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Pumping 101: how to use a breast pump

Pumping breast milk for the first time can be quite daunting. How does this pump work? Which settings should I use? How hard, how often and for how long should I pump? This post will answer all those questions.

Pumping title

First things first: choose your pump

The first important thing you need to do is to choose the right breast pump for your needs. The best pump for you will depend on how often or how much you need to pump, your budget and your personal preferences. If you’re not sure which breast pump to get, check out this post – it explains exactly what types of pumps you get and what situations each pump should be used for.

How to use a pump

1. Fit and position

It’s incredibly important to ensure that the flange of your breast pump is the correct size for your nipple. The diameter of the flange opening should be a bit larger than your nipple, allowing your nipple to move backwards and forwards freely when you apply suction. A flange that is too small will damage your nipple, and one that is too large will be ineffective. This picture should give you an idea of what a good fit looks like:

Pump flange fit

Positioning the breast pump is simple: simply put the opening dead centre over your nipple. Be sure to hold the pump flat on your breast, so that the “tube” part of the flange is in line with your nipple. If you tilt the pump downwards while you’re pumping (which can easily happen if your hand gets tired), it can damage your nipple.

Pump position

2. Apply suction

When you switch on the pump (or, for a manual pump, start squeezing), you may be tempted to put the suction as high as you can stand, thinking that this will give you the most milk. Not true! The moment you set the suction so high that it hurts, you are inhibiting your let-down reflex – and no let-down means no (or very little) milk!

What is a let-down?No, we’re not talking about a disappointment! A let-down is more properly known as the milk ejection reflex. In simple terms, it means that your milk starts flowing freely.

During the let-down, your brain secretes a hormone called oxytocin. Oxytocin causes all the muscles inside the breast ducts to contract, which literally squeezes the milk out of the breast. You may feel a squeeze or tingle in your breast, or you may notice milk leaking from the other breast – or perhaps the only sign is that your baby suddenly starts to swallow with every suck. When pumping, you will notice the flow of milk suddenly increases.

The best way to get a good let-down is to mimic the way a baby feeds at the breast. Babies always start with quick, fluttery sucks, which stimulates a let-down. Then, the moment you milk lets down and the flow increases, they switch over to a slow-and-steady suck. To mimic this with your breast pump, you can do the following:

  1. Start with low suction to stimulate the let-down. Some electric breast pumps actually have a “let-down” setting, which gives you a minute or two of quick, gentle sucks. If your pump doesn’t have this function, simply put it on a low setting – it should feel almost ticklish. With a manual pump, just give quick, soft squeezes (that’s one of the things I love about manual pumps – total control!) Alternatively, do some “soft and quick” hand expressing before you start pumping.
  2. Once you have a let-down (i.e., the milk starts to flow), you can switch things up a gear. Increase the suction to the point where it starts to get uncomfortable, then dial it back a notch. Basically, you want to have the highest setting that does not hurt. With a manual pump, aim for 1 squeeze every 1,5-2 seconds – that is more or less the speed at which a baby sucks.
  3. When the flow of milk stops, you can repeat number 1 above to stimulate a second let-down.

How often, how long, how much?

Why are you pumping?

Before we go any further, you need to answer one question: why are you pumping? This will determine all the rest that is to follow. Some common reasons for pumping are:

  • Pumping all of baby’s feeds when baby cannot feed at the breast, for example if your baby is in NICU or can’t latch for whatever reason.
  • Pumping for some missed feeds, e.g. when you are at work
  • Pumping in-between feeds while baby is still taking all his feeds from the breast, e.g. if you are building a stash while you prepare to go back to work, or if you are trying to increase your supply.

In each of these situations, you will pump on a different schedule. So once you know what your situation is, we can answer the two other important questions: how often should I pump, and how long should each session be?

How often should I pump?

The basic guideline for pumping is to make up for every missed feed – in other words, you want to pump often enough that you are removing all the milk that baby would have been removing if you were breastfeeding. Based on research and experience, it seems that two things are necessary to maintain a steady milk supply:

  • The breasts need to be drained at least 8 times in 24 hours (although some women can get away with 6 or 7, and others need 10 sessions)
  • There should be no long gaps between breast emptying sessions. It seems the furthest you can push it is one gap of 6 hours, although I don’t advise that you go over 4 hours before you supply is well established.

Put in practical terms, it looks like this:

  • If you are pumping for all of baby’s feeds, you need to pump 8-10 times in 24 hours. That may mean you pump
    • every 3 hours around the clock (e.g. 6am, 9am, 12pm, 3pm, 6pm, 9pm, 12am, 3am, for a total of 8 sessions in 24 hours)
    • or every 2 hours in the day and every 4 hours at night (eg. 6am, 8am, 10am, 12pm, 2pm, 4pm, 6pm, 8pm, 10pm, 2am, for a total of 10 sessions per 24 hours – great for building supply and getting a bit more sleep at night)
  • If you are pumping at work, try to pump every 3 hours or so – this will usually mean two or three pumping breaks in a standard work day. Remember, in South Africa you are entitled to pumping breaks by law.
  • If you are pumping in-between breastfeeding, you can pump after feeds, or feed baby from one breast and pump the other one. If you are trying to increase your supply, you will need to do this several times a day.

How long should pumping sessions last?

The short answer to this is: pump for as long as it takes to get enough milk out! There really isn’t a fixed number of minutes. The amount of time it takes will depend on how strong your let-down is, how easily you respond to a pump and how much milk your breasts contain at a given time.

The follow-up question, of course, is this: how much milk do you need? Use this as a guideline:

  • If you have a newborn who is in NICU or not latching, you want to pump until you bring in a full milk supply, which is at least 750 ml per 24 hours. So a simple rule of thumb is: aim for 100 ml in each of your 8 sessions. Just know that it will take a week or two of pumping to get there!
  • If you are pumping at work, it will be a bit of trial and error to see how much milk baby takes in a day; I’ve seen babies take anything from 300 ml to 600 ml in a standard 8-hour workday! It also depends on how much baby is drinking at night, and whether baby is on solids. For planning purposes, 450 ml per day is a safe “guesstimate” (based entirely on experience – few babies need more than that, and most can get by with less)
  • If you need to increase your supply, the important thing is to keep pumping until all the milk is out – and then some. By pumping for a few minutes after the flow of milk stops, you are signalling your body to increase milk production. You will also do this if you are exclusively pumping, but don’t yet have a full supply.

Common mistakes

It can be utterly depressing if you set everything up, start pumping… and get only a few drops. But I would say that is more often than not what happens, at least in the beginning. Here are a few common pitfalls that catch almost everyone at some time or another:

Unrealistic expectations

Let’s make one thing clear: it’s very, very unusual to get significant volumes when you first start pumping. Trust me on this: even I, who could at one stage pump 500 ml in a sitting, started out pumping 10 or 20 ml between feeds. Why? Well, there are several reasons. The biggest one is that your body needs to learn to respond to a pump. Our bodies and brains are hard-wired to respond to a baby suckling – the cold, hard plastic of a pump is a strange, foreign sensation. So it takes time for your body to learn to respond to the pump; and even with all the practice in the world, your body will never give as much milk to the pump as it would to the baby (I read that a study found that a pump can at best – at best­ – get about 2/3 of the milk out of the breast!).

Another factor that plays a big role is timing. If you are in the first few days after birth, your body is only producing colostrum. Colostrum is present in small volumes and it’s thick and sticky and extremely difficult to pump – you will almost certainly get better results with hand expressing. On the other hand, you may be pumping in-between feeds. In this case, you are pumping the “leftovers” – only after several days of regular pumping will you increase your production enough that you will start to get larger volumes.

Panicking

Try not to stress about how much you’re pumping. I know, that’s the most annoying bit of advice ever! But if you are stressed and worried, it inhibits your let-down reflex. So the more you stress about how little you’re pumping, the less you’re able to pump, and the more you stress – that’s not a good situation to be in. So cover the pump or close your eyes, listen to some relaxing music and focus on deep breathing. It sounds corny, but it works.

Poor flange fit

If the flange of your breast pump is too small or too large, it won’t be effective. If your nipple can’t move freely and it’s rubbing against the sides of the flange’s “tube”, you need a bigger flange. If your nipple and most of the surrounding areola are being pulled into the flange tube, you probably need a smaller flange. If you are in doubt, a lactation consultant can help you check the fit. The tricky thing is that only certain breast pump manufacturers make pump flanges in a variety of different sizes, so getting a perfect fit can be a challenge.

Setting the suction too high or too low

You need to find the “sweet spot” in the amount of suction that you apply. Too little suction, and nothing will happen. Too much suction, and you will cause pain, which will inhibit your let-down reflex. I’ll repeat what I said earlier: you want to have the highest amount of suction that is still comfortable. So if you get to the point where it hurts, dial it down a notch; you’ll get more milk that way. I’ve never seen a case where using the maximum setting (or squeezing the handle of a manual pump all the way down) was a good idea; you always get more milk somewhere in the middle.

Old or worn pump parts

We often forget to check the pump itself. If there is a small opening letting in air anywhere on your pump, it won’t generate suction properly. How to check this: close off the opening of the flange tightly (you can press it against a fleshy part of your body or use something like a rubber ball). Apply suction, and then stop the pump, holding the suction. If you hear any hissing of air, or if the pump loses its “grip”, you have a leak somewhere. Check all the connections, and make sure the valve of the pump isn’t damaged.

It’s also important to note that electric breast pumps aren’t designed to be used for more than one baby. So if you have a breast pump that you inherited from a friend (bad, bad idea – don’t do it) or a pump that you used for a previous baby, there’s a good chance that the motor is simply worn out. I’ve found that the most “long-lived” pumps are manual pumps, because there are fewer parts that can wear out or break down.

Still not pumping enough milk?

If you’ve checked all of the above thigs and you’re still not getting enough milk out, you’ll need to try some more advanced tactics to increase our pumping output. I’ll be posting more on that later in this week, so watch this space!

In summary

So, in summary, let’s highlight the most important points for successful pumping:

  • Choose the right pump.
  • Make sure the pump flange fits well around your nipple – not too big, not too small.
  • Position the pump flange front and centre over your nipple, and make sure you are holding it straight ahead in front of your nipple.
  • Start with gently suction to stimulate a let-down.
  • To get the most milk out, use the highest suction that is still comfortable. More is not better, and pumping should never hurt!
  • The reason you are pumping will determine how often and for how long you should pump:
    • Pump for every missed feed
    • Pump for long enough to get enough milk to meet baby’s needs
    • If you are trying to boost your supply, keep pumping for a few minutes after the milk stops flowing.
  • Remember that it takes time for your body to learn to respond to the pump, so relax and just keep going.

Have you ever pumped? How easy or hard was it for you? Do you have any tips to make the process easier? Please share in the comments below!

Breast Pumps and Business Suits: A Practical Guide to Breastfeeding and Working

 

Want to know more about breastfeeding as a working mom? Check out my e-book, Breast Pumps and Business Suits. It contains absolutely everything you need to know about making a success of breastfeeding and working! Click here for more info.

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