Hands on Pumping - More Milk!

To Pump More Milk, Use Hands-On Pumping

Would you like an effective method for pumping more milk? Until 2009, most  assumed that when a mother used a breast pump, the pump should do all of the milk-removal work. But this changed when Jane Morton and her colleagues published a ground-breaking study in the Journal of Perinatology. The mothers in this study were pumping exclusively for premature babies in the hospital’s neonatal intensive care unit.
For premature babies, mother’s milk is like a medicine. Any infant formula these babies receive increases their risk of serious illness, so these mothers were under a lot of pressure to pump enough milk to meet their babies’ needs.
Amazingly, when these mothers used their hands as well as their pump to express milk, they pumped an average of 48 percent more milk than the pump alone could remove. According to another study, this milk also contained twice as much fat as when mothers used only the pump. According to previous research, in most mothers exclusively pumping for premature babies, milk production falters after three to four weeks. But the mothers using this “hands-on” technique continued to increase their milk production throughout their babies’ entire first eight weeks, the entire length of the study.
Hands-on pumping is not just for mothers with babies in special care. Any mother who pumps can benefit from it. How does it work? For a demonstration of this technique, watch the online video “How to Use Your Hands When You Pump” at: http://newborns.stanford.edu/Breastfeeding/MaxProduction.html. As a summary, follow these steps:
1. Massage both breasts.
2. Double pump, compressing your breasts as much as you can while pumping. (for a hands free pumping bra check out PumpEase that fit any brand of pump and allow you to double pump with both hands free.) Continue until milk flow slows to a trickle.
3. Massage your breasts again, concentrating on areas that feel full.
4. Finish by either hand expressing your milk into the pump's nipple tunnel or single pumping, whichever yields the most milk. Either way, during this step, do intensive breast compression on each breast, moving back and forth from breast to breast several times until you've drained both breasts as fully as possible.
This entire routine took the mothers in the study an average of about 25 minutes.
These two online videos demonstrate two different hand-expression techniques that can be used as part of hands-on pumping: http://newborns.stanford.edu/Breastfeeding/HandExpression.html and http://ammehjelpen.no/handmelking?id=907 (scroll down for the English version).
Hands-on pumping can be used by any mother who wants to improve her pumping milk yield or boost her milk production. Drained breasts make milk faster, and hands-on pumping helps drains your breasts more fully with each pumping.
 

Introducing Food and Making Milk 6-12 months

Will you still make milk once you start with solid food? YES!

Your milk still matters to your baby. And it feels great to see your breastfeeding baby thrive. Here are the basics from 6 to 12 months.

Fun Facts

• You will make milk as long as your baby breastfeeds. Your baby's time at the breast drives your milk production.
• Health organizations recommend breastfeeding for at least 1 year. (WHO Recommends 2 years)
• Your baby begins to need other foods, too, at about 6 months.
• Babies get teeth and learn to sit up, so they can help feed themselves. Now meals get really messy!
• As your baby consumes other foods, he needs less of your milk. As he takes less milk, your milk productions slows. This is normal as your body adapts to the needs of the baby.

What to Expect

• Weight gain slows. Expect a weight gain of at least 2-4 ounces (60-120 g) a week or ½ pound (240 g) a month.
• At this age, breastfeeding becomes as much about comfort as food.
• Babies love to play during breastfeeding.
• Expect lots of growing, crawling, and walking!

Things to Learn

• Try each new food for a few days before starting another.
• Try offering liquid in a cup at around 8 months.

Seek Breastfeeding Help When

• Breastfeeding hurts.
• Baby gains weight too slowly.

Even when breastfeeding is going well, you may experience some of the following:

• Your baby has fussy times. (Most babies do.)
• She wants to feed again soon after breastfeeding. (Most babies do.)
• She wants to feed more often. (This adjusts your milk production.)
• Your breasts no longer feel full. (Usually at about 3-4 weeks.)
• She wants to feed less often or for a shorter time. (Babies get faster with practice.)
• She wakes a lot at night. (Babies need to do this to get enough milk.)
• She will take a bottle after breastfeeding. (Babies like to suck.)
• You can't express much milk. (This skill takes practice.)

You Know You Have Plenty of Milk When

• Baby Gains Weight Well On Breast Alone
  • 6-12 months: 2-4 ounces (60-120 g) a week or ½ lb. (240 g) a month
    

Adapted from : Nancy Mohrbacher, IBCLC, FILCA, Lactation Consultant, Ameda Breastfeeding Products
Coauthor of Breastfeeding Made Simple: Seven Natural Laws for Nursing Mothers

Breastfeeding at Night - How Do You Know When to Stop?

Has somebody told you that your baby doesn’t need to breastfeed at night past a certain age? This age often varies by advisor. However, science tells us that in many cases, this simply isn’t true.
Why? Babies and mothers are different and these differences affect baby’s need for night feedings. Some babies really do need to breastfeed at night, at six months, eight months, and beyond. This is in part because if their mother has a small “breast storage capacity” and tries to sleep train her baby, her milk production will slow, along with her baby’s growth. To find out what this means and if this applies to you, you need to know the basics of how milk production works.

Degree of Breast Fullness
Two basic dynamics are major influencers of milk production. The first, “degree of breast fullness,” refers to a simple concept: Drained breasts make milk faster and full breasts make milk slower. Whenever your breasts contain enough milk to feel full, your milk production slows.¹ The fuller your breasts become, the stronger the signal your body receives to slow milk production. This is why pumping can help with a milk supply problem.

Breast Storage Capacity
This second basic dynamic refers to a physical characteristic known as breast storage capacity, which varies among mothers.² This physical difference explains why feeding patterns can vary so much among mothers and why one breastfed baby does not need to breastfeed at night while another one does.
Breast storage capacity is the amount of milk your breasts contain in your milk-making glands at their fullest point of the day. Storage capacity is not related to breast size, which varies mainly by how much fatty tissue is in your breasts. In other words, smaller-breasted mothers can have a large storage capacity and larger-breasted mothers can have a small capacity.
Both large-capacity and small-capacity mothers produce plenty of milk for their babies. But their babies feed differently to get the daily volume of milk they need.³ After baby’s first month, a mother with a large storage capacity may notice that her baby:

• Is satisfied with one breast at most or all feedings.
• Is finished breastfeeding much sooner than other babies (sometimes just five minutes).
• Gains weight well on fewer feedings per day than the average eight or so.
• Sleeps for longer-than-average stretches at night.

If this describes your breastfeeding experience, your baby may already be sleeping for longer stretches at night than other babies you know. But if after the first month of life your baby often takes both breasts at feedings, feeds on average longer than about 15 to 20 minutes total, typically takes eight or more feedings per day, and wakes at least twice a night to breastfeed, your breast storage capacity is likely to be small or average.
Again, what’s important to a baby’s healthy growth is not how much milk he receives at each feeding, but rather how much milk he consumes in a 24-hour day. Breastfed babies of both large- and small-capacity mothers receive plenty of milk, but their breastfeeding patterns will necessarily differ to gain weight and thrive.⁴ For example, a baby whose mother’s breasts hold six ounces or more (180 mL) may grow well with as few as five feedings per day. But to get this same 30 ounces (900 mL) of milk, if a mother’s breasts hold only three ounces (90 mL), a baby with a small-capacity mother will need to feed ten times each day. (This may not apply in the same way to a mother who’s pumping.) You can measure pumped milk much easier as bottles and storage bags all have markers to indicate the number of ounces (mL's) a baby is taking.

How These Dynamics Affect Night Feedings
How does this apply to night feedings? A mother with a large storage capacity has the room in her milk-making glands to comfortably store more milk at night before it exerts the amount of internal pressure needed to slow her milk production. On the other hand, if the baby of the small-capacity mother sleeps for too long at night, her breasts become so full that her milk production slows.
In other words, if you are a mother with an average or small breast storage capacity, night feedings may need to continue for many months in order for your milk production to stay stable and for your baby to thrive. Also, because your baby has access to less milk at each feeding, night feedings may be crucial for him to get enough milk overall. Again, what’s important is not how much milk a baby receives at each individual feeding, but how much milk he consumes in a 24-hour day. If a mother with a small storage capacity uses sleep training strategies to force her baby to go for longer stretches between feedings, this may slow her milk production and compromise her baby’s weight gain.
Each mother-baby pair is unique. Babies will outgrow the need for night nursings at different ages, so a simple rule of thumb doesn’t consider either the emotional needs of the baby or his physical need for milk.

Adapted from Nancy Morbacher, the Breastfeeding Reporter

References
¹Daly, S. E., Kent, J. C., Owens, R. A., & Hartmann, P. E. (1996). Frequency and degree of milk removal and the short-term control of human milk synthesis, Experimental Physiology, 81(5), 861-875.
²Cregan, M. D., & Hartmann, P. E. (1999). Computerized breast measurement from conception to weaning: clinical implications. J Hum Lact, 15(2), 89-96.
³Kent, J. C., Mitoulas, L. R., Cregan, M. D., Ramsay, D. T., Doherty, D. A., & Hartmann, P. E. (2006). Volume and frequency of breastfeedings and fat content of breast milk throughout the day, Pediatrics, 117(3), e387-395.
⁴Kent, J. C. (2007). How breastfeeding works. Journal of Midwifery & Women's Health, 52(6), 564-570.

How to deal with Lactation post Loss - a review

This post struck as a such a huge part of losing a child close to the birth is dealing with your milk supply. It is an emotional topic and there is not a right or good answer. The following is from This post is from Tanya at Motherwear.com. This is a review of a publication By Jessica Welborn.

Review: Lactation Support for the Bereaved Mother

A few years ago I collaborated with Carol McMurrich, the leader of our local bereavement support network, to produce a pamphlet called Lactation after Loss. It's intended to help mothers deal with lactation after they've lost a baby in pregnancy or infancy.
When I heard that the Human Milk Banking Association of North America had just released a book on this topic I knew just whom I'd ask to review it! Carol's review of it is below.
The book is written by Jessica Welborn. I interviewed on this topic for a podcast on the Motherlove Blog.
When my first baby, Charlotte, died during her birth in 2003, I remember that it was me who asked my midwife what I should do when my milk came in. I remember her long, grave face, and her recommendations to wear a tight bra, use ice and ibuprofen for pain, and avoid any stimulation to my breasts at all-- even a hot shower.
The excruciating agony I experienced, mostly emotionally but also physically, during the weeks that it took for my milk to come in and subside left me yearning for a better way for women to go through this stage of their bereavement. At the time I was too bereft to look into whether any resources existed, either for mothers or professionals. But as time went on and I did try to drum up some information, I was dismayed to find that it seemed a blind eye had been turned to the whole topic of lactation after loss.
I was pleased to discover recently that Jessica Welborn, who wrote a dissertation on mothers who had chosen to donate their milk following the deaths of their babies, has produced a document entitled, Lactation Support for the Bereaved Mother: A Toolkit - Information for Healthcare Providers. Here there is finally a resource that spells out for professionals the very real and possibly healing options (or at least not detrimental, as the breast-binding was for me) that mothers have when their baby dies and their milk still flows.
First and foremost, Welborn’s style clearly demonstrates the time and care she has spent with bereaved mothers. The document is extremely compassionately written, yet also fully factual and accurate. It spells out, in careful detail, exactly how a mother who is still producing milk after the death of a baby can and should be supported around the issue of lactation. Welborn does not dance around the fact that lactation is often not addressed with mothers and that this can be very harmful. She is clear in stating the obvious fact that no mother can escape the production of milk; therefore how to manage this milk in a way that is least harmful and most healing is an essential role that a healthcare provider plays.
Welborn beautifully lays out the ways in which milk can be meaningful for a bereaved mother. In sections titled, Pumping as Ritual, Pumping to Identify as Mother, and Pumping as a Tool for Grieving Loss, she is able to make clear the different ways in which continued lactation can assist in the grieving and healing process. As a bereaved mother, I appreciate the sensitive way that these sections were written and could personally relate with much of what Welborn communicated.
This section is particularly important because it precedes the section on milk donation. From work that I have done personally with health care providers who work with bereaved mothers, I know that many of them are very hesitant to bring up the idea of milk donation with mothers, fearing that it is presumptuous to imagine that a mother might want to deliberately maintain some milk supply when she has no baby to feed. Coming to understand some of the ways in which milk production can be a tool for healing may help some of these providers to see that pumping and donation are a very real option for some mothers and should always be offered at the time of a baby’s death.
That said, Welborn also addresses how to assist those mothers who do not choose to continue lactation and prefer to let their milk supply dwindle and subside. This section is written with clear suggestions on how to do this safely and comfortably, and how to support the mother emotionally while this is happening.
While Welborn’s piece clearly leans in the direction of encouraging mothers to donate their milk whenever possible, I also respect that the lens through which she may understand the healing power of this ability to sustain life through milk donation is the result of the many mothers she has known who have benefited from donating. The sections which talk about mothers who choose to dispose of unused milk or dry up their supply are respectfully and thoughtfully written; I will state again that there was nothing in this entire piece that I, as a bereaved mother, found in the least offensive.
The one thing this piece left me yearning for was slightly more division between suggestions for mothers who have had stillbirths versus those whose babies have lived for some time. The experience of lactation is very different for a mother whose milk comes in at a time in which she hopes that her baby will survive and someday need that milk. Likewise, the decision to donate or pump when one has already established a supply and has a relationship with a good, hospital grade breastpump is different from a mother whose baby has already died deciding to build a supply exclusively for donation. It is far more common to find the mother whose baby has died in utero, who has been sent home and surprised to awaken alone at home on the second or third day with engorged breasts and little idea of what to do. Specifically addressing the importance of working with this population could use slightly more attention.
This said, I can’t imagine that a better resource could exist for those mothers whose young babies have died. I am impressed with Welborn’s research and presentation and hope that this document will find its ways into NICUs and birthing centers across the country and the world.


http://breastfeeding.blog.motherwear.com/2012/07/review-lactation-support-for-the-bereaved-mother.html

How Do I Get Started Pumping?

Once you have a pump, you can start collecting milk any time. In the first two weeks after your baby is born, you may want to pump occasionally to relieve engorgement - you can save this milk, but don't get carried away. Pumping a lot in these early weeks tells your body that you had triplets, and brings in an enormous milk supply. (Remember more milk out means more milk made!) While this may sound like a good thing, it puts you at very high risk for breast problems like clogged ducts and engorgement.

When your baby is a little older, you can start adding pumping to your daily routine.  To do this, start adding a pumping session at about the same time each day as soon as you want to. It is important to ensure that breastfeeding is progressing well before you start incorporating pumping.

When you first start pumping, you will get very little milk. This is normal. After all, you've just spent the first weeks of your baby's life getting your milk supply into an exact balance with your baby's needs. There's not supposed to be any extra.(Demand = Supply!)  What you're doing by pumping in these early days is building a little bit of a stash, and getting used to pumping. You're also increasing your milk supply by just a little bit. This is a great time to make sure your flange fits properly as well. (See post on Finding a good Flange  Fit)

When to pump: By pumping at about the same time each day, you're telling your body that it needs to make a little more - you're tricking your body into thinking that your baby has really taken to that 10am feeding! Even if you pump and no milk comes out at all, you're placing the order for milk to be made later.

Learning to pump: It may take you a while to get the hang of pumping. You may be tense and worried about whether you'll be able to pump enough (don't worry, you will). You may be uncomfortable with a machine hooked to your breasts (imagine!). Don't worry, that's why you practice. This time pumping at home teaches you how to set up your pump, how to set it so that you get the most milk in the least time, and most importantly, how to relax when you're pumping.  A hands free pumping bra can help you if you are double pumping and find it hard or awkward.

How often to pump: When you're pumping at home to build up your supply and a stash of milk, once a day is plenty. Don't make yourself crazy with it!



If your baby nurses every two hours, you may need to spread out your pumping sessions a little more, but make them a bit longer than your baby typically nurses

If you don't have time for enough pumping sessions during the day, pump when you get up, before work, after your baby goes to bed, or during the night - it can be done! Having an extra set of collection kits can help at this time, so the washing and drying doesn't get overwhelming.

If your baby nurses very infrequently, you may need to pump more often, since the baby is usually more efficient at getting the milk out. 

How long should you pump?
In short, you should pump until milk isn't coming out any more. Or, if you're trying to boost your supply, pump a little while longer after the milk stops flowing. You don't need to watch the clock, but it is a good idea to check the bottle to see if it is still flowing. In general, pumping for 15 minutes should do it for most people. The Ameda Platinum pump has a timer if you having milk supply issues and you need to "watch the clock" (If you're having trouble letting down for the pump, read Better Pumping, below.)

There is no harm in pumping for a few minutes after the milk stops flowing, and it's a great way to send your body the message that more milk is needed (if it is).

Pump Settings
Contrary to popular belief, your pump does not get the milk out of your breasts by brute force alone. Stronger suction does not necessarily mean that you will get out more milk. Stronger suction may mean that you're in excruciating pain, or that you're damaging your breasts, so back off a little, OK? What your pump needs to do to get the most milk out is imitate your baby. Pay attention to how frequently your baby sucks and the strength of that suction. Then try to adjust your pump to match your baby. From there, you can experiment to see if slightly more, less, faster or slower suction feels better and produces more milk. What's the best setting? The one that works for you, so don't pay attention to how other people's pumps are set. It's a personal thing. Custom Control makes this easy for you to adapt as your baby changes and grows.

Better Pumping
A few tricks can increase your pumping output without increasing the amount of time it takes. The most effective ways to increase your output are good relaxation skills and breast compressions - both described here.

Relaxing while Pumping
To some people, relaxing while pumping is akin to asking them to relax during a root canal, but it can be done. Relaxing is important, because it's really hard to have a let-down if you are tense. Some tips for relaxation:

Positioning: Sit back in your chair, don't tense your shoulders, and support the bottles so that you don't have to lean forward.

Environment: Play relaxing music, have a comfortable chair for pumping, have a cup of tea before you start - in general - be comfortable!

Baby Cues: If you are away from your baby when you are pumping, bring some cues to help you think about your baby. Some mothers respond very strongly to the smell of your baby, so bring whatever your baby slept in last night (as long as there's not too much spit-up on it!) Other moms respond better to pictures or sounds - you can put photos of your baby right in many of the pump carriers, or bring a tape of your baby's "hungry noises" (all out crying doesn't usually work - it's too stressful)

Bottle Watching: For me, the best way to stop a let-down in its tracks was to watch the bottles. I always had trouble pumping enough, and the stress of watching the ounces was enough to severely limit my ability to pump. Look at something else - anything! Say to yourself "any breastmilk at all is a precious gift to my baby" and visualize waterfalls, spilled milk trucks, your baby's contented face after a feeding - whatever relaxes you.

Activity: Some people like to work while they are pumping - for me, pumping time was when I rewarded myself for the hard work of the rest of the day (or for a particularly good run at FreeCell). Find something you enjoy doing while you pump - maybe the latest Janet Evanovitch novel, maybe reading the paper or People magazine, maybe surfing the web if you're lucky enough to pump at a computer. Make it relaxing time. Or, if you're stressed about the work you're missing, pump hands-free and keep on working - whatever relaxes you best. 


Breast Compressions
Doing breast compressions while you are pumping can help stimulate additional let-downs, and helps to thoroughly drain all of the milk ducts. While you are pumping, use one hand to massage your breast from the armpits towards the nipple (or as close as you can get without dislodging the pump flange). Gradually increase the pressure, and finish with a few firm squeezes of your breast, like you do when you are hand expressing milk.

Adapted from Kristen Berggren, PhD, IBCLC
Author of Working Without Weaning and creator of the website, www.workandpump.com

Cleaning Your Breast Pump and HygieniKit

Simple Steps to Keep Your Ameda Breast Pump Clean

Keeping your breast pump clean is not time consuming. But there are a few things you can do to simplify your pump care — so you can spend more time with your new baby.

Sanitize Your Ameda parts Before the First Use

Always follow the manufacturer's instructions. If your pump kit package is not marked "sterile," put all the pieces that come into contact with your milk in a pot, cover them with water, and boil for 20 minutes before using the pump for the first time. It is best to let the parts air dry so make sure you have a bit of time for this.  With an Ameda pump that would be the bottle, flange (part that goes on your breast), white valve, and silicone diaphragm. All Ameda pumps use the same kits so this will apply to any personal use pump or rental/hospital pump. Unless your doctor or hospital has told you otherwise, there is no need to do this again.

Everyday Cleaning of Your Ameda Breast Pump

With an Ameda pump, you don't need to boil, microwave or wipe your pump pieces with disinfecting wipes on a regular basis. After every use, rinse the pieces that come in contact with your milk with cool water then wash them in warm, soapy water (using mild detergent), rinse with clear, warm water, and air dry. You can also clean pump parts in the dishwasher. You may want to get one or more extra pump kits and wash them all once at the end of the day. That way you don't need to wash your parts every time you pump.

To clean your pump motor or bag, just wipe it with a clean, damp cloth. This is also a good way to clean the outside of your pump tubing if milk drips onto it.

No Tubing Care

For mothers using a pump with tubing, any moisture in the tubing can contaminate their expressed milk with bacteria, mold and viruses. That’s why Ameda breast pumps have Proven Airlock Protection™. During pumping, Ameda’s diaphragm keeps the air from your pump from coming in contact with your milk. You don’t have to clean the narrow tubing and your milk stays purely yours. Ameda has the world’s only breast pump with a proven protective barrier.

Adapted from Nancy Mohrbacher, IBCLC, FILCA, Lactation Consultant, Ameda Breastfeeding Products
Coauthor of Breastfeeding Made Simple: Seven Natural Laws for Nursing Mothers

Learning About Breastfeeding from your Newborn

We don’t give our newborns enough credit. Those tiny babies—like all newborn mammals—are born with the reflexes they need to get to the breast, take it in their mouths and feed without help. Your baby knows what to do! Just get her into position and cheer her on.

Your baby’s hardwiring works best with a little help from gravity. To make it easier for her, lean back with good neck, shoulder, and back support and your hips forward. (Think about how you sit when you watch your favorite TV show.) Lay your baby tummy down between your exposed breasts. When your calm, hungry baby feels your body against her chin, torso, legs, and feet, this triggers her feeding reflexes. When her chin touches your body, her mouth opens and she begins to search for the breast.

Laid-back breastfeeding refers to both a mother’s positioning and her approach to nursing. After birth, leaning back to feed can make breastfeeding easier while you’re learning. Gravity keeps your baby against your body. Feedings are more relaxing because you don’t have to support your baby’s weight with your arms. Whatever position you use, make sure your arms, neck, head, shoulders, and arms are well supported so you can be comfortable for a long while.

Adjust for comfort

To find your best positions, first adjust how far you lean back. This is easy to do in a hospital bed. You can also adjust your baby’s position on your body. Babies can go to the breast from many angles. Your baby can lie tummy down below your breast either straight or at an angle.

After a cesarean birth, position your baby so her weight doesn’t rest on your incision. Try laying her across your breasts or use a pillow to support her at your side. You can even bring her to breast from over your shoulder.

There is no one “right” breastfeeding position. Do what feels best to you and your baby. Because women have different body types, what works well for your friend may or may not work well for you.

Other positions

After you’ve had some practice with laid-back breastfeeding, you may want to try sitting upright to feed. If so, find a seat with good back support. Try a footstool and/or pillows to see if they make you more comfortable.

When sitting up, many mothers like to hold their baby in front. You can support your baby’s back and head with your forearm near your wrist. Or, you can support your baby’s back and head with your hand from the side of the unused breast. The baby can also be held along your side. Some mothers with large breasts find it is easier to cuddle their baby close in this position and enjoy having a better view of their baby’s face.

Learn to breastfeed while lying on your side so you can rest and sleep while you feed. Practice during your waking hours. No one learns best when half asleep.

In all positions, check for the following:

• Your baby’s head, shoulders, and hips are in line, not twisted or turned.
• She is directly facing the breast, no head-turning needed.
• Her body is pressed against yours, with feet, bottom, and shoulders pulled in close (no gaps).
• Her head is free to tilt back a bit, and she comes to the breast chin first
  

Relax and try to enjoy this experience, it will go by before you know it.


Nancy Mohrbacher, IBCLC, FILCA, Lactation Consultant, Ameda Breastfeeding Products
Coauthor of Breastfeeding Made Simple: Seven Natural Laws for Nursing Mothers