All About That Pump

Answers and info from All About That Pump, a Spright workshop held June 10, 2016, with Nancy Held, RN, IBCLC, co-founder of DayOne Baby, and head of perinatal operations at Spright

Nancy, what’s the weirdest place you’ve ever had a mom tell you she pumped?

Weirdest place I've had a mom tell me she pumped was on a San Francisco fire truck!  She was a firefighter and we found a way to have her always have a battery pack for her pump with her (no plugging into the cigarette lighter on a firetruck!) and that gave her the flexibility she needed.  She pumped for 6 months once she was back to work as a firefighter!

Can you share a little bit about your background?

I am an RN and an Internationally Board Certified Lactation Consultant. Before Spright, I co-founded DayOne Baby, a San Francisco based parenting/breastfeeding education and support center. I'm also the mom of two breastfed kids and one sweet grandbaby.  I stayed home with my first and easily breastfed for a year while with my second baby I went back to work at 8 weeks and dealt with the challenges of pumping and working first hand.  I later went on for my Master's Degree in Nursing and wrote my master's thesis on Supporting Breastfeeding at Work- so this is a topic near and dear to me!

You’ve worked with a lot of new moms. What’s the #1 piece of advice you’d give pumping moms?

The #1 piece of advice I give pumping moms is to try and keep in perspective that you won't be doing it forever!  It definitely may seem like it at the time but looking back, most working moms realize that the time spent pumping represents a small blip in your child's life and you and your child will reap the benefits for many years to come.

Is the general rule of thumb that it's OK to mix milk as long it's the same temp? Even if the milk was pumped different days?

Yes, totally fine to mix pumped milk that is the same temperature from different days. The key is to remember how old the oldest milk is, and time how long the milk is good for based on that date and time. Temperature mostly matters if you try to pour warm, freshly pumped milk into milk that has already been frozen and then refreeze. The warm milk will thaw the top of the frozen milk and then it will refreeze, which is not good.

Can you freeze milk that has been refrigerated?

Yes, you can freeze milk that has been refrigerated as long as it is not older than 48 hours old. At 48 hours you should try to decide if you will use the milk in the next day or so. If yes, keep it in the fridge. If not, freeze it.

Can you re-refrigerate milk that has already been cooled to room temp but not used?

Yes, you can re-refrigerate milk that has not been used as long as you put it back in the fridge or a cooler within an hour.

I'd like to start storing a frozen collection for an upcoming weekend away from baby - what is your pumping schedule recommendation for doing so while still having a bottle or two on hand?

In order to start a "milk bank" of frozen milk, most women pump once a day, specifically for the freezer. That means, in addition to whatever you are doing with feeding or pumping, one pumping a day is dedicated to storing milk. Most women find they can pump the most milk early in the morning (6-8am), right after the first feed of the day. Even though you fed, there is usually still plenty of milk to pump and store. Your breasts can also be "trained" to produce extra milk at this time if you are consistent and do it around the same time every day. It's like telling your breasts you have twins, but only early in the morning.

If you are pumping for an evening feed so your partner can offer a bottle, continue doing that. The pumping for storage should be an extra pumping.  You can also think about pumping what you can when you can, knowing you may not be able to pump a full bottle's worth.  For instance, if your baby usually nurses on both sides, but one feed just does one side and falls asleep, grab the pump and pump what you can.  It's great to have different amounts of stored milk (1-2 ounces) for growth spurts or if you are running late but will be home soon and don't want the baby taking a full bottle.

Any tips on how to build a freezer stash when planning to return to work? How much frozen milk should you have on hand before you go back to work?

The amount of frozen milk that is ideal to have on hand is 10-20 bottles. Depending on your baby's weight and age, most moms store 3-4 ounce bottles. Many women return to work with just a few bags of milk in the freezer and do fine. The goal of the milk bank is help decrease your anxiety if you miss pumpings at work, so you can just grab an extra bottle/bag if you run short.

How do you use your freezer stash when you begin working/pumping? Workandpump.com recommends that you only feed what you pumped the day before and frozen milk is just for covering for accidents/spilled milk/etc.

Yes, fresh milk is always best so what you pump today is what is given to the childcare provider tomorrow. But if you run short, you pull from your frozen stash.

Any tips on pumping while at work?

Have a conversation with your employer before you return to work so everyone's expectations are clear. The Affordable Care Act requires all companies with 50 or more employees to provide a private room with a chair and an electrical outlet for employees to pump in and to provide you with break time (usually 15-20 minutes) to pump throughout the day. Knowing where this mother's lounge is before you go back helps you figure out timing.

Pack up items the night before so you don't forget pump parts!  Happens all the time and is a real challenge to get to work and realize you forgot some of your pump pieces.
Always have a spare blouse and bra pads at work in case you leak!

No need to wash out pump parts between pumpings during the day. Just place the pieces in a clean zip-lock bag and refrigerate them until your next pumping! When you go home, soak the parts in a bowl of hot, soapy water until you have a chance to clean them thoroughly or put in the top rack of the dishwasher. You can also use Medela's quick clean microwave steam bags but most professionals feel you don't need to do this everyday if your baby is healthy.

I am currently away from 8.30am- 6.30pm and my son has three bottles about 3.5-4oz each while I am away so I pump three times. Will this always be the case or will the frequency/quantity change over time as he gets bigger?

What your baby takes at 4 months in terms of volume of milk is usually the maximum amount that they need. Most babies max out at 32-36 ounces in 24 hours, picking up the extra calories in solid foods from 6-12 months. Depending on how well your baby sleeps, it depends on how many of these 32-36 ounces are taken while you are at work!

My baby seems to be drinking more than I pump during the day. Besides pumping again at night what else can I do to up my supply?

It is unfortunately very common for many women to have challenges keeping up with their baby's demand for milk, especially once the mom goes back to work. Some suggestions for helping to increase your milk include: Nursing as frequently as you can (the baby can almost always do more for increasing your milk supply than a pump!). Frequent nursing (every 1.5-3 hours) is more helpful for increasing a milk supply than duration. So nursing or pumping more often is always better than pumping or nursing longer.

It's also helpful to be sure you aren't dehydrated. Drink to thirst and try to get in the habit of always grabbing a glass of water every time you nurse or pump.

There are many foods and supplements to help increase your milk supply as well. Mother's Milk teas and/or lactation cookies are an easy way to start. Supplements such as Fenugreek, Mother Love's More Milk Plus and Shatavari are usually very effective but you should check with your lactation consultant or doc for their specific recommendations. Most of these need a few days to kick in so don't give up on them before they have had a chance to work. I have seen moms experience huge increases in their milk supply with Fenugreek so I am a believer!

How often should you change the membrane on the pump?

The white membrane on the yellow valve in Medela pump kits is a surprisingly important part of your success with Medela pumps. If the membrane is torn, missing or not laying flat on the yellow valve, you may get little or decreased suction and therefore less pumped milk. Depending on how much you use your pump and how careful you are handling the membranes, I would say you should replace them at least every 3-4 months or any time you are experiencing decreased suction. They give you a second pair because of this and because many moms lose them down the garbage disposal!

How do I know if I have the right size flanges? The instructions on the side of this box are super confusing.

The flange should fit over your nipple and form a seal around your areola and when the pump is turned on, the nipple can move freely within the shaft of the shield and the areola is gently compressed.

If the flange is too big, too much of your areola is taken into the shield and that could also decrease how much milk you can pump since it can pinch some milk ducts and slow the milk flow.

It's all about your comfort and knowing that the standard 24mm flange only fits about 50% of all women- so there is a good chance if pumping is hurting or you feel like you aren't getting most of the milk in your breasts, you should probably go up one size to the 27mm flange. In my experience, 95% of women are using too small of a flange, not too big!

And, since most of us aren't symmetrical, you may need one size flange for one breast and one for the other or change sizes as your breasts change over the months. It is a bit of a guessing game but it shouldn't hurt!!

You’ve mentioned bringing in your pump for a quick check-up. When should you do this and what are you looking for?

Anytime you notice you aren't getting as much milk as you expect and you still feel like you have plenty of milk left in your breasts, consider it could be a pump problem, not a supply problem. I always feel bad when a mom blames herself for having a milk supply issue when many times it's a pump issue! There are a huge range of pumps out there and they aren't all the best quality and some may last longer than others. Medela and Ameda pumps are the gold standard since they have stood the test of time and are usually very responsive when you call and tell them about an issue you are having with your pump. I can tell you that a surprising amount of the time when we check a pump that isn't working correctly, it's a problem with the membrane, so check that first!

What are your thoughts on the Freemie collection cups?

Personally, I am not a fan of the Freemie cups. I totally love the idea of something less obtrusive but the moms I know that have used it say their milk supply has dropped since they can’t get as good of a seal with the cups as with flanges. Also, the plastic is frosted so you have no way of seeing if you positioned them correctly on your nipples or how much milk is in them.

Are there any pump accessories that can help up your milk output? What about the Pumpin' Pals flanges? Or duckbills?

Duckbills don't make any difference in terms of pumping more more milk, they just are one piece to clean rather than the yellow valve and white membrane. The Ameda pumps all use Duckbills and they seem not to disintegrate as easily as the white membranes but I wouldn't go out of my way to buy them for other pumps. 

I love Pumpin' Pals. They are angled pump flanges that fit into any pump flanges you already have but have a right angle to them so you don't have to strain your neck and shoulders leaning over to pump. Many moms have found they get more milk when they pump with Pumpin' Pals because they have ridges that massage the breast a bit, helping the flow of milk.

Also, there is a great deal of research showing that if a mom massages her breasts during a pumping (which is only possible if you are using a hands-free bra/bustier like Simple Wishes, she may get a lot more milk. Again, a pump can never obtain as much milk as a healthy baby can!

Going on a business trip, bringing my pump. Any advice about flying home with the breast milk?

When traveling by plane with breastmilk, it's always a good idea to tell the TSA agent that you have breastmilk with you since you are allowed to break the 3ounce liquid rule with breastmilk and formula. I usually suggest putting the milk in a cooler with a blue ice pack vs transporting frozen milk since if the frozen milk defrosts, it will all need to be used within 24 hours

Since it's a business trip, you could ask your employer to cover the cost of having the milk shipped home for you. Companies like milkstork.com will ship packing materials to your hotel and then you hand back the packed milk to the hotel and they ship it FedEx to your house. It should be a reimbursable expense, just like other business travel expenses. It depends how long you will be gone — if it's just an overnight trip, bring the milk back with you. If the trip is more than that, consider having it shipped home.

Can you talk me through the logistics of pumping on a plane? I might have to do this soon and the thought of it is super stressful. Where do you go? How do you do it discreetly?

Suggestions for pumping on a plane: Consider selecting a window seat (although that may not be your first thought!). It is much easier to be discreet while pumping or feeding if you are not on the aisle. The window seat lets you only have one side exposed. Many women use nursing scarves or a swaddle blanket to cover themselves when they are pumping. The noise of the plane will cover up the noise of the pump!

After I’m done pumping on the plane, any tips for discreetly removing the flanges/bottles and packing everything up?

I would suggest facing the window of the plane to dismantle everything. It's surprising how oblivious most people are! Most of the time they are all thinking about themselves and not worrying about what you are doing

I’m an exclusive pumper trying to wean. I've been paring back frequency and duration and have been weaning for at least 6-8 weeks. Any additional tips on weaning? Any thoughts on how long this process takes?

Let me congratulate you on hanging in there, exclusively pumping for so long! You are a super mom! In terms of weaning from pumping or breastfeeding, our goal is for you to do it gradually, which is exactly what it sounds like you have been doing. We suggest eliminating one pumping or feeding every three days or so. The pumping you are dropping should be around the same time of day, every day. In other words, you drop the noon pumping consistently, not the noon one today and the 8pm one tomorrow etc. Weaning gradually allows you to let your body adjust and minimize issues like plugged ducts and mastitis.

And as much as I am sure you will be delighted to kiss your pump goodbye, just know it's not uncommon to have hormones go a bit weird again- It's pretty common for women to experience the blues for a week or so after they stop producing milk as their body adjust. Fun times.
You might want to prioritize the pumpings that you find the most annoying as the next ones to drop and leave the ones that are the easiest to do/or capture the most milk for last.

Is it possible that switching from my hospital grade Medela to the Pump in Style (for travel) and then back is causing me to have clogged ducts?

Yes, there is a difference of the quality of the suction and effectiveness of the Symphony (hospital grade pump) and your Pump in Style. However, if you try massaging your breasts during pumping with the Pump In Style, especially where you have experienced clogged ducts before, you can help minimize the clogged ducts.

Lecithin is suggested for dealing with recurrent plugged ducts. It's basically a form of soy that is a fat emulsifier, so it helps prevent the clogging. 1200mg 3-4 times a day. Can buy it anywhere. Really works!!