EXCLUSIVE EXPRESSING/ EXCLUSIVE PUMPING
Many women end up exclusively expressing. Some through choice, some through circumstances beyond their control. I totally understand that there can be strong emotions to work through, especially if you wanted to breastfeed directly and for what ever reason, that hasn’t worked out. I exclusively expressed for my first for 18 months, and while I don’t regret spending one second attached to a pump, it was hard work at times. When I directly breastfed my second child, my admiration for mums who exclusively express went up even more. It takes serious determination (and perhaps a little bit of obsession) to exclusively express. If that’s you, pat yourself on the back. You’re pretty awesome!
This article aims to make that process a little bit easier and help you avoid the pitfalls, so that you can meet your goals. This is just a quick summary of how to get off to a good start with exclusive expressing, but I’d really recommend reading Stephanie Casemore’s book Exclusively Pumping Breastmilk if you’re planning to express long term.
Top tips for exclusive expressing
In the first few days hand express, don’t use a pump.
Hand expressing works best in the early days because you get quite small volumes of colostrum (which is also quite sticky), these precious drops will just get lost in the pump parts. You can collect every last drop of colostrum on a sterilized spoon in a syringe, or in a small cup. Using a pump to collect colostrum can also be quite uncomfortable; hand expressing, when done correctly, shouldn’t be sore at all. I’ve got a video on hand expressing here. We also know that mums who hand express in the early days, rather than using a pump, have a better milk supply long term and tend to breastfeed for longer. Once you notice the colostrum is starting to change to the more watery milk and you get bigger volumes, then you can switch to a pump. You may still want to add in a few extra minutes of hand expressing at each session after pumping – it’s surprising how just how much milk you can still get, even after the milk stops flowing into the pump!
Little and often gets more milk
For the first few weeks, babies feed little and often. This helps stimulate a good milk supply, and ideally you want to mimic that with expressing. The time period just after milk is removed from the breasts is when milk production is highest. So remove milk more often, and your breasts work harder to make milk. Most breastfed babies feed 10-12 times in 24 hours, so aim for that. If you are finding it tough to get that many sessions in, try to do at least 8. It can be a bit easier to get frequent sessions in if you:
Go for shorter sessions Most women find that they get the biggest volume of milk with the first letdown (when the milk flow increases and “sprays” into the bottle). If you continue to pump, you’ll continue to have more letdowns, but with each letdown you get less milk. So it’s perfectly acceptable to stop after that first letdown, when the milk stops spraying and instead goes to drops, especially if you commit to pumping again within a couple of hours. So you might find that you only need to express 10-20 minutes each session.
Double pump This cuts the time you spend expressing in half, because you remove milk from both breasts simultaneously. Ideally use a hospital grade double pump, as you can adjust the suction and cycle speed, and they are designed for frequent use and will last for several hundred hours of pumping. Just a word of caution: higher suction does not equal more milk. You only want enough suction to get the milk flowing, if it’s too high, it’ll become uncomfortable and actually inhibit a letdown! There’s a lot of information out there about flange size. I tend not to worry too much about the size. Is it comfortable? Is the milk flowing? Then the size is probably ok. You may need to try a smaller or larger flange size if you are having issues though. Some mums feel a lot of friction when they pump, so you can lubricate the flanges with either some nipple cream, or a food grade oil (eg coconut, olive oil) to make it more comfortable.
Have more than one pump set This means you don’t need to deal with washing, rinsing, sterilizing after every session. Some mums will choose to store their used pump sets in the fridge in between sessions and reuse them – either in a clean box or sealable food bag. Breastmilk inhibits the growth of bacteria and we also know that breastmilk can stay at room temperature for around 4-6 hours, so this is probably ok, providing your baby is healthy, full term and doesn’t have a compromised immune system. I’d probably still wash the pump sets thoroughly at least once a day, and NHS advice is to sterilize them after washing .
Use a pumping bra (home made or purchased) This will leave you hands-free. You can either use your pumping time to relax with a drink, the tv remote, or your phone, or you can compress your breasts with your hands as you pump – this actually increases the volume of milk you get and can increase the fat content too. If you have older children to entertain, you can use this time to read them stories or play quiet games with them.
Get some sleep! Of course, your baby may wake up a lot during the night. However, rather than waking up every three hours during the night just to express, it can be helpful to express more frequently during the day, and pump at least once overnight. This feels slightly less soul destroying than pumping every 2-3 hours round the clock. So you might aim for 2 hourly during the day, with a longer gap at night, and one expressing session in the middle of the night.
Routine It may be helpful to feed your baby, wind them if necessary, then put them down for a nap, and then you use nap time to pump. Have a baby that won’t settle in a cot? Try sitting cross-legged with your baby resting in that hollow. Some mums even master using a sling and pumping
As time goes on...
Put in the hard work at the start and it will get a lot easier as time goes on. Ideally you’d pump 10-12 times in 24 hours for the first six weeks or so. The way milk is regulated starts to change at around 6 weeks. This means that you can sometimes change the frequency of pumping at around 6 weeks. Depending on your supply and your storage capacity, you may be able to reduce the frequency of sessions quite a bit.
If you have a good milk supply and are making more than you need, you might find that when you start to reduce the frequency of sessions your total volume goes down a bit. I usually suggest you need around 10% more in 24 hours than what your baby takes. That allows for a little bit of wastage, accidental spillage and a cushion for growth spurts. Your baby isn’t going to increase the amount of milk they need after about 4 weeks, and at 4 weeks, ideally your supply will be sitting at around 900-1000 mls a day. It can be helpful to use a paced bottlefeeding technique because it’s still easy to overfeed a baby if you use a bottle, even when it’s breastmilk in the bottle! Making sure you don’t overfeed is better for your baby, but also, means you aren’t under so much pressure to make loads of milk either.
Every woman has a different “storage capacity”. If you find that you only ever make a couple of ounces per session and have a small “storage capacity”, you might have to continue to express more frequently to maintain a full milk supply. However, if you can easily express several ounces per session (large “storage capacity”), you might find that you can drop quite a few sessions before you “level out”. So, after 6 weeks, you can drop a session (you’re better spacing them out evenly rather than dropping a session and leaving a big gap), leave it for a week or two, see what happens and then drop another. Some women find that they can drop the night session, but a lot of women have to add it back in if their milk supply drops (milk supply is often influenced strongly by night feeds/ expressing sessions at night time). You may also find that as you drop sessions, you have to increase the length of time you pump at each session. So for example, if you were pumping for 10-15 minutes 10 times a day, you might have to drop to 20 minutes 6 times a day, or half an hour 4 times a day.
When is it time to stop?
It can be helpful to set yourself short term goals, and then reassess at those points. You might pick 4 weeks, 3 months, 6 months, a year… but these goals are yours. It is possible to exclusively express long term, but try to cut yourself some slack if you decide to stop. Never underestimate the value of providing breastmilk to your child. Every drop, every ounce is a success, but it is HARD WORK exclusively expressing. When it’s time to stop, you’ll know, and when it’s time, you’ll feel incredibly proud of what you’ve done.