Separation from Baby & Milk Supply

By Krista Gray, IBCLC. Last updated February 19, 2013.

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803925_4805295522531_1396786813_nIf a mother’s supply is low and she is not able to nurse her baby at the breast (perhaps baby is preterm, mom is trying to relactate, or baby has other health issues) then she will need to express her milk diligently to increase supply.  Maintaining optimum supply over the months by pumping, but never being able to nurse baby at the breast, can be challenging.  The touch of a mother and baby together and the hormones produced while breastfeeding or in skin-to-skin contact are not the same when a mother is sitting in front of a breast pump (or hand expressing) without a baby.  Many mothers have succeeded though and there are many things you can do to optimize results.

Express Frequently

First, you need to begin expressing at least every three hours, at least eight times every 24 hours, for at least 15 minutes on each side.  There are several ways you can express your milk – by hand, with a hand pump, or a single or double electric pump.  Many mothers around the world use hand expression successfully, even in cases of increasing low milk supply, exclusive pumping, relactation, etc.  While you are expressing, it is helpful to try to relax, sit beside your baby or look at a photgraph, listen to music, express in the same location each time, etc.  These items can help a mother’s milk ejection reflex and optimize what she is able to express.

However, if you are going to be pumping for any amount of time (several days – several months or more) you may want to check with your hospital about renting a hospital grade double electric pump.  Along with by pumping frequently, breast compressions while pumping and finishing off with hand expression has been found to garner significantly more milk than pumping alone.

Let’s begin with pumping frequency.  If your goal is to produce enough milk to exclusively nurse your baby, then you need to build your supply so that you are able to express at least 750 ml every 24 hours.  (If you have twins this amount should be double; for triplets, tripled; and so forth.)  In order to reach this goal, you should express on both sides for 15-20 minutes every three hours at a minimum.  If you begin expressing at 10 a.m. and finish at 10:30 a.m., you need to express again at 1:00 p.m. (not 1:30 p.m.).  Once you’ve reached your goal of 750 ml each woman’s pumping schedule should be tailor-made.  There are many things that come into play.  Every woman’s breast capacity is different.  Some women have a large breast capacity and could pump four or five times in a 24 hour period and have more than enough milk.  Other women have a much smaller breast capacity and must pump more frequently to attain the required volume.  Both women are fully able to produce enough milk for their baby!  But, a one-size-fits-all pumping schedule will not fit all women.

Ensure pump is comfortable

Not only is it important to frequently empty your breasts, but how you do this is also critical.  One study found that a good quality double electric breast pump was able to remove 99% of milk in the breasts within the first five minutes of pumping for most mothers. 1  It is important to make sure the vacuum is comfortable.  A strong vacuum that causes pain is not helpful to milk expression!

Breast compressions increase output

Research shows that using breast compressions while pumping will increase milk output.2 This is important to note since some moms notice a drop in their supply when they pump (versus nursing at the breast).

Breast compressions can easily be done while pumping.  Either use a hands-free pump (you could even cut small holes in a nursing bra to allow your pump flange to be held in place by your bra) or sit high enough that your pumping bottles can rest on the counter while you use your hands for breast compressions.  As you are pumping, gently massage spots on your breast working from your chest forward to your areola.  Hold down until you feel the area soften with milk expression and then work on another area.  Continue breast compressions while you pump until your breasts feel very soft and no more milk is being collected by your pump.

Hand expression after pumping can increase supply

If you are still concerned about the volume of milk you are expressing, following pumping with hand expression can further increase milk output.  In fact, Morton et al found a 48% increase in milk production when breast compressions while pumping followed by hand expression were incorporated!

Cluster Pumping

Another strategy for increasing supply is to set a block of time, say two hours, and during this time pump every 10-15 minutes for just as long as it takes to elicit the first milk ejection and collect this milk.  Typically, this is about 5 minutes and research shows that up to 45% of milk available in the breast will be collected with the first let down. 3  Remembering that an empty breast makes more milk, this strategy capitalizes on collecting milk as soon as it is made and leaving an empty breast to rapidly begin to make more, and so forth.

Show 3 footnotes

  1. Mitoulis LR, Lai CT, et al. (2002) Efficacy of breast milk expression using an electric breast pump Journal of Human Lactation 18(4):344-52
  2. Morton J, Hall JY, Wong RJ, et al. (2009) Combining hand techniques with electric pumping increases milk production in mothers of preterm infants. Journal of Perinatology. 29(11):757-64
  3. Ramsay D.T., et al (2006) Milk flow rates can be used to identify and investigate milk ejection in women expressing breast milk using an electric breast pump. Breastfeeding Medicine 1:14-23.
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