Maximizing Your Maternity Leave

Whether you will have 6 weeks, 6 months, or something in between for you maternity leave, you’ll want to use the time getting to know your baby, finding your rhythm of being “mommy” to a new little blessing, and be preparing for the time when you return to work.  Many new moms spend this time worrying about who will take care of their child, how they will express milk, wondering whether they will have enough milk to express, and so forth.  And some things you read and hear encourage new moms to express from the very beginning and practice giving your baby bottles each day.  Even more stress!

While there are some things you will want to do to prepare for your return to work, the most important thing you can do during this time is bond with your baby, get to know your baby, and fall totally in love with your baby.  You need to get breastfeeding off to a good start and not have to worry with pumping and giving bottles in the beginning.  So, until 3 weeks before you return to work, it is a good idea to not spend time worrying about pumping and bottles or teaching your baby to drink from one!

Several weeks before you return to work, though, you will want to familiarize yourself with your pump, learning how to operate it, clean it, and store your milk.  Never throw milk you pump away but you also don’t need to give all the milk you pump to your baby right now.  You are still home with her so enjoy these moments of cuddling and nursing before you return to work.  This milk can be frozen for the future when you do go back to work.

You will also need to give thought as to how you want your baby’s caregiver to feed your baby your expressed milk.  Do you want to give a bottle?  Cup?  Sippy cup?  Make sure to talk about your desires with your baby’s caregiver beforehand.  Many moms and caregivers choose to use bottles for their convenience but the other options should be explored.  Make sure to educate your baby’s caregiver on how to give a bottle if this is what you choose to do.

Finally, don’t worry about your baby “taking a bottle” from you.  Many babies refuse to take a bottle when their mothers are around.  They know what they want and prefer and therefore won’t drink from a bottle when you’re around.  When you are away, though, these same babies will take a bottle from someone else.  Your baby may also “reverse cycle” and drink less milk while away from you throughout the day and take in more while with you in the evening, night, and morning before work.

Ultimately, you want to feel comfortable with how your pump works and how to store your milk before you return to work.  You will want to feel comfortable with your caregiver and share with her your desires for feeding your baby while you’re away.  But, as you plan and prepare for your return to work, make sure to enjoy these precious moments while you are with your baby.  Enjoy nursing at the breast while planning for the time you are away.  Try not to stress and worry about it.  You are mommy to your precious little one and if you are exclusively nursing your baby at one month old then you have the milk to feed your baby at six months and beyond as well!


How to Pump Effectively

How to pump effectively and efficiently is extremely important so you spend the least amount of time behind a pump as possible.  If you are returning to work or have other children, your time is limited!  Learn what steps to take to maximize output in minimal time.

How frequently you express depends on how much milk you require.  If your supply is established and you are returning to work, you will need to pump to make up for the times your baby eats while you are away.  Learning how pump effectively is an essential time saver.  If you are jut starting pumping and trying to build your supply, make sure to read about building your supply pumping.

Not only is it important to empty your breasts when you pump, but how you do this is also critical.  Effective pumping is key.  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  Not only is a double electric pump going to increase output, but choosing one that has intermittent suction of 50-80 cycles per minute and an adjustable vacuum ranging from 50-250 mm Hg is important.  Also, make sure the vacuum is comfortable.  A strong vacuum that causes pain is not helpful to milk expression!  However, research also 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.

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! 3

If you just have a few minutes here and there while away from your baby, it may be easier to hand express.


Nursing Twins

Grace & Leo 10-2-12 (133)

Elizabeth lives in Nebraska with her husband and 2 kids, twins Grace and Leo. Her days are spent being a referee, cleaning never ending messes, making delicious meals, and trying not to wish the moments away.  Elizabeth blogs about raising twins, being married to a farmer, and living in the country over at My Glad Heart.

I am still currently breastfeeding and plan to do so until they choose to wean. For me, breastfeeding wasn’t really something I thought about. I just knew that God made my body the way he did for a reason. My boobs were meant to feed my babies. It just made sense. I found out I was pregnant with twins and I started reading anything and everything I could get my hands on about twins and breastfeeding. I thought I was prepared for nursing twins. But I was wrong.

The babies were born on Sept 12, 2012 at 36 weeks via cesarean. While that’s not ridiculously early, they were both on the smaller side. Grace was 4 lbs 7 oz and Leo was 6 lbs 3 oz. They were both jaundiced and everything put together made for 2 very tired and very lazy babies. I think Leo would have been able to breastfeed somewhat from the beginning if he had had more time on the breast and if I had known what I was doing. But it’s hard to give your undivided attention when you have 2 babies to take care of.

Grace on the other hand wouldn’t even open her mouth to eat. When we bottle fed, we had to force the nipple in her mouth or catch her in the middle of a yawn. In the beginning she latched, but she got tired really fast and she just needed to gain strength. So I pumped and bottle fed them. We still worked on latch though, and by 5 weeks Leo finally figured out latching. So I would bottle feed Grace on my lap and I would breastfeed Leo. But Leo mostly hung out at the breast and after awhile I would take him off and he would still be hungry. So I would have to bottle feed him.

gleditedIt would have been easier in the beginning if I had been able to feed them separately, but they always woke up at the same time to eat. I couldn’t give Leo the attention he needed to get more efficient. Grace finally figured out latching at 8 weeks, but then 2 weeks later we all got sick and when she started to get better, she had forgotten everything we had learned. We started over from square one. First she learned to open her mouth, then she learned to take more of the breast into her mouth, then she learned how to suck, and then finally she got it all working together.

They started breastfeeding better, but they never took a complete meal in one sitting. I used to breastfeed them until they pulled off, and then I would immediately get bottles and start pumping. But that never gave them the opportunity to try and get more from the breast. So around month 4 my lactation consultant suggested I get a scale, feed them each session until they pull off and then let them play for 20 min to 1/2 an hour, put them back on, and repeat. Weigh them in between and keep track of how much they’re taking and keep feeding them until they get enough, which for us is usually around 3 1/2 to 4 oz. It worked for us, most of the time. Sometimes they got too frustrated and hungry to eat like that so I would bottle feed them the rest of their meal and pump. Anytime I had to supplement them I pumped, that way I could keep my supply up.

This worked great for a while, but I just go so sick of pumping and supplementing them at each meal. They were both capable of getting a full meal, they just weren’t doing it. So I just quit supplementing them. We basically had to redefine what eating was. I always assumed I needed to get them to a specific number each time they ate. But they didn’t. They were also in the habit of having the same amount each time they ate, so anything less than their usual resulted in screaming for more. I returned the scale and I quit pumping during the day.

Around 6 months I felt confident breastfeeding. We made it past lazy eating, flow preference, and milk supply issues. We had so many frustrating feeding sessions and lots of tears, but when they started eating better, it was so worth it. And honestly? Breastfeeding is so much easier than bottle feeding. No more washing and sterilizing. All I had to do was lift my shirt up and put it back down when we were done. So easy.

I’m so glad I stuck with breastfeeding. I don’t regret the effort I put into this. I have always kind of halfway done stuff. I am constantly starting projects but never finishing them. This is something that I have given 110% and I will never regret that. But I am sad that it was my main focus for 6 months. I was so focused on making this work that I missed out on spending quality time with my babies. But I know that if I hadn’t given this my all, I would have regretted that forever. I want people to know that you CAN breastfeed, even if you get off to a rocky start. You just have to be patient and you just have to stick with it. I go into more detail on my blog about our journey. I want to be honest about our struggles and I just want to be a beacon of hope for those who want to breastfeed but got off to a rocky start like we did.

  • Some advice I have is find a good lactation consultant. Find someone that listens to you and works with you. We went to ours 5 times.
  • Rent a hospital grade pump, especially if you’re building a supply.
  • Don’t overfeed your baby when you bottlefeed. This was something huge to overcome for us. The other thing I can say about this is vary the amount you give them each bottle. We always gave them exactly 4 oz. When they got just under 4 oz, they screamed for more and more. You don’t eat the same thing and same amount for every meal, don’t expect your baby to either.
  • Unless you have an overactive let down, invest in slow flow nipples. We love playtex VentAire bottles. We dealt with flow preference and that was tough to overcome. It’s easier for babies to drink from a bottle than it is from the boob, so you want to make them work for it when they’re bottlefeeding. You know it’s a good bottle when you tip it upside down and nothing drips out of it.
  • Just be patient. If you stick with it, they will get better. It took us 6 months.
  • Understand that breastfeeding isn’t all or nothing. If you feed them 5 out of their 8 meals from the breast, you’re still breastfeeding. If you breastfeed and then have to supplement, you’re still breastfeeding. I don’t think it has to be something that moms feel like if they can’t do it all, they shouldn’t do it at all.

Perseverance at the Pump

Mary Straits HeadshotMary Straits resides in North Carolina with her husband of ten years and two energetic boys, ages six and three.  She earned a B.A. in English and music from Columbia College and a Masters of Education from Liberty University.  In her spare time, Mary teaches 8th-grade English and somehow finds time to blog at www.marystraits.blogspot.com.

When our ob gave us the list of classes the hospital was offering for soon-to-be parents, we actually said, “Nah.  We don’t need the breastfeeding class.  I mean, how hard could it be?  It’s natural, right?”

Out loud.  To each other.

It took about two hours of mommy-hood for me to realize that breastfeeding, albeit natural, is an art form.  It takes coaching and practice and patience and sometimes a trip to the ER at 2 am.

When my first son was freshly born, we started nursing about two hours later. I came to the hospital ready.  I didn’t just have a Boppy—I had a “My Breast Friend.”  I had my own pump and all the parts.  I thought breast-feeding was going rather well until the nurse came in and started saying things like, “Nope.  He’s not latched.  Let’s try it again.”  And, “It’s not supposed to hurt.  You’re wincing.”

Then, when they called in the lactation specialists, things got real.  I learned about all sorts of positions that involved stacks of pillows.  They gave me something called a nipple shield.  Then came a syringe with a tube to connect to the shield.  In the tube, we put formula.  The idea was to make baby associate my breast with his food source.  But we couldn’t use the shield too long or he would become dependent on it.  And then we’d REALLY have problems.  I was to feed baby with the system and then pump to get my milk to come in faster.

Two days later, we went home with a shield and a syringe feeding system, which I promptly abandoned once my milk came in the next day.  In fear, I used the shield off and on, and pumped after each feeding.

When our pediatrician’s lactation specialist called me at home to see how nursing was going, I stupidly said it was going fine.  And no, I didn’t need to see her.  She didn’t let me off the hook, though.  When she found out we were bringing baby in for his weight check, she said, “Great!  I’ll check in with you then!”

The next day, however, I came down with a high fever and chills that would not go away.  Being that our baby was five days old at this point, we ended up in the emergency room at midnight and I endured all sorts of trauma I hope I never relive.   I was discharged hours later with a heavy dose of Tylenol and a label of “Fever of Unknown Origin.”

When we showed up at the pediatrician the next day, I looked like a mess.  But not your average mess.  A HOT mess.

The lactation nurse took one look at me and said, “Oh, you poor thing.”  Then, when we showed off our breast-feeding ritual, she knew we were really in bad shape.  My nipples were raw and cracked in several places.  She said I had a touch of thrush as well and gave me a concoction of creams to put on my nipples after every feeding:  Neosporin, Monistat, and Lanolin.  We were to use only the shield until my nipples healed and continue pumping in between.  And see her again in two days.

A few days later we checked back in, and my skin was on the mend finally.  Baby, however, was not latching properly.  Come to find out, his frenulum was tight, which prevented him from latching properly.  We had to drive across town to the pediatrician who could clip his frenulum and then continue on with the work of breast feeding.  With the shield, pumping after a feed.

At this point, my milk supply was very profound, as I was pumping off 4-5 ounces after baby was done with a feed.

A few days later, the fever came back with a vengeance.  It hit me almost instantly, and I struggled to even pick up the baby to feed.  I somehow loaded up the baby, lifted the car seat, and headed to the ob-gyn, who said I had a bladder and sinus infection.  They gave me a z-pack and sent me on my way, and I felt remarkably better in about 6 hours.

At this point, I tried abandoning the nipple shield, but it didn’t take long for me  to get a little crack and then have shooting pains during a feeding.  I promptly used the compound the lactation nurse told me about.  A few days later, we found out both baby and I had thrush.  At this point, I didn’t try to feed him straight from my breast, but just pumped and bottle fed until we both were cured.

The next week or so, the fever came back AGAIN on a Saturday.  This time I had a red patch on one my breasts, which really freaked me out, but I took ibuprofen and waited for my primary care doctor to open on Monday.   All the while, I continued to pump for feedings, as I was too weak to try and latch baby.

On Monday, all mysteries were answered.  My primary care doctor finally figured out what was causing the fever:  Mastitis.  There is a specific antibiotic that treats it, and he advised me not to feed the baby the milk I was expressing but to be sure that I completely emptied my breasts often.

At this point, my milk supply reached epic proportions, as I was pumping for a long time every two hours or so.

After I finished the antibiotic, my husband and I decided that we had enough drama with this breastfeeding journey.  But, it was so important to me that my baby had breast milk.  For one, I knew it was the best for him.  For two, formula feeding would have cost us $30 a week (at least).  For three, we had a great pump and my supply was ample, to say the least.

I ended up pumping on a schedule of 5:45 am, 8:30 am, 11:15 am, 3:15 pm, 6:30 pm, 10:30 pm, and maybe during the night if baby woke up.  It took me about 10 minutes to totally empty both breasts, which was a lot easier/ faster for me than before.  After a while, I was able to drop a pumping session and still maintain my milk supply very well.  In the end, in fact, I ended up giving my sister bags and bags of frozen milk and using the other bags of frozen milk in baby food purees.

I found pumping much less stressful than our previous experience, which I learned later was pretty extreme.  When I ran into the lactation nurse on a routine pediatrician visit when Noah turned one, she congratulated me on making it a full year and assured me that pumping “counted.”  For some reason, I had it in my head that I wasn’t really breastfeeding by pumping full-time, but I couldn’t bring myself to give up and quit.  And I knew it was best for my baby.

When our second son was born, as soon as we started having latch problems and I started getting cracked nipples, I broke out the pump and began pumping full time.  With a very energetic almost three-year-old, I did not have the stamina and the time for any semblance of our first go round.  I brought out my trusty pump (Medela, if you’re wondering!), and once again, had a solid supply in about 5 days time.

The second time around, though, I worked on pumping a bottle right before baby would eat so that he could have fresh milk more often than not.  I ended up having an epic milk supply the second time around, all from the pump.  At one point, I had so many bags of milk in the freezer, that our freezer actually broke.  Ha!

The point of my story is this:  If you’re passionate about breast feeding and struggling to find peace from any challenges you may be facing, consider pumping full time.  Don’t listen to the masses, who tend to view a breast pump as a ball and chain.  It was an awesome avenue for us to be able to give our boys the most optimal start. And saved us hundreds of dollars!

{Note from Nursing Nurture: Mary’s determination allowed her to give her babies breast milk even when the medical system really failed her.  Though every issue she had could have been remedied with good, qualified lactation support this mother – like so many – did everything she knew to do.  If you are experiencing breastfeeding issues and your lactation support is not helping solve the problems at hand, find someone else!  Look for an IBCLC – which is the only certification showing a lactation consultant is a specialist.  And, if your IBCLC is not helpful, find another (just like you would any medical doctor you weren’t pleased with).}


Exclusive Pumping

When a baby isn’t breastfeeding, effective milk removal from the breasts becomes critical in order to build or maintain a milk supply.   Exclusive pumping can be necessary in a variety of settings: when a baby is born prematurely or cannot breastfeed due to illness; when a baby refuses to latch at the breast; in cases of adoptive breastfeeding, induced lactation, and relactation, or when mom needs to be away for a period of time.  Some moms begin pumping and, though the reason they initially began to express is resolved, find that their baby prefers receiving expressed breast milk. If you are in a situation of exclusively pumping, here are 5 tips for your situation.

  1. Establish your milk supply.
    The most important thing you need to do when exclusively pumping is establish a full milk supply. Your body needs to get the message to make enough milk for your baby. Perhaps your baby was born prematurely and isn’t taking much milk in a 24 hour period. This will change in a few weeks and your body needs to make sure it has the supply ready for your baby. In the beginning, a mother should pump a minimum of eight times in a 24 hour period for at least 20 minutes on each breast.  It will help to record what time you pump and how much milk you get. A double electric pump is the most efficient way to do this.  Though hand expression, single pumps, and manual pumps are all other options, a double electric pump of good quality has been found to stimulate greater milk production. 1
  2. An empty breast makes more milk.
    It’s the law of supply and demand. Therefore the more completely the breast is drained and the more frequently this occurs, the more milk a mother’s body will make. 2 It is completely possible for you to make enough milk to exclusively nurse twins or even triplets!
  3. Shorten pumping duration AFTER supply is established.
    After a full supply is established (25-35 ounces per baby every 24 hours) 3 then you can shorten the duration of pumping at each session to the amount of time necessary to gather the required milk. Many times this is as short as 5 minutes!  In general, once a strong milk supply is established, one nighttime pumping session can be dropped but it is important to ensure you are still pumping at least once during the night and never going more than 4-6 hours between pumping during the longest interval between sessions. Every mother is different and every breast has a different storage capacity. While a few mothers may be able to go 10-12 hours between their longest stretch, other mothers can only go 3-4 hours. Full breasts make milk more slowly so the longer a mother waits between pumping sessions, the slower the milk production becomes. Every mother will have to work out what her “magic number” is for how many times to pump and how long in order to maintain supply.
  4. If you begin to notice a drop in supply, increase pumping sessions and/or duration.
    A general guide, once milk supply is established, is to pump 6-7 times in a 24 hour period, at least once during the night, and only for the time it takes to get the required amount of milk. Should you notice your milk supply beginning to decrease from the shortened pumping duration and/or number of sessions you should return to pumping more often and for a longer duration.
  5. Your “magic number” will be different than another person’s.
    Don’t worry if you have to pump more often than another mother to get enough milk. Don’t worry if you don’t have to pump nearly as often. Every mother is different. Not only is every mother’s breast storage capacity different, but each breast on the same mother can vary! It only matters what your magic number is. Therefore, once you have worked out how frequently you need to pump and it works for you, don’t worry if someone else does it differently.

Expressing breast milk is hard and can be very emotional. You may need to grieve not being able to nurse your baby at the breast. While expressing milk can help you connect with your baby, it also is a symbol of the disconnection. 4 Realizing that grieving is not only important but normal is critical to dealing with one’s feelings and healing. Also realize that no matter how long a mother has been exclusively pumping, transitioning back to breastfeeding is an option.

When the time comes to wean from expressing there are ways to do this both safely and comfortably.


Hygeia Breast Pump Review

This article was written by Julia, a Physical Therapist and mom of two.  She writes at www.julia-transition.blogspot.com

The Hygeia Enjoye is available with many accessories.

Before I returned to work I was a giant stress ball that cried a lot over the ‘unknown’ changes I was facing. The biggest source of stress, besides simply being separated from Truman, was the fact that being at work meant I could no longer breastfeed my babe at any time. It meant I had to enter a whole new world of pumping and storing milk and washing parts and using bottles. When you are a new mom and everything is so different from your ‘norm’ it sort of sucks that right when you get the hang of things, you need to go back to work and change it all again. But you know what, it really has not been that bad and I never thought I’d say that statement a month ago. Yep, I’m one month into this working-breastfeeding mom thing and although I’m FAR from an expert on the matter, I feel like I have a lot of tips and advice on what has worked for me thus far. I know there are other new moms out there dreading the day they return to work and I hope that if you are committed to breastfeeding beyond your maternity leave that you’ll find this helpful.

I myself have discovered that I truly enjoy breastfeeding Truman (despite two rounds of Mastitis and the extra effort and time it takes to make it work!) and I really don’t want to stop anytime soon. And so I have become a pumping fool and you better believe the pump makes one feel like a cow hooked up to an utter sucker. I borrowed a very nice Medela double-electric pump that was about 4 years old and sterilized the appropriate parts and bought new tubing. Admitting to using a second-hand pump is a huge no-no according to the pumping gods out there but I figured it was free and it worked, so what’s the big deal?

The problem was that it was a GIANT bag with the motor embedded into it and was a huge hassle to carry back and forth to work in addition to the milk, my lunch, and my purse. My Aunt suggested having two pumps: one to keep at home and one to keep at work, to cut down on the baggage. I tried to tell Memaw that I’d just buy it on my own but she insisted and thus, I got one of the coolest breast pumps on the market: the Hygeia EnJoye. You better believe I researched the heck out of this puppy before taking the plunge.

4924764185_ea512d6901_oThe reason why this pump first caught my eye is that it’s a ‘green’ pump. It’s green because when you are finished using it, you don’t just toss it out and let it sit in a landfill like all of the other pumps out there, but you return it to the company and they recycle it for you. I never thought about how many breast pumps are out there, some of them barely used, but because they are made as a single user product you pretty much have to throw them out or be deviant and let a friend use yours. Seems pretty wasteful, right? I think it’s so ridiculous that you void the warranty on almost all breast pumps if you have more than one person using it.

The other awesome thing is that this pump is NOT designed as a single user product. It’s totally acceptable and even encouraged to be used by other people after they each buy their personal accessory kit (only $30) and that means I can try to sell my beloved pump eventually to recoup some of the money or just let a friend borrow it without worrying about voiding a warranty.

And speaking of the warranty, we have two amazing things going for this pump: an extensive three year warranty (unheard of!) and also a 21 day money back guarantee. Um, seriously? The company feels so strongly about their product that they are willing to give you your money back if you try it out for 3 weeks and don’t love it? That’s a sign of a confident company! I am totally keeping mine, by the way, but I like the safety net of a money back promise.

Another pimped out feature on this pump is also highly entertaining. There is a ‘record’ and ‘play’ button on the front of the pump that allows you to capture your baby’s crying and then play it while you pump to assist in letdown. Hilarious! There is a generic baby cry that comes with the pump when you get it and I accidentally hit the play button numerous times while I was carrying my bag into work and let me tell you, the looks I got from passersby were awesome.

I really love how small this pump is and that you can pull it out from the adorable bag and just go to town on your boobs. In fact, this EnJoye version has an internal battery so after you charge it up at night you don’t even need to hunt for an outlet while you pump! One less step of plugging the bad boy into the wall is a time saver and every little bit helps. Yes, the size of it and the beautiful bag (that could totally double as a diaper bag) won me over for sure.

Although I got this pump to leave at work, I actually do bring it home with me each night. The bag is so roomy that I can fit my pump, the cooler, my lunch bag AND can use it as my purse by zipping in my wallet, cell phone and keys into the inner pouches. So basically, I now have this one bag to tote with me instead of 3-4 separate ones. Consolidation is key, my friends.

So basically, this pump was made for someone like me who has to pump frequently and plans to pump long term. It also comes with two wide mouth bottles but it has two adapter rings so you can still pump into the smaller-type bottles, too. It’s really easy to clean the horns because there aren’t a ton of tiny parts that hold milk in secret places. I really disliked the way my Medela had tiny little ‘membranes’ to clean and this one does not have those weird things. And remember, ease of cleaning = saves you time = very good in the world of a working mom.

The motor is fairly quiet and I like that I can easily control the strength and the speed of the suction, too. All in all I am really digging this ‘green’ pump with a cute bag that can be used by others in the future. I never thought I’d be so excited about a breast pump but I am not kidding when I say that the day it arrived on my doorstep I was literally jumping up and down like a little kid. My how times have changed.



Hygeia Breast Pump Review

This Hygeia breast pump review was written by Julia Hornung, a Physical Therapist and mom of two.  She writes at www.julia-transition.blogspot.com

EnJoye LBI Brown Tote Set copyBefore I returned to work I was a giant stress ball that cried a lot over the ‘unknown’ changes I was facing. The biggest source of stress, besides simply being separated from Truman, was the fact that being at work meant I could no longer breastfeed my babe at any time. It meant I had to enter a whole new world of pumping and storing milk and washing parts and using bottles. When you are a new mom and EVERYTHING is so different from your ‘norm’ it sort of sucks that right when you get the hang of things, you need to go back to work and change it all again (unless you are one of those blessed SAHMs out there. And if so, this post does not apply to you). But you know what, it really has not been that bad and I never thought I’d say that statement a month ago. Yep, I’m one month into this working-breastfeeding mom thing and although I’m FAR from an expert on the matter, I feel like I have a lot of tips and advice on what has worked for me thus far. I know there are other new moms out there dreading the day they return to work and I hope that if you are committed to breastfeeding beyond your maternity leave that you’ll find this helpful.

I myself have discovered that I truly enjoy breastfeeding Truman (despite two rounds of mastitis and the extra effort and time it takes to make it work!) and I really don’t want to stop anytime soon. And so I have become a pumping fool and you better believe the pump makes one feel like a cow hooked up to an utter sucker. I borrowed a very nice Medela double-electric pump that was about 4 years old and sterilized the appropriate parts and bought new tubing. Admitting to using a second-hand pump is a huge no-no according to the pumping gods out there but I figured it was free and it worked, so what’s the big deal?

The problem was that it was a GIANT bag with the motor embedded into it and was a huge hassle to carry back and forth to work in addition to the milk, my lunch, and my purse. I was considering buying a new, smaller pump when Memaw came to the rescue and informed me that she wanted to buy me a new pump after talking to my Aunt about how to make life a little easier for this working mom. My Aunt suggested having two pumps: one to keep at home and one to keep at work, to cut down on the baggage. I tried to tell Memaw that I’d just buy it on my own but she insisted and thus, I got one of the coolest breast pumps on the market: the Hygeia EnJoye. You better believe I researched the heck out of this puppy before taking the plunge.
The reason why this pump first caught my eye is that it’s a ‘green’ pump. It’s green because when you are finished using it, you don’t just toss it out and let it sit in a landfill like all of the other pumps out there, but you return it to the company and they recycle it for you. I never thought about how many breast pumps are out there, some of them barely used, but because they are made as a single user product you pretty much have to throw them out or be deviant and let a friend use yours. Seems pretty wasteful, right? I think it’s so ridiculous that you void the warranty on almost all breast pumps if you have more than one person using it.
The other awesome thing is that this pump is NOT designed as a single user product. It’s totally acceptable and even encouraged to be used by other people after they each buy their personal accessory kit (only $30) and that means I can try to sell my beloved pump eventually to recoup some of the money or just let a friend borrow it without worrying about voiding a warranty.

And speaking of the warranty, we have two amazing things going for this pump: an extensive three year warranty (unheard of!) and also a 21 day money back guarantee. Um, seriously? The company feels so strongly about their product that they are willing to give you your money back if you try it out for 3 weeks and don’t love it? That’s a sign of a confident company! I am totally keeping mine, by the way, but I like the safety net of a money back promise.

Another pimped out feature on this pump is also highly entertaining. There is a ‘record’ and ‘play’ button on the front of the pump that allows you to capture your baby’s crying and then play it while you pump to assist in letdown. Hilarious! There is a generic baby cry that comes with the pump when you get it and I accidentally hit the play button numerous times while I was carrying my bag into work and let me tell you, the looks I got from passersby were awesome. I’m sure they thought I had an actual baby in my bag and might have called the cops on me. Whoops! I admit that I don’t actually use this feature at work because I’m worried the crying is too loud and people will hear it coming from inside my little pumping room. And plus, I don’t think that actually helps me have a let down as much as strong suction does:)

I really really love how small this pump is and that you can pull it out from the adorable bag and just go to town on your boobs. In fact, this EnJoye version has an internal battery so after you charge it up at night you don’t even need to hunt for an outlet while you pump! One less step of plugging the bad boy into the wall is a time saver and every little bit helps. Yes, the size of it and the beautiful bag (that could totally double as a diaper bag, don’t you think) won me over for sure. I’m so glad I got the brown bag because it has the cute aqua lining.

Enjoye bagAnd isn’t the extra insulated cooler super cute, too?

Although I got this pump to leave at work, I actually do bring it home with me each night. The bag is so roomy that I can fit my pump, the cooler, my lunch bag AND can use it as my purse by zipping in my wallet, cell phone and keys into the inner pouches. So basically, I now have this one bag to tote with me instead of 3-4 separate ones. Consolidation is key, my friends.

So basically, this pump was made for someone like me who has to pump frequently and plans to pump long term. It also comes with two wide mouth bottles but it has two adapter rings so you can still pump into the smaller-type bottles, too. It’s really easy to clean the horns because there aren’t a ton of tiny parts that hold milk in secret places. I really disliked the way my Medela had tiny little ‘membranes’ to clean and this one does not have those weird things. And remember, ease of cleaning = saves you time = very good in the world of a working mom.

The motor is fairly quiet and I like that I can easily control the strength and the speed of the suction, too. All in all I am really digging this ‘green’ pump with a cute bag that can be used by others in the future. I never thought I’d be so excited about a breast pump but I am not kidding when I say that the day it arrived on my doorstep I was literally jumping up and down like a little kid. My how times have changed. 🙂


Separation from Baby & Milk Supply

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.


Nursing a Preterm Baby

Babies who are preterm have unique nutritional needs and your breast milk could make the difference between life and death.  However, the “how’s” of nursing a preterm baby can be overwhelming, even for moms who have breastfed before.  If your baby is in the NICU, the most important thing you can do following birth is begin to express your milk.  At first you may not get anything, or just a few drops.  But this initial milk – colostrum – is the richest source of nutrition your baby could possibly have.  Unable to be replicated , different in composition from any other mammal, and different even to full-term colostrum, every drop is precious and should be saved for your baby.  In fact, even days later when you are pumping fresh milk for your baby, it is best to give any remaining amounts of colostrum first, and then your freshly-expressed milk.

There are several ways you can express your milk – by hand, with a hand pump, or a single or double electric pump.  For those first few drops of colostrum, hand expression is very effective and often preferred over a pump because every drop can be saved into a small container rather than going through the pump flange. (Click here for information on hand expression.)

If your preterm baby is going to be in the NICU for a few days or longer, check with your hospital about using a hospital grade double electric pump.  The most effective way to build a solid milk supply for your baby is twofold:  first, by pumping frequently – at least eight times every 24 hours; and second, by using breast compressions while pumping and finishing off with hand expression.

Let’s begin with pumping frequency.  Your goal is to be able to express at least 750 ml every 24 hours within 10 days following birth.  (If you have twins this amount should be doubled; 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 for just five minutes each time 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.

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!  However, research also 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).  And this is critical for a mom of a preterm baby who is working to establish her supply.

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.

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!

I’ve shared my story here about pumping and building a milk supply for my preemie twins.


How Often Should I Pump?

How Often Should I PumpHow often you should pump depends on if you are trying to build your milk supply or maintain your supply.  If you are attempting to build your milk supply while separated from your baby, please read this article.

When you have established your supply but will be separated from your baby during a feed(s), you should pump anytime your baby eats.  If your baby is taking in 4 bottles during the day while away from you, you should pump four times.  Pumping for 15-20 minutes on both sides (until you have a strong supply built) is a general guide.  However, you only need to pump until you get the required volume.  Many moms find that with an established milk supply 5-10 minutes of pumping is usually sufficient.

Some women are not able to pump as often while at work.  Here are some tips to allow you to pump more frequently:

  • Keep a refrigerator in your office/classroom/workspace.  Don’t worry about cleaning/sterilizing your pump each time you use it.  Just keep it in your fridge between sessions and then take the pump home to clean and sterilize at the end of each day.
  • Get a bra that will allow you to pump hands free so you could pump while working
  • Even if you can’t pump a full session, pumping a little is better than not pumping at all.  You may find that it is easier to pump more frequently but only for 4-5 minutes per session.
  • Use breast compressions while pumping to increase the milk volume you get in a shorter amount of time.
  • Try pumping at drop-off and pick-up to minimize the time you are apart from your baby.