom past 15). If I'm pumping at home, I do not watch the clock, just my body. If I'm at work, I watch both. This keeps me from worrying that I'm taking too much time away from work, which is stressful in itself.

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Other important notes:
  • Practice. Do not panic if the first day back at work you don't get as much as you hoped. It takes practice. If you haven't practiced at home, try that, too. It takes me two weeks to get to a stable output.

  • Aim for early. The earlier you pump in the day, the more you'll probably get. Most women find that their supply is highest in the morning and declines through the day. So if you can only pump twice, pumping at 9 and 12 is usually better than at 11 and 2. Try for different times if you have the flexibility to do so, and see what results you get - it might or might not be worth changing the times, but you won't know unless you try it.

  • De-stress. Stress interferes with letdown, and there's plenty of stress if you need to pump. No matter if you are pumping because your baby is in the NICU, or if you are back at work and away from your precious little one for the first time, it is going to be stressful. It is worse when you worry about how much you are getting. Try the following for destressing:

    • Get a professional massage. Tell the masseur/masseuse that you are breastfeeding, so they will be gentle around your milk ducts (they should know where these are, by the way). Reducing the body stress you feel should help with letdown (my supply was higher for weeks after a full-body massage).

    • Take a deep breath, shake your shoulders, shake your arms out, and let the stress and thoughts of your day drain away.

    • Make sure you feel 'safe' wherever you are pumping - lock the door if you can.

    • Reassure yourself that even if you have to use formula briefly while your pumping skill improves, you will eventually get more and more milk when you pump, and that every bit you get is beneficial.

    • Try to get enough sleep. (Okay, but TRY!)

    • Explore and experiment. This list is just my personal tips. Something different may work for you. Experiment, ask questions of others who have pumped, call the pump manufacturer, try a different pump, search the Internet. An answer may be out there that works for you, possibly one I've never heard of.

© Copyright Heather Petit 2002. All rights reserved. Used With Permission.

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