Expert: Sally Wendkos Olds - 4/16/2008

Question
Hi! I am struggling with getting a store of milk built up for those times I need to give my daughter a bottle. Each time I pump, after a feeding, I can only get about one ounce at a time. This seems like an awful long time just to get one meals worth of milk for my baby. I am wondering if I need to invest in a pricier pump, or if this is to be expected. Right now I use a dual electric pump made by evenflow. I am a stay at home mom, so at first I didnt think I needed a hospital grade pump, but now I am wondering if those are the only ones that will pump out a sufficient supply.

Thank you so much for your time and help, I truly appreciate it!

Mia

Answer
Dear Mia,

First, congratulations for giving your daughter the best start in life by breastfeeding her!

You will probably be able to get more milk if you don't pump right after a feeding. I am attaching an excerpt from my book (see below) with lots of suggestions for increasing the amount of milk you can get from pumping.

Good luck!

Sally
--------------------------------
Sally Wendkos Olds
Author, THE COMPLETE BOOK OF BREASTFEEDING: Eiger & Olds, 3rd edition 1999, published by Workman Publishing & Bantam Books, and available in most public libraries, bookstores & La Leche League chapters. Now in revision for a fourth edition, with Laura M. Marks, M.D.
---------------------------
  PRINCIPLES THAT APPLY TO ALL METHODS OF COLLECTING MILK
  Cleanliness. Before you express or pump by any method, wash your hands with soap and water, and clean your fingernails with a good nail brush. Germs on your hands can contaminate the milk you're preparing for your baby.
  Rinse your breasts with clean water (no soap, alcohol, or other drying agents), and dry them with a clean paper towel. Dry the nipple first and then the rest of the breast; do not let your clothes touch your nipple until after you have finished collecting your milk.
  Follow the manufacturer's instructions for keeping your pump clean, and before using the pump for the first time, sterilize the parts as the manufacturer directs. Be sure your containers are clean as well. (See section on "Containers.")
  It takes time and practice to master all the methods. If you can plan ahead (as, for example, for going back to work), practice at home for a while before you need to express regularly. Consider the first few times practice sessions, just like an infant's first few feedings. Practice once or twice a day, five minutes on each breast. If you don't get the amount of milk you'd like at first, keep it up. The more you do it, the more efficient you'll become.
  At first it may take you up to 30 minutes each session to drain both breasts; eventually you may be able to get it down to eight minutes each time; some women continue to need 15 to 20 minutes. And the amount of time needed may vary from time to time. The more you practice, the better you'll do.
  Effect of timing. You'll most likely produce more milk early in the day and early in the week. Most women's milk supply tends to drop at about 6:00 p.m. Between 7 a.m. and 1 p.m. is the best time for the first sessions; late afternoon and early evening are the worst. If you're currently nursing your baby, wait for about an hour after the first morning feeding.
  Working women often find that their milk supply diminishes during the week, so that by Friday they're giving less than they did on Monday, when they had the weekend to take things a little easier. Knowing this may help you plan your schedule and accept your body's ability to yield milk.
  Take advantage of your milk ejection reflex. Even if you don't pump during your baby's feeding, your let-down reflex will help you produce more milk. Some of the suggestions in Box 17-2 will help stimulate your let-down. Give it a chance to get going; don't pump harder or increase the suction in the pump if you don't see any milk coming out. This will just make you uncomfortable and will not produce more milk. Time and practice will improve your efficiency.
  Collect your milk according to your baby's feeding schedule. Once you've learned the basics of expressing or pumping, try to schedule these sessions at about the times your baby would ordinarily nurse. This will help keep up your supply of milk.
  Amount of milk collected. It is normal for the amount of milk you collect to vary from time to time. Quantity will depend on many factors, including how much time has elapsed since your last nursing or pumping session, what time of day it is, how established your milk supply is, and how proficient you have become.
  At first you may get no more than an ounce at a time, but as you increase the frequency of pumping, you will increase your milk yield. The amount of milk pumped does not necessarily reflect how much milk you can give your child, since your nursing baby is more efficient than the best pump. See the suggestions in Box 17-2 for increasing the amount of milk you collect.
  Experiment with breast inserts. If your pump comes with inserts that fit into the breast shield portion, see which size feels best. You might try pumping with the smaller size first, and then switch to the larger one.

PRINCIPLES THAT APPLY TO ALL PUMPING METHODS
  The cost of buying or renting a pump. Hospital-grade electric pumps are quite expensive, but there are ways to reduce the cost. If your doctor prescribes breastfeeding for some medical reason (such as your baby's prematurity or allergy to cow's milk) and if pumping is necessary, your medical insurance may cover the cost of buying or renting a pump. Or you may be able to join with other nursing mothers to ask your employer to buy a pump to keep at your place of work. Or you and a friend may rent one that you can share. Although you can share the pump itself with other mothers, you each need your own attachable kit and tubing so that your milk will not come into contact with any surface touched by another mother's milk.
  Choosing a pump. To find the type of pump you like the best, see whether you can borrow different models, either from a friend who isn't using hers at the moment, or from a local hospital, lactation consultant, childbirth education group, or La Leche League chapter. Decide which features are important for you and evaluate the pumps based on your own needs. Take the time to read carefully the manufacturer's instructions for each pump.
  Mimic your baby's suckling action as much as possible. High-grade electric pumps do this automatically. You can do this to some degree with a manual pump by beginning your pumping with a rhythm of fast, short bursts. Once you feel your milk flowing, you can slow your pace.
  Pumping while nursing. You can take advantage of the ejection of milk that occurs from one breast while the other is being stimulated. Instead of wasting this milk, or looking on it as a nuisance, you can build your milk-collecting program around it. Doing this has another advantage: it tends to increase your milk supply. This double-duty nursing can fool your body into thinking that you're nursing twins; operating by the law of supply and demand, it will produce more milk.
  To pump while nursing, first get your baby started at your breast. Prop her on a pillow under the nursing breast. For the first few times, when you're ready to pump ask a helper to hold the pump in position. Then you can use both your hands to hold your baby. After you do this several times, you'll get the hang of it and will be able to do it by yourself.
  Getting started. The first time you express or pump, try to choose a quiet time when you're not likely to be distracted or interrupted. Give yourself as much help as you can. Ask someone to be with you, if possible someone who's done this herself. It's wonderful to have someone to answer the telephone or doorbell, take care of an older child, provide another pair of hands in any way you need them. This person can help you maneuver both the pump and your baby (if your initial pumping is done on the non-baby side while you're nursing on the other side). Then get yourself comfortable -- in a chair or couch, with pillows for support. And do whatever you can to relax. The suggestions in Box 17-2 may help you enhance your milk production.
  
  BOX 17-2
  ENHANCING MILK PRODUCTION WHEN EXPRESSING OR PUMPING

You may want to try one or more of the following methods to increase the amount of milk you can collect for your baby. Different ones work well for different women in different situations. If you're pumping at work, for example, some of these suggestions will not apply. As with the rest of this book, take the suggestions that make sense to you, see which ones work, and stick with them.
  * First, take care of yourself: get as much rest as possible, and be sure you're drinking enough liquid throughout the day.
  * For two to five minutes before you begin, do deep breathing or some other relaxation exercise.
  * Drink a cup of hot tea before beginning. If your baby is not sensitive to cow's milk products that you eat or drink, you might try warm milk or cocoa.
  * Make yourself as comfortable as possible. If you can, sit with your feet up.
  * If you have time, massage your breasts. Just before you begin, if possible, lay a warm towel on your breasts for a minute or two. (The towel is helpful, but not essential.) Then massage your breasts gently, one at a time, starting from the top and moving around the sides and the bottom, moving your fingers in a circular motion. With your fingertips, stroke yourself lightly from the armpit, from above and below the breast, and from the middle of the chest toward the nipple. You don't need to massage or stroke the nipples themselves. (If necessary, you can massage your breasts even while you're dressed.)
  * Pump both breasts at the same time, using a good electric pump.
  * If you are expressing one breast at a time, switch breasts at least once during each session and preferably twice, to insure maximum draining. Usually the second expression on each breast is briefer than the first.
  * Pump frequently. It's better to pump three times for no more than 10 minutes each time than to pump twice for 15 minutes each time. It yields more milk, it's more efficient, and it's also more comfortable, since it will cut down the likelihood of trauma from too much pressure exerted for too long a time. Some women get sore nipples from pumping more than seven or eight minutes on a breast.
  * Prop a photo of your baby in front of you. Look at it and remember what it feels like (or imagine what it will feel like) to have him at your breast. (Or use a photo of you nursing your baby.)
  * Visualize your baby in your mind. Imagine what she looks like, sounds like, feels like, smells like when she nurses.
  * Make the time go faster while you're expressing or pumping by talking with a friend, listening to the radio, reading something light, or watching television.
  * If your baby is present but cannot suckle and if you don't need two hands to express, hold him while you're pumping.
  * Wear comfortable clothes that open up or pull up but still cover your shoulders, so you don't get chilled.
  * Listen to a musical record that you associate with nursing. This works best if you play the record initially during actual breastfeeding sessions; then when you're expressing, hearing the same music may help evoke the memory and the sensations you felt then. (Handel's "Water Music" gets high marks from women who enjoy classical music.)
  END OF BOX