Pumping 101 From A St. Joseph’s Women’s Hospital Lactation Consultant

written by: Bobbi Taman, BSN, IBCLC, CLE | SJWH

August is National Breastfeeding Month, a time to celebrate and support all mothers who are breastfeeding or breast pumping for their infants and children. Every woman has her own unique breastfeeding experience and sometimes when the pregnancy or birth has deviated from the norm, a mother can find herself with an infant in the NICU. This can be a stressful and very difficult time especially for a mother who was planning on breastfeeding. She may not know what to do to ensure that her breastfeeding journey will be a success, but with proper education, good support, and a breast pump she will be able to provide breast milk to her baby in the NICU and continue breastfeeding once the baby is discharged home. While pumping for a NICU baby can be time consuming and exhausting, it is an important way for a mother to be involved with her baby’s care. This guide is intended to help new mothers learn how to make pumping in the NICU as easy and as stress-free as possible.

Establishing your breast milk supply is first and foremost- After your baby is born, you will want to start pumping to stimulate breast milk production. The recommendation is for you to begin pumping within the first six hours after delivery or sooner if medically possible. Research has shown that the sooner you start pumping, the faster your mature breast milk will come in. A lactation consultant or your nurse will meet with you and provide you with a pump to use while in the hospital. She will also give you a personal pump kit and ensure you have the proper flange fit (very important). You will need to double pump (both breast at the same time) every three hours for 15 to 20 minutes or you can single pump 15 minutes per breast. This will include waking to pump at night. You can go a slightly longer stretches at night, but do not exceed 4 hours. In the early days postpartum, the lactation consultant may also teach you hand expression because it has been shown to be more effective for removal of colostrum which is the first breast milk a mother makes.

It typically takes a 3-5 days for your mature milk to come in and sometimes even longer. During the colostrum phase of breast milk production, it is completely normal to only pump a few drops at each session, but every drop counts! Colostrum is packed with immunological properties and the perfect nutrients for your new baby. Don’t get discouraged by the small amount you express or the time it takes to see your supply increasing, just keep pumping. The early stimulation and emptying of your breast will help build your milk supply later.

Breast milk volume is based on a supply and demand relationship, so the more your breasts are emptied, the more breast milk you will make. Breast pumping schedules should mimic a full-term infant’s breastfeeding schedule. Most newborns eat at least 8-12 times per day for at least the first six weeks and sometimes longer. The first months are very important for establishing your milk supply. Frequent pumping will ensure you produce enough milk for your baby while he or she is in the NICU and also that you continue to make breast milk for when your baby is ready and able to breastfeed.

Skin to skin is also beneficial for increasing breast milk supply. When you hold your baby skin to skin (baby in just a diaper laying between your breasts) it stimulates an increased release of Prolactin, the hormone responsible for breast milk production. In addition, skin to skin has many other health benefits for your baby such as increased brain growth, temperature regulation, and stress relief for both of you. If your baby is medically unable to do skin to skin, pump while you are looking at or touching your baby. (Pictures and videos of your baby can be used when pumping at home.)

A hospital-grade electric breast pump is the most effective type of breast pump to use when establishing a breast milk supply. You will have access to a hospital-grade pump while you are in the hospital and staying with your baby in the NICU. Some insurance companies will cover the cost of renting a hospital grade pump for home use and most WIC offices will lend hospital grade pumps to women who qualify for the WIC program. Personal breast pumps are also effective, but for the exclusive pumper, even if your goal is to eventually breastfeed, a hospital-grade pump is recommended to use in the first 4-6 weeks after birth as you establish your breast milk supply.

Expect your breast milk to change in the first few weeks in volume and in color. It will appear thick and yellow in the colostrum stage but become white as mature breast milk is coming in. Mature milk can look watery in the morning but appear creamy in the evening, much like skim milk vs whole milk. The volume you pump throughout the day will fluctuate with most women expressing more milk in the morning and less as night. Once mature milk is established, most women make between 20 and 32 ounces of milk in 24 hours with the average being 25 ounces in a day. This is approximately one ounce an hour from both breasts combined. Mature milk volume is usually established by 2 to 4 weeks postpartum but can take longer with premature birth.

Cleaning your breast pump parts is essential to prevent contamination of your breast milk. You will need to clean all of the personal pump pieces (flanges, bottles, membranes, and valves) with warm soapy water, rinse with warm water, and air dry after each pump session. Dishwashing soap and a bowl or basin are essential. It is also recommended to sanitize pump pieces at least once daily, which can be done by placing your parts in a bottle sanitizer, the top rack of the dishwasher, boiling for 10 minutes, or using a microwavable quick clean bag. You do not need to clean your pump tubing. If your tubing gets condensation in it, attach only the tubing to the pump and turn the pump on allowing air to dry out the excess moisture.

Here are a few more tips for your pumping experience:

Listen to soft music, a podcast, or try meditation while pumping. Watch television or read a book. Relaxing helps with your letdown and more efficient emptying of the breast.

Put a sock on it- cover your bottles while you pump with a pair of clean socks! Do not watch how much milk is flowing in the bottle. Stress from worrying if you are making enough milk can cause a poor letdown, which means less breast milk expression.

Use a hands-free pumping bra, this will allow you to massage your breast, eat and hydrate, or just relax. It gives you the ability to multitask while pumping. You can purchase a hands-free bra/camisole or you can make your own from an old sports bra (cut two slits in bra to slip your flanges through).

Purchase a second (or third!) set of pump parts. This will alleviate having to constantly wash pump pieces. Make your significant other the caretaker of the pump. This gives them a role in providing breast milk for your baby.

Always have food and drink available when pumping. Producing breast milk makes you hungry and thirsty! Set up your breast pump station/bag with all the necessities you will need while you pump: bottles of water, snack basket, hand sanitizer, tissues, lotion, a pillow, and a blanket. Make it cozy.

Reach out to other new mothers, especially NICU moms, for support and guidance. This can be done by talking to other mothers in the NICU, support groups, online chat rooms, or social media.

Take the time when your baby is in the NICU to learn as much about breast pumping and breastfeeding from the lactation staff and NICU nurses. Ask questions and seek out support often!

Contact your insurance company about securing a personal pump for home use if you know you are at risk for delivering your baby prematurely. This way you will have a pump available at home when your baby arrives.

Finally, having a baby in the NICU is tough and stressful. Remember to take care of yourself so that you can take care of your baby. You will need to eat healthily, stay hydrated, and rest when you can. Let friends and family help by providing meals or helping with household chores. Remind yourself that pumping is temporary and you are providing your baby with the best medicine possible. Breast milk is the gold standard for all babies but even more so for premature infants as they are at a higher risk for infection. Only you can produce this Liquid Gold for your baby!