By Ellen Rubin, IBCLC

When your breastfed baby is gaining well in the first month, generally there is no need to express milk

A baby who is transferring milk well, demonstrates good weight gain and nurses on cue is all that is needed to maintain milk supply. Parents may wonder if they should also begin pumping in addition to nursing. As the first few weeks can be exhausting for new parents, it’s best to simplify. Parents should be encouraged to focus on establishing direct breastfeeding, which may promote a stronger milk supply. Direct breastfeeding also helps baby build breastfeeding skills and fine tune milk production needs. Early pumping may set parents up for oversupply and contribute to potential plugged ducts and breast engorgement.

Breast fullness in the early days. Should I pump?

At times, breasts may not feel softer after nursing, causing parents to question if they should pump. When babies are nursing effectively, research suggests they remove about 2/3 of the available milk. Pumping to feel “emptier” encourages the body to continue to make milk beyond baby’s needs. If you find yourself feeling uncomfortably full after nursing, apply cold compresses to the breasts and dogentle lymphatic massage. If fullness is making it difficult for your baby to latch, reverse pressure softening prior to feeds may help, see here: Reverse Pressure Softening

What if baby is not gaining as well as expected, or is not able to directly feed at the breast?  

For these situations, pumping is recommended to have for additional supplementation to promote baby’s weight gain and to protect and maintain milk supply. Feeding plans that involve nursing, pumping, and supplementing (commonly referred to as triple feeding) are not meant to be long term. Complicated feeding plans can be physical and emotional stressors on parents. Time does not always allow for both pumping and putting baby to the breast.  While there is no single plan that applies to every situation, when the goal is more breastfeeding, maintaining milk supply is often more important than putting baby to breast. Do try nursing a few times each day when baby is just starting to get hungry. Skin to skin with infant as able is also encouraged. Try to continue with regular milk expression so baby will be encouraged by available milk when practicing. If milk production drops, it may become more difficult to build nursing skills.

Building milk supply 

Typically, the best way to increase milk production is through regular, effective, milk removal, with direct nursing being optimal and milk expression a second choice. Herbal supplements are sometimes suggested but not well backed by research and cannot replace breast stimulation. If pumping is part of the plan, use a well-fitting double electric pump for about 15 minutes each pumping session. For most parents, power pumping is not a good use of time. Example: pumping in four, 15-minute blocks with a short pause between blocks to mimic cluster feeding. This is time consuming, can be rough on breast tissue and is something we do not routinely recommend. Frequency of pumping is generally more important that duration of pumping.

What if I’m pumping, my breasts still feel full?

When breasts feel full, yet milk collection is low or the tissue is not softening, this can be related to swelling due to pump use or a poor flange fit. A good fitting flange, reverse pressure softening or hand expression prior to pumping, and a focus on nursing rather than pumping can help.

Choosing the right pump and related tools 

If you plan to pump regularly, or need a pump to help establish milk supply, typically the most effective tool is a plug-in double electric pump. Battery operated pumps are easily portable but may not have the power of a plug-in pump. Hands free pumps/wearable pumps are convenient, but often not reliable in establishing and maintaining milk supply. However, they can be used in addition to a double electric breast pump.

When primarily nursing but pumping occasionally, look to convenience and comfort in choosing an occasional pump. While many collect the most milk when using a plug-in double electric pump, some do fine with hand expression or a manual pump. If milk expression is not a regular part of your routine, these pumps may work well for you.

Finding the correct flange size 

 A well fitting flange is key to comfort and good milk removal. The nipple should move freely within the pump tunnel with the minimum amount of areola entering. There should be no discomfort, rather a feeling of a gentle tug or nothing at all. If pumping instead of a feeding at the breast, the aim is to obtain the amount needed for a full meal, usually between 2-4 ounces total. Major pump manufacturers share instructions and videos online specific to their pump models. Start by watching those and experiment with the pump settings while keeping an eye on comfort and milk yield.

If you need personalized guidance with milk expression, the Breastfeeding Center of Pittsburgh offers a specific, pump-only appointment. For more details on this specialized visit, please contact us at 412-246-4726.