Choosing a pump
The pump you choose depends on your needs. If you have low milk production, especially in the early days post-partum, renting a hospital grade is best.
Once your milk production is established, if you plan to be pumping frequently, get a good electric pump.
If you are going to be pumping only once in a while, you may be able to use a hand pump.
Get the correct flange size
When the nipple gets pulled into the shaft of the flange, there should be 1-2 mm of space between the sides of the nipple and the flange shaft. If the sides of the nipples are rubbing against the flange shaft, try a slightly higher flange size or angled flanges. Be aware that some nipples and areolae will expand to whatever size flange you use. In this case, do not keep changing to bigger and bigger flanges. This will only increase the surface area that is traumatized.
When to pump
When to pump also depends on your needs.
If you are trying to build up a store of milk to be used at a later time, you can pump directly after feeds. The early morning (around 6am), you tend to have more milk in the breasts and you may get a nice yield if you pump after the baby nurses.
Another good time tends to be after the baby has “gone to sleep” and before you go to bed at night.
Also, if there is a time when the baby takes an extended sleep (4or more hours), you can pump in between feeds.
If you need to go out at a time when the baby would feed, pump before you go out and nurse or pump when you return.
How to Pump
Make sure you read the directions on your pump. Some pumps come with two settings, one to increase the vacuum and one to increase the speed. Other pumps may only have a vacuum setting. I’ve seen many mothers adjusting the speed dial, thinking they were adjusting the vacuum. Know your pump.
Start pumping at the lowest vacuum and a fast speed (if it’s adjustable), to minimize trauma. The most traumatic pulls occur at the start of pumping. Then after you see a little milk at the nipple tip, slowly increase the vaccum to the highest level that does not cause pain. Bring the speed down to “standard” or somewhere in the middle.
The nipple should be pulled into the shaft of the flange and should continue to be pulled and released within the cylinder. If the vacuum releases, or the breast “separates away”, from the cone portion of the flange, you are may not getting a good seal and milk may pool or leak from below the cone. If this happens, adjust the flange, make sure you press it against the breast securely, and perhaps increase the suction temporarily until the nipple is pulled into the flange shaft. Do not stay at the higher vacuum if it is painful. If you cannot get the nipple to be pulled and released within the cylinder despite being on the highest vacuum setting, you may need a stronger pump.
How long to pump
We usually say to pump for 10 to 15 minutes because the most of the milk will be removed within this timeframe. Stop pumping approximately 2 minutes after the flow stops. Pumping when no milk is coming out does not help you make more milk and will not increase your production. It will only cause pump trauma.
Rarely, there are women who do not let down until after 15 minutes of pumping. If this is the case, contact a lactation consultant and your doctor about ways to get milk out more quickly.
Pump trauma
Definition: pain, redness and inflammation of the nipples and areolae due to overuse or misuse of a breast pump. Blood blisters and/or bruises may also be present.
The pain due to pump trauma may range from a superficial burning or stinging of the nipples and areolae to severe deep breast pain (sharp or dull) between feedings or pumpings. Sometimes it is difficult to differentiate between pump trauma and yeast.
Pump trauma may occur if:
- you are pumping for long periods of time,
- pumping at too high of a vacuum
- starting at maximum vacuum rather that slowly bringing it up
- using pump flanges that are too small
Pump trauma can be difficult to resolve, especially if pumping is your only form of milk removal.
Here are some guidelines:
1. Pump only for 2 minutes after the milk stops flowing. There is no need to pump “dry.” This does not help increase milk production.
2. Massage breasts while pumping, to help milk exit faster.
3. Try to pump for no more than 10-15 minutes.
4. Use olive oil on the nipples and areolae while pumping, to decrease friction.
5. Keep suction at the minumum setting for at least 30 seconds and then slowly bring it up. Take the suction up to the lowest level that gets milk out.
6. Get the correct flange size. If you are using the standard size, 24 mm, try going up to 27 mm or using angled flanges which are wider. Ideally, the shaft of your nipple should not rub against the side of the flange. If it does, you may need a bigger flange size. Be aware that some nipples and areolae will expand to whatever size flange you use, so do not keep changing to bigger and bigger flanges. This will only increase the surface area that is traumatized.
7. Hospital grade pumps tend to be more gentle pumps and can help decrease pump trauma.
8. Use olive oil or another soothing ointment on the nipples and areolae between feedings or pumpings.