Breast Pump Pointers: Your Ultimate Pumping Guide

Whether you're returning to work, have seen your milk supply kick into overdrive, or have concerns about missing the occasional feeding, a breast pump may be your saving grace. Expressing and storing milk allows your baby to reap breast milk's abundant health benefits.

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Pumping also solves a host of other issues; for example, pumping can help relieve engorgement, clear a clogged milk duct, correct an inverted or flat nipple, increase your milk supply by creating a bigger demand, and give mothers of hospitalized babies (such as preemies) a way to give their infants breast milk. Plus, you'll save some serious cash by opting for breast milk over formula – approximately $124 per month, according to Consumer Reports.

There are lots of decisions you'll need to make when picking the right breast milk pump for your needs.The two main kids of pumps are hand pumps (you move a handle to work the vacuum motion) and electric pumps (a battery or electricity runs the vacuum). A hand pump is cheaper, more portable, and sometimes more comfortable. But an electric breast pump can be more efficient, especially if it works both breasts simultaneously.

Shari Criso, M.S.N., R.N., a certified nurse-midwife and board-certified lactation consultant in Flanders, New Jersey, recommends that you look for three key features in a breast pump:

1. Adjustable speed and suction, so you can customize your pumping to what is most comfortable for you
2. A closed system, meaning one that prevents milk from backing up into the pump parts or tubing
3. Multiple-size flanges that either come with the pump or are available for purchase (the flange is the "dome" that fits over your breast; if it doesn't fit well, you may not be able to express milk effectively and it could be painful).

Keep in mind that it's not unreasonable to own one of each kind of breast pump (manual and electric), if you can afford it.

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Still not sure what breastfeeding pump is right for you? Talk to your lactation consultant. "What works best for one mom might not be the best for another mom," says Kathy Parkes, BSPsy, RN, RLC, IBCLC, a certified lactation consultant at Christus Santa Rosa Children's Hospital in San Antonio, Texas. "We ensure you get what you need for your particular situation." If you're exclusively pumping, for example, you'll want a hospital-grade rental pump. "The kinds of pumps you buy in stores are not meant to build up milk supply without Baby being at the breast," she says.

Delegate time to practice positioning and using your breast pump. The action of "letting down" to a pump is hormonally triggered, and it can be psychologically started or stopped. "It takes practice to get your body to cooperate with a pump," Parkes says. And don't worry if you don't produce a lot of milk at first. In fact, you're making progress if you can cover the bottom of the container the first time, she says. "After all, your body naturally responds faster to a soft, sweet baby than to a hard, cold breast pump."

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Criso recommends pumping very small amounts—about 1-2 ounce—every day beginning about one week after delivery. You can then feed your baby that milk with a bottle at the beginning of one nursing session and finish the feeding at your breast. Doing so will get your baby accustomed to taking a bottle. "Up until about six weeks postpartum, you're establishing your milk supply and you have just enough to feed your baby," she explains. Criso adds that many babies will reject the bottle if you wait four to six weeks to introduce it, which is often recommended.

After the six-week mark, you can begin pumping greater amounts—often 2 to 4 ounces. The best time to pump is often first thing in the morning, as many women have ample milk to both nurse and pump. But keep in mind, you need to continue giving your baby a bottle— Criso recommends once a day, even if only an ounce or so—or she may reject the bottle altogether.

Like breastfeeding, pumping should bring a natural tugging sensation. It should never, ever hurt. "There should never be pinching, biting, or toe-curling pain," Parkes says. If you experience discomfort, lower the suction setting or adjust the number of cycles per minute. You might also buy different-size breast shields that more comfortably fit your nipples. Can't change the settings? "Try a different breast pump," Parkes says.

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To make the pumping process more fruitful, get comfortable and encourage letdown beforehand. Gently massage your breasts, apply warm compresses, or remove your bra and move forward, gently shaking your breasts side to side, Parkes says. You can also let your baby inspire letdown. Drape her blanket across your shoulders, listen to a tape of her babbling, or scroll through pictures or videos of her while pumping. Indulging in a pleasant distraction – such as watching TV, taking a warm shower, listening to music, or talking to a friend on the phone – can also aid milk flow. 

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The more you pump, the more milk you produce – so once you become a pro at pumping, you'll start seeing results. Most moms with a well-established milk supply and lots of practice with a high-quality breastfeeding pump can get 2-4 ounces of milk per pumping in 15-20 minutes, Parkes says.

To increase your breast milk output, Corky Harvey, a registered nurse and certified lactation consultant, suggests pumping at the same time every day. "If you pump for a few minutes and nothing happens, quit for a few minutes and relax before trying again," Harvey says. "If the flow stops, eat or drink something and then make another attempt."

Although it requires a bit of coordination, women may also be able to increase their milk flow by pumping on one side while they nurse the baby on the other or by using a pump that attaches to both breasts at once. And remember, not all women are the same. While some may be able to use a manual breast pump to get the job done, others may need a stronger electric breast pump.

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How, exactly, do you know when you're done pumping? Kathy Lewis, RPA-C, LCCE, IBCLC, cofounder of Ten Toes in Staten Island, New York, recommends stopping after 20 minutes, or two minutes after you stop producing milk. "Women do more damage if they stay at it all day," she says. If you're unsure whether or not you're finished, gently massage your breasts. If that doesn't produce any milk, go ahead and disconnect.

It's still possible to maintain constant skin-to-skin contact with baby while pumping. Nurse right before you head to work or school, and nurse as soon as you get home. Then nurse throughout the evening and night, Parkes says. "Babies often will wake up frequently at night to make up for the lack of Mom contact during the day," she says. And if you exclusively pump, make sure your baby is held in your arms – or in someone else's – at all feedings.

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To avoid wasting milk, store it in 2- to 3-ounce increments (or in amounts your baby typically eats at each feeding). Keep your milk in designated nursing bags, which are thick, sterile, and meant for breast milk, Lewis says. Other smart storage options? Plastic or glass containers or bottles with tight lids or seals.

Expressed milk can safely be stored at room temperature for four to six hours, in the fridge for eight days, in the freezer for four months, or in a deep freeze for six months to a year, Parkes says. Label each container with the date and time the milk was pumped. And if you're freezing it, leave an inch of space at the top of the container to allow for expansion. Stick milk in the back of the fridge or freezer, where it's less likely to warm or thaw every time the door is opened. Keep in mind that thawed milk should be used within 24 hours. 

It's a good idea to have a week's supply of breast milk on hand so you're never caught in a pinch when the need to feed arises. In addition, "I always tell Mom to put a half-dozen 1-ounce 'snacks' in the freezer," Parkes says. "If Baby is hungrier that day, she can have her regular 2- to 3-ounce serving as well as the snack, without wasting milk from another full serving she might not finish."

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When it's time for a feeding, serve oldest milk first. "The consistency of the milk changes with the age of the baby," Lewis says. Thaw frozen milk by running it under warm water or placing the bag or bottle in a cup of warm water until it reaches room temperature. Never boil or microwave breast milk – that depletes valuable nutrients and may create hot spots that can scald your baby's mouth. Gently shake the container to redistribute fat throughout.

After each pumping session, disconnect washable pumping parts from the tubing, place them in a bag, and put them in the fridge to "decrease bacterial count between pumping sessions," Lewis says. Or clean breast pump parts in hot, soapy water. Wipe down electrical units and batteries, but don't submerge them. Every four to five days, sterilize washable parts in a pot of boiling water, the top rack of the dishwasher (check manufacturer's recommended washing instructions first), or in a microwave sterilizer bag. Air-dry breast milk pump equipment on a clean surface.

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"Your overall goal should be that your breasts are emptied at least seven times in 24 hours, whether by nursing or pumping," says Kathleen Huggins, R.N., M.S., I.B.C.L.C., a board-certified lactation consultant in San Luis Obispo, California, and the co-author of Nursing Mother, Working Mother (Harvard Common Press). Huggins says you should aim for every 2.5 to three hours at work, or as many times as your baby will likely take a bottle throughout the day. "Be sure not to pump right before going home," she adds. "You want enough milk that you can plop down with your baby and have him get a full meal." 

While breast pumps can be pricey, woman's health care insurance usually covers lactation services. The flip side, according to Huggins,  is that while insurance companies must cover breast pumps for either purchase or rent, there is no control over the quality of pump they offer. "Call your insurance company and find out what pump they cover, then check with a lactation consultant to make sure it's high quality," she advises. "If not, you might be better off paying for it yourself."

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