Tuesday, August 25, 2009

Exclusively Pumping

I meant to begin this blog with an introduction and mission statement. But since I've been asked by several people how best to go about exclusively pumping breastmilk (EPing), I decided to post my information here so I can link it rather than type the same thing over and over.

For those who know nothing about this practice, EPing is the art of maintaining a breastmilk supply without actually breastfeeding a baby. There are many reasons a woman may choose to EP -- inverted nipples, a baby's extended stay in the NICU, latching problems, etc. -- but one thing these women have in common is that they are convinced that breastmilk is best for their children. When most mothers would get discouraged and switch to formula, these moms take on the full-time task of pumping their milk for the benefit of their babies.

I had a difficult time breastfeeding the Thorn as a newborn: he had strong suction from the beginning, but tended to suck only on the tip of the nipple, which resulted in -- there's no way to put this delicately -- a lot of blood. As I am a large-breasted woman and both nipples are very inverted, the task was even more difficult. Despite lactation consultations and diligent attempts at feeding, my baby lost weight and I lost confidence. That's when Sparrow found out about EPing on a websearch late at night. Faced with the dilemma of failing at the breast or switching to formula, I decided to EP.

At three months, I now produce 50 ounces of milk a day. Some people raise their figurative brows at the number, but based on forum seatches, getting at least 30 ounces isn't all that uncommon with diligence.

Things I've learned about maximizing my milk output while exclusively pumping (EPing):

1) Make sure your flanges fit your nipples -- there is no one-size-fits-all! In order to easily measure your nipple width, try the coin method: hold a dime, a nickel, and a quarter to your nipple. Which is about the right size? Then put the coin in your flange. Does it fit? Another key to knowing your flange is too small is if your nipples look pinched and rub up against the sides.

2) In general, dual electric pumps are best, but some have more success with manuals, so experiment (it never hurts to have a backup manual anyway). Insurance may help pay for the cost of a pump, but even if you have to foot the entire bill, remember that formula feeding is far more expensive in the long run.

3) Drink at least 100oz a day and get at least 300 calories in addition to what you'd normally eat;

4) Pump every two to three hours for at least twenty minutes for the first three months (generally, every time baby would feed) -- make sure that each time you keep pumping for five minutes after the milk flow stops;

5) Make sure at least one of your pumpings happens between midnight and five in the morning to take advantage of higher prolactin levels;

6) Keep as rested and de-stressed as possible;

7) Put hot compresses on your breasts to stimulate milk during pumping and help relax you (I find that putting hot water in my breast pads makes the heat last longer than using a washcloth);

8) Have your partner feed and change the baby while you pump at night (good for companionship and helps you get more rest -- Sparrow was brilliant at it);

9) When you drop a pump time, wait a week to make sure your production isn't suffering before dropping another pump;

10) Try to hold, touch, or look at a picture of the baby before you pump -- sometimes a recording of the baby's cry also works;

11) Gently stroke your breasts from outer edges toward the nipple to stimulate milk flow and help unclog any clots;

12) Put the pump on low suction/fast repetition for the first minute or three (until you get letdown); follow up with seven to ten minutes of high suction/slow repetition (until your breastmilk stops squirting and/or you get only a drop every few reps); end with low suction/fast repetition for the rest of the session;

13) Add a touch of olive oil to the flanges if you're getting pump-burn; use Lansinoh to moisturize your nipples after pumping (not before -- it is sticky and can make the friction worse); if you've really got a pump-burn or backache problem, consider these sorts of flanges;

14) Cardinal rule: if you're looking to increase your milk production, frequent pumping at 15-20 minutes is better than infrequent pumping for longer. With the latter, it may seem like you're getting more with each pump, but the overall number of ounces per day will be lower.

15) Keep a record of the number of pumps you do per day, the number of ounces you're getting, and the number of ounces you're drinking.

16) Don't watch the pumps! You'll only stress about it. Find something to read or listen to.

17) Many women believe they need galactagogues to increase supply. Often their supplies are fine, or would benefit from more time, calories, or liquid intake. Make sure you do research before using a galactagogue. Oatmeal, for instance, hasn't actually been proven to assist with supply -- any help is likely the increase in calories when a mother makes sure to eat regularly. Blessed thistle has been praised, as has fennel: these are in Mother's Milk tea. Again, it is likely that any increase seen is due to the liquid intake. Fenugreek is the only galactagogue I'd trust -- but be aware of potential side effects.

18) Yes, doctors used to suggest drinking beer, though they've ceased doing so. It's the extra hydration and calories that help, not the beer itself. In fact, alcohol can have adverse effects on breastfeeding. It isn't forbidden for a breastfeeding mom to drink beer, though. The alcohol content in breastmilk mimics the content in the bloodstream: wait an hour for a pint of 5% beer to metabolize, and you won't need to "pump-and-dump." However, plain old water is by far a better choice, if you're going to drink anything.

19) If your production is starting to suffer in later months, have a Pump-a-thon! That's two hours for twenty minutes each, all day.

Saving Money & Time
* Glad freezer bags are just as good at storing milk, for a fraction of the cost of milk-specific bags. Put one milk expression's worth in each sandwich-sized bag, "burp" the extra air out, and lay it flat in your freezer. When you've enough, double-bag the lot in a gallon-sized bag. Or freeze milk in ice cube trays and put the frozen cubes in freezer bags. Each milk cube is about 1 ounce.
* Instead of spending money to buy an expensive hands-free bra for pumping, try buying a sports bra and cutting small slits in the front, or looping rubber bands around the flanges and your nursing bra hooks.
* Rinse used pump parts and put them in the fridge between pumpings -- that way you'll save on dishes. You'll want to wash them eventually, but doing two pumpings with the same parts, properly chilled, is fine.

Built up a large freezer stash? Save a NICU baby! Donate your milk to an approved Milk Bank.

What Do You Use?
* Ameda Purely Yours (backpack version features a dual electric pump with manual option; you can also buy additional custom flanges and inserts to make sure your nipples get a good fit)
* Sassy MAM Anti-Colic 5oz (silicon nipples, BPA-free plastic, unscrewable bottoms)
* Itzbeen Timer (though you could just as easily use a free online stopwatch)
I use Ameda pump bottles when pumping and transfer the milk to the MAM bottles for fridge storage (or Glad bags, if I'm freezing milk). When in a true hurry, I can fit the ends of my flanges into the MAM bottles, though I have to hold onto both, since it isn't a screw-tight match. All products are available on Amazon.com.

Exclusively Pumping
kellymom.com :: Links: Exclusive Pumping
Exclusively Pumping Rules

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