Exclusively Expressing: Sioned Hilton Offers her Expert Advice on Pumping and Expressed Breastmilk Part 1
Next in our Exclusively Expressing series, we asked our Lactation Consultant, Sioned Hilton, to answer some questions from pumping mama, Lucy. In the first part of this focused Q& A, we explore the topic, gaining Sioned’s expert advice on how often to pump, keeping your equipment clean and how to adjust pumping as your little one grows.
We loved hearing from new mum, Lucy, about her journey exclusively expressing her baby. Following our conversations with Lucy, we found she had some great questions about the topic for our Lactation Consultant, Sioned Hilton, which we thought could also be great to share with fellow #medelamums!
1. I have been told that I need to pump every time my baby feeds to establish my supply, how can I hold her whilst doing this to help us bond?
When we express either in or just after skin to skin, the evidence supports an increase in milk volume compared to not being near or next to your baby. (Hurst 95).
This can be a little bit of a juggle but whilst she is in a feeding hold (rugby or cradle) you can have your baby in mummy cuddles. You can use a single pump or if you want to double pump, you can use an Easy Expression Bustier (a hands free bra) and have your hands available to cuddle your baby in your lap or on your chest.
2. How much milk should I expect to express each time?
This is a difficult one to predict as it is programmed within the first 14 days after birth when your storage capacity adjusts to the frequency that your baby feeds/ your pumping frequency. In established lactation – after 30 days the range of normal can be 54ml/feed to 234ml per feed between different mothers.
A guide that is shared internationally for exclusively pumping mothers is volumes greater than 500ml/24 hrs with a benchmark of 750ml. The ideal for long term milk outcomes to support your baby for exclusive human milk feeds in first 6 months.
3. Should I be pumping each session for a certain time e.g. 20 mins, or should I go by volume?
You should watch and observe how your milk flows and the time it takes when no more flow is there. Your breast is programmed in that first 14 days. At the same time, your breast has a unique milk ejection reflex (MER _ let-down) that is exactly the same every time you feed and pump. There are 4 different patterns classified by Danielle Prime, one big one, smaller pulses, pulsing in wave like motions, one big one at beginning – smaller pulses and a late big pulse, and lastly – a mixture.
By watching your milk flow over 15-20 minutes, you can see how your milk flows and the pattern of MER – once you see this it is exactly the same every time you feed or pump. This can then help you to determine if you are a mum that needs to pump for longer due to a later let-down or finish when there is no further milk flow. You check the breasts for fullness and comfort – if you are well drained the breast is soft and no milk flow.
If you have a larger storage capacity – the mum with volumes 234ml per feed, then it may take longer than the mum who has 54ml – it is very individual and no one size fits all.
4. Do I need to fully empty my breast each time I pump? Is that in line with what the baby would be doing if she was nursing?
When a baby is nursing, they complete a feed when satisfied and mums feed in response to feeding cues and own comfort.
When a mum is exclusively pumping, the patterns are more time led and you miss the suckling action and interaction with your baby – so you need to ensure that the breast is effectively drained at each pumping session. The recommendations in the early weeks is 8 or more pumping sessions in 24 hrs, fully draining the breast. This suppresses the endocrine response of Feedback inhibitor of lactation (FIL) When FIL is low the breast is well drained and supports milk production. If milk remains in the breast, combined with ineffective drainage and increased times between feeds/expressing the FIL rises and mother nature uses this to regulate supply. As it increases it protect the breast tissue from engorgement and mastitis and will down regulate supply.
5. Do I need to wash and sterilise my pump each time I use it? At the start, you are advised to pump 8x per day so I'm finding this tricky.
The best practise is to wash the pump kits that come into contact with the milk after every use and once a day sterilise. Wash with cold running water, followed by hot water with detergent, rinse and dry with paper kitchen roll. Store until use.
Some mums who pump may choose to place the kit in a bag and place in refrigerator between uses, however you will have skin flora present as well as those amazing cells in your milk that protect it against the natural flora present. Best practice is to wash between uses – you can use dishwasher, steam steriliser, microwave bags or boil in saucepan as methods to sterilise daily.
6. Where can I find advice on which bottle and teat is best to use for my baby?
There is a vast amount of feeding products on the market which have many claims. All bottles now have a venting system to support the pace and flow. The teat depends upon if you wish to continue breastfeeding or if breastfeeding is not possible based upon your baby’s age and flow rate of milk.
There are so many claims but if you are breastfeeding, using a teat can influence and modify your baby’s natural suck resulting in challenges with feeding, expectations – with breastfeeding- baby has to create a vacuum and the tongue moves up and down in a flat way, initially baby does shallow rapid sucks to stimulate the milk ejection reflex and then once this is triggered the baby coordinates suck swallow breathe with deeper slower sucks.
With a conventional teat the milk is released straight away, flows with gentle compression and flows faster if it is warm. This results in your baby changing the way the lips and tongue work to regulate the flow – the tongue changes to a u shape and pushes the tip on the teat up into the roof of the mouth to regulate the flow to breathe whilst milk is flowing, the lips purse as it works to seal the teat, rather than the lovely jaw and cheeks muscles that you get with breastfeeding.
When you introduce a teat, it’s important to start with slow flow and review the flow and pace of the feed, and how your baby copes.
If you are looking at the occasional expressed milk feed with breastfeeding, look for a feeding device that supports natural tongue and vacuum associated with breastfeeding or consider a soft cup or beaker.
For more advice, talk with your midwife / health visitor or lactation specialist- as there are so many brands out there it is not possible to discuss them all.
It is a trial and error to find a system that works for you – but pacing and feeding to feeding cues are the key principles.
7. I am struggling with winding and burping her, it seems I need to do it after only a few gulps on the bottle, is this normal?
It sounds as though the flow rate maybe too fast for her. When she feeds as she swallows air is pushed out of her nose so swallowing air with the teat is less likely. Changing her feeding position and teat flow rate may help.
With some babies, side lying feeding can be useful to pace if the flow is still too fast. Adjusting the angle of the bottle – as it drains sometimes, she may suck air as the milk level adjusts.
If she is reluctant to share her wind, you can practice some gentle tummy massage techniques, try small rotations following her tummy to small intestine, down to groin, across and back up to tummy – anti clockwise – you can do these from newborn. Sometimes, what mum eats can make little one a little gassier – Sunday dinner with lots of cruciferous vegetables are a boost for mum’s diet but they can be a little more unsettled next day when they have had those subsequent feeds. Keep a note on what you eat to pick up any foods that are contributing factors and plan the next day to be chill and cuddles if it’s a big challenge.
8. Will the amount of milk I produce change to meet my baby's needs as she grows? If I am pumping to a schedule, how is that possible?
Your milk is ever-changing and tailored to her age and environment. You both are exposed to the environment so if you are in contact with a virus, your milk makes antibodies, if she starts nursery you drop and pick up, so you are again protecting her. Breastmilk changes composition protein, carbohydrates and some minerals over time – this is the same for breastfed and expressed milk.
She will tailor volumes – if she has a growth spurt, she would go to breast more, but for the pumping mum and baby she will still show that she is hungrier by her cues and appetite when she received expressed milk in bottle – these growth spurts are around 3 weeks, 3 months. As she weans again, she will adjust what she takes from the bottle, but you as a pumping mum can see if you need to be pump as frequently as she takes more quantity of food and tailors her milk.
9. I am using the Swing Breast Pump and have read that I should be pumping for 20 mins each session - is that 20mins total or per breast? The article isn't clear if that is for a single or double pump.
There is no fixed time for effective emptying of the breast it is individual to breast storage size, flow of milk and as you mention if you single or double pump.
What the scientist have seen and measured is that once you get an effective first milk let-down the average pumping session is around 12 minutes – but the range can be shorter or longer. This research is with a double pump – these are guides and in combination with watching your milk ejection pattern, checking that you have the correct breast shield size, vacuum strength, positioning of the ‘flange’ a guide would be around 15-20 per breast or until no milk further flows.
If you are a mum whose milk drained in 10 minutes, why would you pump and get no more milk for another 10! Times are individual to your flow, storage capacity and if you single or double pump.
10. Should I try to ensure that she finishes each bottle each time she wants to feed? How much should she be having?
Breastmilk is so amazing that it has appetite regulating hormones.
If she was breastfeeding and had reached satiety, she would come off breast even when there is more milk there in the breast. With the conventional teat, this is more difficult as the flow of milk will continue even if she is full – this is where the discussions are for babies who are fed by formula and link that they tend to demonstrate a higher trend for being obese later in life.
Her tummy has adjusted to the volumes – she may be content with 90-120ml and feed every 2-3 hours, or she may take more and feed 3-4 hrs. Breast milk is so easily digestible with very little bulk/waste so it will be digested quickly through her system hence – ready for next feed sooner. Cue based feeding will help with this. Some feeds will be a thirst/power snack other maybe a longer or come back for a dessert after a short pause, other feeds may be grazing as she goes through a growth spurt.
We hope you found this information useful, be sure to come back next week to see part 2 of the exclusively expressing Q&A!
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