Aug 14

Exclusive Pumping

Exclusive Pumping – One Mother’s Story

Emily Golden PNP, UC San Diego
My baby was born with a few medical issues that made breastfeeding difficult. He could latch well, but was not able to transfer much milk.  We tried all sorts of therapies including a frenotomy, multiple lactation consultant visits, occupational therapy, neck stretches, and jaw massage.
Initially, I was lucky to have lots of breast milk and a strong letdown, so he was able to get a little from the breast, but over time my milk supply decreased and his weight dropped.
At that point I started pumping and supplementing.  I fed him with a long-term supplemental nursing system at the breast with pumped milk for 6 weeks.
After 6 weeks, he still was not able to transfer at the breast so I switched to exclusive pumping and bottle feeding with expressed milk.
I was fortunate to make enough breast milk that he never needed any formula. Ultimately, I ended up pumping for 16 months.
While not what I envisioned during my pregnancy, I’m proud to say I was able to provide him exclusive breastmilk.
Along the way I learned a few lessons that might benefit other mothers with a similar problem.

The Downside Of Exclusive Pumping:

  • Pumping can be time consuming (washing bottles and pump accessories, labeling and storing milk, thawing milk).  Women who only pump at work still have to deal with this but not also at home.

  • I always had to have my pump with me
  • I had to plan my day around pump times
  • Trying to care for my son while pumping became difficult especially as he got older and mobile, especially in public
  • My baby did not like thawed frozen milk, so I had to make sure I had enough fresh milk for him every day.

The Bright Side Of Exclusive Pumping:

  • My baby still got breast milk and important antibodies – when I got sick and didn’t have the energy to breastfeed
  • Other people were able to feed my son. My husband and mother really enjoyed these opportunities.
  • I had an easier transition back to work because he was accustomed to bottles.  Some of my friends had a difficult time getting their older infants to accept a bottle for the first time.

  • I was able to help other babies receive breastmilk.  My son didn’t like thawed previously frozen milk, so I had a lot of milk I couldn’t use.  I was able to donate 1,300 ounces to the San Diego Mothers’ Milk Bank which provides milk to premature and sick infants.

Emily Golden MSN, RN, CPNP, UCSD Health Newborn Service

Exclusive Pumping – The Pediatrician’s Commentary

Michelle Leff, MD, FAAP; UC San Diego Pediatrics
Emily was a very motivated mother.  It’s not easy for a working mother whose baby breastfeeds well to pump for this long and provide exclusive breastmilk, let alone a mother whose baby never nurses.
Emily’s story raised a few important topics.

First, When Thinking About Babies Who Are Not Good Breastfeeders:

When getting support for breastfeeding know the different types of help available.  Many outpatient clinics and support groups use lactation educators.  They are great for common breastfeeding questions.
Specialists in breastfeeding (IBCLCs) have more advanced training and are better able to help with more complicated issues.  Sometimes an occupational or physical therapist is needed to help with oral motor dysfunction or oral aversion as can be seen in premature infants.
Beware of mouth surgery.  Recently there has been a strong push for procedures that cut various anatomy in the mouth to help with breastfeeding. Tap here to learn more in our Birth Plan Recommendations section.
Very little research has been done on these procedures so it’s hard to say that they are actually beneficial and they can be harmful.  Consider getting a second opinion before having anything done.
Some women who are unable to feed from the breast choose to do long term supplementation at the breast.  Many women use a makeshift setup for short term supplementation which really isn’t appropriate for long term use.
If you want to do supplementation at the breast long term, invest in a commercial grade product made for this. The equipment will last longer, hold more milk, and be easier to clean.  These can be ordered online.
Tap here for information on retail supplementation systems.

Second, I recommend Thinking About How To Make Pumping Easier Since Exclusive Pumping Is An Extra Workload:

  •  Try out different bras.  Some women are able to use their regular bras and just tuck the pump flanges into the cups.  Others prefer to switch to a hands-free bra while pumping.  A cheaper option is to take a sports bra and cut holes in the cups to insert the flanges.  What works best for you will depend on your breast size and bra type and may change over time.
  • One way to save time with exclusive pumping is to skip the milk warming step.  Many babies are perfectly happy to drink cold breastmilk straight from the fridge.  There is no medical need to warm it, although some infants to prefer it warm.
  • The number of times you’ll need to pump per day will be specific to you.  We generally recommend at 6-8 times per day until your milk comes in.  Once milk comes in many women find they can pump 6 times per day without a drop-off in their supply.  Try cutting back and pay close attention to your comfort and supply.

Finally- Consider The Emotional Aspect.

A lot of women have strong emotions around breastfeeding and when expectations aren’t met they can experience significant disappointment and even depression (https://postpartumhealthalliance.org).
I want all moms to know that breastfeeding may not come as easy as you expect.  For some women it does, but for others, like Emily, it doesn’t.  There should not be any guilt about this.
We can’t force a baby to be a good breastfeeder, to nurse, or force a breast to produce.  Friends and family members can help support new moms by encouraging them but not making them feel guilty.
The amount of effort any one person can devote to nursing varies from person to person.  Some women may not have jobs that will support pumping every 3 hours like Emily’s did.
Other women might have several other children or one with special needs and not be able to pump at regular intervals.
Some moms might have medical conditions that require them to sleep for longer stretches at night.  Family and friends should not make assumptions based on their own experiences.
Those of us who are healthcare professionals need to assess a mom’s specific medical and social situation and her personal feeding goals when developing a course of action.

Emily Golden PNP, UC San Diego
Michelle Leff, MD, FAAP; UC San Diego Pediatrics