There is more to pumping breastmilk than powering on your pump and sticking your boob in the flange. While it is not rocket science, there are techniques we can use to maximize how much milk we get which in turn helps increase our supply. By understanding HOW your supply and demand functions, you can manipulate your production to increase milk supply. Many of these techniques will help you better empty the breast. The more milk you express, the more your body will make. Read on and you too can learn how to PUMP LIKE A BOSS.
Every breastfeeding mother should know how to hand express. While more research is needed to totally quantitate the benefits of hand expression, a few studies have begun to demonstrate it's significance. A 2010 study examined mothers who were separated from their infants in the first 48 hours postpartum. They were taught hand expression and instructed to alternate with pumping every three hours. Hand expression yielded more than DOUBLE the output.
Many mother’s pumping in the first few days of their infant’s life will get NOTHING. I routinely tell mothers in the hospital not be discouraged if they initially get zippo when they start pumping. Yet, we know that part of establishing supply is empting the breast (Supply and Demand), not just manual stimulation.
Hand expression has been shown to be a more efficient means of extracting colostrum and has been demonstrated to influence later supply. Early on, the amount of milk removed from the breast actually dictates how many PROLACTIN receptors our body will make. More PROLACTIN receptors equates to an ability to MAKE MORE MILK throughout our lactation cycle. Hand expression is a wonderful tool to jumpstart a healthy milk supply from day one!
HOW DO WE DO IT?
Most women want to pinch by their nipple to express milk. While this method will succeed in expressing some milk, it is not adequate to get a steady stream and tends to be uncomfortable with repetition. To successfully hand express, cup your breast in a "C" hold (thumb on top and index and remaining fingers on the bottom). Thumb and index finger should be wide spaced about and inch beyond areolar tissue. With the "C" hold lift the breast gently up and back toward the chest wall. Then, roll the thumb and index finger forward with slow steady pressure toward the nipple.
Your breast is full of ducts that carry milk down to the nipple. Think of the area where all these ducts converge as a region of pooling. In a sense, milk comes down the ducts pool behind the areolar in the terminal ducts before being expressed. Placing your "C" back a bit ensures your compression is behind this region so milk can be pushed forward and expelled from the breast.
It is equally important to fully release pressure between squeezes and allow the ducts to refill with milk. Constant pressure or not fully releasing between compressions does not allow fresh milk down to refill after each expression. Once milk letdown occurs, alternating between breasts can be a helpful technique to allow for full drainage. Play around with positioning. When you hit the right spot you will see results.
WHEN DO I HAND EXPRESS?
Before your milk supply comes in, your baby is eating colostrum. Colostrum is the thick yellow "first milk" that is rich in antibodies designed to provide your baby with a passive immunity (protection from disease provided to baby via the mother instead of through exposure). Colostrum is thick and it takes some work for your baby to extract it from the breast. I often equate it to trying to drink a milkshake with coffee straws. You really got to suck to get it moving! This is why it is notoriously difficult to collect via breast pump. Pumps are simply not as efficient at emptying the breast as your baby.
ALL Momma's should learn and practice hand expression. Read THIS POST for my Top 10 Tips to Succeed Breastfeeding in the Hospital. If you are required to pump for ANY REASON before your milk comes in, you should be ending your pump session with hand expression. As shown by the aforementioned studies (and through my own anecdotal experience) hand expressing yields better results. Some women choose to forego pumping all together in favor of hand expressing colostrum. Either way, it is a much better tool for extracting colostrum and establishing a healthy supply than pumping alone.
Some women will initially only get a few drops hand expressing. Do not get discouraged. Regular practice and stimulation will yield results. Do not forgot, and average newborn feed is only 5-7mls so we are not looking for a massive yield. Spoonful is a bounty for colostrum expression.
If breastfeeding is an art, pumping is a job. You will hear many women extol the beauty of the time they spent breast-feeding but you will almost never hear anyone rave about pumping. Pumping is a grind. It is something we do as a means to an end. We do it out of love and responsibility for our babes not for the pleasure of the experience. With that said, there is nothing worst than pumping and getting next to nothing. Sometimes, that is a reality we must deal with but for MANY there are tools we can use to MAXIMIZE pumping output so you get the most yield for your time. If you think you have Low Supply, the key is trying to determine the underlying cause. Check out THIS POST for possible culprits that may undermining your supply. If you are just starting to pump for the first time, check out THIS POST to learn some of the basics of supply and demand, when to start pumping and bottling, and how to accumulate a freeze stash.
Once you get started pumping and have addressing the underlying cause of any low supply issues, put some of these practices to work and lets see if we can get you some MORE MILK!
WHAT HAPPENS AFTER COLOSTRUM?
So what happens after the colostrum transitions into mature milk? Hand expression is still a powerful tool that many women use to relieve fullness, initiate letdown , or aid in flow while breastfeeding. In relation to pumping, hand expression is used in combination with an electric pump to maximize milk output. This technique is called Hands On Pumping. During a normal pumping session, using hands to compress and massage the breast can aid in letdown and help fully empty the breast. Work any hard nodules with gentle pressure. Massage up by the armpits and work down toward the breast. With the same "C" hold, compress the breast while pumping. You should see a stream of milk shoot into your pump. Hands on Pumping not only increases output but speeds up milk emptying making your pumping time more efficient.
A 2009 study showed mothers using hands on pumping INCREASED daily output BY 48% despite pumping less time than the control group. A second study further demonstrated that mothers who used hands on pumping have higher fat content in their expressed milk. Manual massage and compression combined with the suction force of an electric breast pump is more efficient at completely empting the breast and extracting the fatty hind milk. By further empting the breast, we are boosting supply! Remember, the key to breast milk supply and demand is EMPTYING THE BREAST! For more on supply and demand, Check out the first post in this series. This technique is especially important for mothers who are working or find themselves pumping for extended periods of time.
Stress and pain have been shown to impair the milk ejection reflex by blocking the effects of oxytocin. On isolated occasions, this does not have any long term effects. Prolonged exposure to stress or pain (like a painful latch!) will cause repeated episodes of incomplete emptying of the breast. Decreased demand eventually leads to decreased supply. Because of this cascade, chronic stress is an impediment to a healthy milk supply.
I know all you new mothers out there are "harmphhhh-ing" me. Life with a newborn is stressful. Telling you to chill out and get more sleep does not make it magically attainable. If new moms were able to get some R&R they would have already done so.
While a stress free life may not be within your grasp right now (or in the foreseeable future as a parent), you CAN make your pumping session a time for relaxation. Too often, we mothers are "on the go" trying to cram everything into a day without enough hours. I encourage you to make pumping time an exception.
Do not multitask.
This is a time for you.
Make a pumping ritual that ooooozes relaxation.
One study actually found that mothers who listened to guided meditation and relaxing music while viewing photos of their babies where able to pump 2-3x the volume collected from the control group. The theory linked to this phenomenon stems from the idea that relaxation techniques decrease stress and promote oxytocin release.
Do you need to zen out like a yogi when you pump? Only if it floats your boat.
The point is that you need to find a relaxing ritual and make it your habit. Self care is important... ESPECIALLY I you are a mother. Read THIS POST for more self care tips.
If baby is nearby, visual and olfactory cues can have a powerful effect. Photos or videos of your baby can be beneficial if you are away from your infant. Find your happy place. Whether it is listing to relaxing music, reading a book, drinking some tea, eating a pack of Oreos, infusing essential oils or watching the Real Housewives of Orange County, rock it and enjoy some time sitting with your feet up and your boobs out.
Heat has been shown to increase efficacy of milk removal from the breast. An Australian study showed that by using warmed breast shields, mother's could expect to remove more milk in a shorter time. Ultrasound supports these findings by demonstrating the effects of heat to the nipple and areola. Warming dilates the milk ducts allowing for quicker and more efficient removal of milk. Mothers who use warmed breast shields report feeling more relaxed and comfortable during pumping sessions. As we know from our last header, comfort and relaxation have effects on milk ejection and only further support the benefits of using heat while pumping.
So how does one warm their breast shields. You can warm them in a water bath before pumping... but my feeling is "What women with a baby has time for that?" There are a variety of warming packs that you can apply to your breast that work nicely but my absolute favorite is Lil Buds.
Lil Buds are all natural breast comfort packs that can be heated or cooled for treatment of engorgement, clogged ducts or mastitis. They are also super handy to wear while breastfeeding and pumping because they fit snuggly in your nursing bra. They are handmade and covered in a super soft flannel adorn in simply adorable prints. They are kinda hard to resist.
For heating purposes, they are made to be stuck in the microwave for 5-10 seconds, which simplifies the heating process immensely. They also keep their heat a lot longer than many of the of heat pads on the market. The half moon shape fits nicely in a nursing bra so that
it can be worn while nursing without fear of pressing against the infants face. While pumping, two half moons can be combined to make a full circle for ultimate heating power.
There is even an option of selecting a flax and lavender buds filling so you can bathe their sweet calming scent while pumping. Can you tell I am a fan? I wish I had known about these babies while I was pumping.
Pain can also inhibit letdown. Learn how to care for your nipples as the adjust to the rigors of breastfeeding a baby. My giving your nips some TLC, you can speed up recovery and maintain a healthy milk supply. CLICK HERE for a FREE PRINTABLE full of Tips for your Nips.
Power pumping is a pumping technique used to mimic baby cluster feeding at the breast. Cluster feeding (and power pumping) results in repeatedly emptying the breast which jacks up your supply and demand curve. This technique is really helpful when you have a dip in supply. Some moms experience a dip when they return to work... Power Pumping to the Rescue! Best results are seen when power pumping is used for at least two consecutive days.
Want to Know More?
This post is part of series about pumping and preparing for the transition back to work. Check out the first post: Working Pumping Momma
Still want more? Check out this Pumping E-Book!
Get this awesome complete resource that covers everything you need to know about pumping for $25. I am affiliate for this product which means I get a portion of the proceeds at no extra cost to you. I offer this e-book on my site because it is a quality resource that I support! Check it out!
Dewey, Kathryn G. “Maternal and Fetal Stress Are Associated with Impaired Lactogenesis in Humans.” The Journal of Nutrition, vol. 131, no. 11, Jan. 2001, doi:10.1093/jn/131.11.3012s.
La Leche League International. Manual Expression of Breastmilk: Marmet Technique. Manual Expression of Breastmilk: Marmet Technique, Lactation Institute, 2003.
Morton, J, Hall, JY, Wong, RJ, Thairu, L, Benitz, WE, Rhine, WD. Combining hand techniques with electric pumping increases milk production in mothers of preterm infants. J Perinatol. 2009;29:757-764.
Ohyama, M, Watabe, H, Hayasaka, Y. Manual expression and electric breast pumping in the first 48 h after delivery. Pediatr Int. 2010;52:39-43.
Wiwanitkit, Viroj. “Warm Breastshields and Breast Milk Pumping.” Journal of Human Lactation, vol. 28, no. 2, 2012, pp. 115–115., doi:10.1177/0890334412437765.