Mothers going back to work or wanting a few hours away from their baby often have questions about pumping and feeding their baby while they're away.  How do you get started?

Is pumping necessary?

This really depends on your situation.  If you're going to be away from your exclusively breastfed baby for more than 2-3 hours, yes you'll likely need to leave some expressed milk.  If your baby is supplementing with solids, then you might be able to stay a little longer without expressing milk.  Keep in mind that introducing solids too early or too late can cause digestion and immune system complications, so be cautious about doing this.  When baby shows all the signs of being ready (sitting up on their own, able to pick up food with a pincer grasp and feed themselves, move tongue to all folds of their mouth, and types of teeth dictate types of food) this is the best time to start introducing solids in very small amounts, not as a replacement - to prime the gut and the body for new textures and experiences.  Remember that breastmilk digests very rapidly, and as long as the majority of their nutrition comes from breastmilk, they'll need access to it often.  A breastfed baby will rarely ever drink more than 4oz at a time (granted the baby isn't spurting or changing developmentally or a life change isn't occurring like mom returning to work), no matter their age, but every baby is different.  Some babies may go shorter or longer between nursing sessions, so it is always good to pay attention to your baby and their specific needs.

If you're just going out for dinner, you can usually just nurse the baby right before you leave, and you'll often have enough time to go out to dinner (be sure to get call ahead seating if possible) and be back by the time they want to nurse again.  Keep in mind that many babies cluster feed and comfort nurse more in the evenings, so altering your times out can be helpful.  You may also consider having the care giver drop you off and then take baby to a local park for a walk so they can be close by and bring you the baby whenever they need you (which helps reduce your anxiety about checking your phone constantly and possibly missing dinner).  That first evening out can be a little bittersweet, but it is nice to take some time off every once in a while.  If this just doesn't work for you or your baby or you're not ready to leave baby with a care giver, wrapping your baby in a woven or stretchy wrap (any simple piece of cloth like a long sheet) is easy peasy.  For those first few months, a snug wrap keeps a new baby calm *much* better than those uncomfy car seats (often used as carriers).  And, if baby does wake at dinner, grocery shopping, or walking in the park, just loosen up the wrap a bit to drop them closer to nipple level and nurse them right back to sleep or into calm bliss without ever skipping a beat.

If you're going to work, being close to your baby's care giver helps and may mean that you can leave work on your breaks and/or lunch to simply nurse your baby rather than pumping.  Some businesses allow moms to work from home, or partially work from home, or you may bring your baby to work with you while they’re very small.  Don’t hesitate to ask if this is an option, the worse they can do is tell you no.  However, if you do need to express milk, know that Federal Law requires businesses to provide moms with a clean space (not a bathroom) and enough time to pump milk for their baby.  They can apply for a hardship and cases will be reviewed individually.  For more information on the working while pumping laws, visit here.  Additionally, most insurance companies are now required to pay for breast pumps, but be cautious because they don’t always cover quality pumps.

Does the pump really matter?

Yes!  Which pump is best for you depends on your situation.  Most importantly, get something that works for you and your situation.  If you’re going to be pumping regularly, a double electric pump will usually save you time and energy.  If you just want a pump to express milk for a night out here and there, then a single manual pump may be all that is needed.  Pumps can get pricey, but they are often worth the cost.  If you respond better to manual expression, then you may not need a pump at all.  Bottom line, if you need to pump, this isn’t a piece of baby gear that you want to skimp on.  A lot of moms are stressed because their $20 pump isn’t meeting their full time pumping needs.  Save your money - $25 a week will get you a great pump in no time.  But again, check with your insurance company to see if they cover a quality pump

A quality pump needs to be closed system.  A closed system pump means that all parts that have the potential of coming in contact with the milk can be fully sterilized.  Open system pumps, like personal use Medela, cannot be fully sterilized and because of such are known to have mold built up in the system.  Hygeia and ARDO are the only breast pump manufacturers, that I'm aware of, that completely comply with the World Health Organization’s (WHO) breastmilk substitute marketing code.  Both Ameda and Lansinoh make quality closed-system pumps, but either they or their parent companies don’t comply with the WHO code.  There are a variety of new companies offering more discrete pumping options great for when you want to pump anywhere.  I personally used an Ameda Purely Yours and loved it (purchased prior to their parent company deciding not to follow the WHO code).

Additionally, get a pump with adjustable speeds, cycles, and flanges.  You need to get a flange that correctly fits for comfort and efficiency, and the cycles and speed help you mimic the suction to resemble a baby’s patterns at first – short and shallow in the beginning to trigger your let down, and then long and deep once let down has occurred.  You’ll have to play around with it to see what pattern works for you.  The cycling and flange size can be the difference in a mom being able to express milk or not, so research this a little.

How does expressed milk affect the baby?

Being at the breast is optimal for baby.  Beyond the bonding aspect of breastfeeding, the contact between the baby and your breast allows you to pass antibodies most efficiently.  If for whatever reason baby can’t be at the breast, do lots of snuggling when you are together and keep the milk as fresh as possible so that your baby gets the most amounts of antibodies possible.  The longer your milk is stored, the more of these properties are reduced.

Depending on how your baby gets expressed milk can affect your experience when baby is at the breast.  Even for a baby that does “fine” between an artificial nipple and the breast, their latch is still changed and this can cause sore nipples or inefficient milk transfer (not to mention changes in the palates and musculature of the face).  A baby squeezes and sucks on an artificial nipple, whereas they massage the areola and lactiferous sinuses to squirt the milk out the breast – two very different mechanics.  When baby is away from the breast, a supplemental nursing system (SNS) is the least likely to interfere with breastfeeding.  If you’re supplementing while mom is nearby, an SNS is incredibly valuable at keeping baby at the breast to stimulate milk production, keep baby learning how to latch, and helping to avoid breast refusal and nipple preference.

You can purchase an SNS, or make your own with a milk storage bag or a bottle and a #5 feeding tube.  Use this as a finger feeder, so the baby sucks on your finger and at the same time gets milk, which allows the baby to work a little (mimicking breastfeeding) to get their nourishment.  Or, latch baby on to the breast, and once they’re not actively sucking any more after using breast compression, insert the SNS for any necessary supplementation.  Using an SNS in this manner helps prevent nipple preference while stimulating milk production.

If an SNS is not your choice, a spoon, dropper, cup, or your hand can be used to transfer milk to the baby.  However, if bottle feeding, be sure to mimic the breastfeeding relationship as much as possible.  Hold the bottle so the baby works for the milk and it doesn’t stress the baby out by pouring too fast.  Check out the Best for Babes foundation guide to bottle feeding for some excellent advice.

Milk Supply & Pumping Efficiency

After your milk matures, milk supply works by supply and demand.  Whatever you remove from the breast, your body will replenish. You never stop making milk, even though we often refer to the breast as being “drained.”  Even once you decide to stop nursing, or your baby weans, you’ll often still have milk for months.  In the first few days after birth, active and unlimited nursing let’s your body know that baby is breastfeeding and your alveoli multiply for enhanced milk production and storage.  The longer you go between nursing or expressing, the less milk you make, but as long as when you’re with baby, you’re not limiting nursing (especially with pacifiers), then milk supply is rarely an issue.

Let me repeat this.

PACIFIERS AND ARTIFICIAL NIPPLES AFFECT BREASTFEEDING - ESPECIALLY YOUR SUPPLY AND COMFORT. 

Likewise, you cannot spoil a baby that has biological dependencies for care givers.  They need to know that you're going to provide them with nourishment, stability, and comfort.  Pacifier use as a parenting tool is your choice, just like starting solids, birthing naturally, getting an epidural, using a bouncy seat, eating well in pregnancy, choosing a care provider, and every other parenting choice you'll make.  It isn't my business (unless you're asking me to help you) but, I'm not judging you. What I want you to understand is just because your baby does "fine" going from artificial nipple to breast, doesn't mean the discomfort you feel during latch is a part of the normal process of breastfeeding, and doesn't mean your supply won't be affected.  If you truly want to have the best supply you can have, especially when you're running into supply issues or weight gain issues in the baby, you need to get rid of the pacifiers.  Don't stress yourself out with techniques and galactogogues if you're not going to try unlimited nursing first.  If you need a break, try a birth ball to soothe your baby and babywearing.  Parenting is supposed to be involved - despite what our culture may have you believe.  I know, I know, a lot of moms use pacifiers and their babies are "fine" - I used a pacifier for a few weeks with my daughter while I was going nuts with every other soothing technique without having much support at all (ask me about it sometime) - but I refuse to jump on the bandwagon that pacifier use doesn't cause problems - especially when a lot of mom's breastfeeding experiences aren't fine.  Almost every single mother that has ever asked me for support for pain or milk supply while nursing is using a pacifier.  While I understand the reasons they want to use a pacifier - they simply change the musculature of the face, tbe bone structure, and the latch.  If you're having pain.  Get rid of the artificial nipples.  If you're not having pain and your supply is excellent and you're not experiencing milk supply issues...  that's one thing... if you are, you cannot expect someone to help you fully if you're unwilling to remove some of the barriers causing problems.  Until our breastfeeding rates increase to a significant level, I'll adamantly promote the biology of the body and baby and let you make the decision. I digress...

Have as close to a biological birth as possible, keep baby skin to skin and near the breast often and especially immediately after birth, and don’t limit or schedule nursing sessions.  A baby that has a poor latch and unlimited access to the breast, will stimulate the breast and get milk and eventually latch better.  That doesn’t mean don’t get help with latch, it just means that all the time limits and scheduling we do for babies (including birth experience and induction), and the pacifiers we use, are causes of milk supply issues.

Babies weren't meant to sleep in cribs away from their mothers.  They were meant to be close to mom at all times, and within a coo's distance for the first few years.  Bedsharing, when done safely, helps everyone sleep better and is the best way to get baby calmly attached to the breast, get more sleep, and promote an amazing supply of milk.

During the first few weeks, when milk supply is really amping up, is the easiest time to increase supply.  If you know you’ll be returning to work early, pump a few extra ounces a day.  Don’t let this interfere with resting and bonding with your baby postpartum, and don’t pump everything you’re making because this can trigger oversupply, which isn’t always the amazing thing that it sounds like.  If, however, you have a bit of time before going back to work, you can slowly build your supply over the next months making sure to start no later than a week before going back to work.

Pumping tips:

• Relax, de-stress, and eat well.  It is hard to let down your milk when you’re stressed and it takes around 500 extra calories to make milk (vs. about 300 to gestate a baby... you need to eat and drink).  Our hormones just don’t work optimally with stress, especially oxytocin, which is what contracts your alveoli and creates the "let down."  Smell your baby’s clothes, listen to their coos on a recording, look at a picture, take a bath, do some yoga, say a prayer.  Whatever helps you take a deep long breath, stimulate oxytocin, and cleanse the stress out of your body, do it.
• Prolactin (hormone that makes milk) levels are highest at night.  Pumping at night will help increase supply.
• Don’t go more than 2-3 hours between pumping sessions when you’re away from your baby or the proteins in the milk will trigger your body to decrease supply.
• You usually have more milk available in the mornings when baby has gone a little longer between nursing – pump when you wake up.
• Use the 24 hour rule.  It usually takes about 24 hours for your supply to change.  Don’t focus so much on pumping as much as baby eats at each session, but focus on pumping as much as baby eats in a 24 hour period.  So, if it takes 8 pumping sessions to get the amount of milk your baby eats while you’re away, then do that.  If it takes 3 pumping sessions, then do that.  You are a human, not a robot – do what works for your body.
  • My full time work days looked like this:  Roll over in the morning and nurse baby, eat breakfast/get ready, pump (put milk in bottle on counter to be fresh for first feeding), nurse, pump about every 3 hours at work (for 9 hours), nurse, cook dinner, take a shower, pack lunches, go to bed and nurse every 1-2 hours throughout the night.
  • My part time work days - My son has been exclusively breastfed so I drove home every 2 hours or took him to work with me.  At 16 months, I only drive home once or twice a day to nurse.
• Pump one side while you nurse the other to allow baby to trigger let down.  You can buy a pumping bra, or you can simply cut a hole in a sports bra big enough to fit the tube of the flange in to help hold it in place if you have trouble maneuvering baby and pump together.
• Use breast compression.  There are lactiferous sinuses close to your areola that are basically like little storage tanks for the milk.  These sinuses are what your baby’s tongue needs to reach to squirt the milk out of your nipple (hence the necessity of a deep latch).  If you squeeze these sinuses while nursing and/or pumping, more milk comes out.  If baby stops actively sucking, you can squeeze your breast to wake them and get them to suck more to stimulate milk, and you can squeeze these while pumping to get milk faster and help increase supply.
• Use lanolin or similar while pumping to reduce friction and get more milk.  Of course, be sure your flanges are the right size first.
• Switch pump (like switch nursing) and pump often.  If you are pumping on one side, pump (with breast compression) until the milk stops flowing, then switch to the other side and repeat.  Once that breast stops flowing, switch back to the first side and repeat.  Do this for as long as it takes to get the milk you want or for as long as you have time.  If you’re double pumping, after the milk stops flowing (with breast compression), then pump for about 15-20 minutes longer and/or wait 15-20 minutes and then pump again. Both of these trigger your body to make more milk, but they also give your breasts a little time to build up the storage supply so that it is simply easier to get more milk out with a pump.
• Learn the art of manual expression – it is invaluable, and some moms respond better to manual expression than any other method.

Storing Breastmilk

Breastmilk, being a live substance, is amazing.  For a healthy baby, you can leave it fresh on the counter for up to 10 hours, then put it in the fridge for up to a week, then put it in a freezer for up to 3 months, and then in a deep freeze for 6 months to a year.  When in doubt, smell it or taste it to see if it is still good.  The longer you store milk, and the more you heat it, the more of the properties are diminished, but it is still the healthy option for your baby.

Store in containers made for breastmilk in small increments – 2 to 4 oz – a breastfed baby, no matter if they’re 3 months or 15 months, will rarely ever eat more than 4 ounces at a time.  You can always add more, but you don’t want to warm up too much milk and have to waste it.  If you’re using bags, lay them horizontal so they are easier to store once they’re frozen and take less time to thaw (which means less heat) when you’re ready to use them and thaw them in warm running water to be sure you don't overheat.  Be sure to label the expression date, and put their name on it if they will be cared for by someone with more than one baby.  Talk with the baby’s care givers about breastfeed babies and be sure they know the differences in breastfed baby’s demeanor than that of a formula fed baby.

Pumping can work!  Talking with your work about your desire to breastfeed before taking maternity leave will help the transition once you return to work.  Be open and honest and know that most employers meet moms with respect for their wishes.

Do you have questions not listed here?  We’ll keep updating.  Let us know!