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Breastpumping FAQ (Frequently Asked Questions)
Reprinted with permission from the listowner
Information about the listserv (the Pumping List):
This list is geared toward supporting the pumping mother.
This list began as a support group of women who, for a number of reasons, use a breast pump to supply their children with mother's milk. Pump activity varies from occasional to full-time use. This group discusses pumping and related topics (ie: lactation problems, supply boosters.
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Upon subscribing please introduce yourself. Also, they have compiled a list of frequently asked questions (FAQ) that may be helpful. Please ask to receive it.
********Pumping list Frequently Asked Questions:********
1) Supply Boosters
2) Relaxation Techniques
3) Letdown Techniques
4) Frequency and Duration
5) Thrush remedies
6) Milk Storage
7) Tips to lessen time it takes to pump
9) Pump suction
1) Supply Boosters:
* feed more often and longer
* pump after every feed
* pump while feeding
* pump more often at work
* eat nutritiously and in copious amounts, drink plenty, get enough sleep
* relax- try relaxation techniques
* spend a weekend relactating (do nothing but feed, sleep and be waited on by your other half)
* (my own oddity:) wear breastshells all the time
*Try sleeping with your baby next to your body. It may naturally stimulate you to produce more.
*Drink LOTS of water - keep a large bottle full by your desk, and take sips frequently. Be sure to at least try to get enough sleep.
*If you are truly desperate, ask your physician for a prescription for Reglan/Maxaran (same stuff, different names). It is a gastro-intestinal drug that happens to have a side-effect of boosting production in lactating women. If your GI tract is fine, it won't cause any problems there and it
is harmless to infants (in fact, it is one of the drugs used to combat reflux in infants). This is not a permanent fix but can be used to boost production for women trying to relactate or after a stressful period has depleted your supply.
*I was looking in newest edition of _The Nursing Mother's Companion_ and the author mentioned the drug Reglan (although she called it by the generic name) and said it did indeed safely increase supply if taken for less than two weeks BUT that it could cause depression or worsen depression if you are already depressed.
HERBAL REMEDIES (As with anything, consult your medical professional)
*From The Complete Book of Herbs", by Lesley Bremness
- To Stimulate the flow of milk, a standard infusion of the leaves and seed of borage (Borago officinalis), dill seed, aniseed and fennel seed three times a day can help.
- A decoctation of fennugreek seed is a strong stimulant. Simmer 1.5 teaspoons seed in one cup water for 10 minutes and drink three times a day. A teaspoon of aniseed or honey will improve the taste.
- Another powerful stimulant is found in the flowering top of goat's rue (Galega officinalis): increases in milk flow of up to 50% have been recorded in tests done with animals. Infuse one teaspoon dried leaves in one cup boiling water for 10 minutes and drink twice a day.
*Brewer's Yeast tablets (easier to find than Fennugreek or Mother's Milk tea, at least around here anyway).
*Fenugreek capsules &/or mother's milk tea -- I have found them very useful. Take two with each meal and two before bed. I take 3 tablets at lunchtime (I use a local preparation which doesn't have gelatin capsules). That's 1800 mg. For our Canadian members - it is HSC, distributed by Vita Health. If I'm trying to increase my supply rather than maintain it, I take the same amount in the morning, as well.
*Many recommend Fenugreek as a temporary booster, not to be taken regularly. Also, you may notice a maple syrup smell to your urine and body odor while taking it.
*herbs: blessed thistle & fenugreek (both in mother's milk tea, also available at health food stores)
*Blessed Thistle! It's more effective in Tincture form. 30-60 drops (depending on body weight) 3 times a day. This is a very famous galactigogue.
*Also, another tip the herbalist in the store gave was to drink Blessed Thistle tea cold. Apparently you just put a teaspoon or so of either one in a tea-ball and make into a cup of tea - they suggested steeping 10 minutes.
The fennel, for those who don't know, tastes like licorice. I only bought the fennel to try as the herbalist said I really only need one thing at a time and I chose the fennel since she said the blessed thistle is more bitter tasting.
*The recipe for Tiger's Milk is as follows:
1/2 cup frozen undiluted orange juice (or any fresh fruit, a couple of bananas, peaches, blueberries, strawberries),1 cup fresh skim milk,1-2 teaspoons vanilla extract,1-3 teaspoons Safflower Oil. Blend all the above in a blender. Add: 3/4 cup instant powdered skim milk, 1/4 - 1/2 cup Brewer's Yeast (may want to start low and build-up STRONG TASTE). Stir in 2-3 cups skim milk. Drink at least 1/2 cup at a time, at least 4 times a day (Brewer's Yeast is available at health food and natural stores. Also some pharmacies and grocery stores) (Can substitute rice milk for skim milk for lactose intolerance)
2) Relaxation Techniques (Also see separate post on this subject)
*I read magazines/books & that keeps me occupied on more than 'how much is there/how long has it been'!
*Distraction -- talking on the phone, reading
*Deep breaths, slowly to clear the head and body
*Dim the lights
*Make it known that you are not to be disturbed either by a sign or by word.
*Take the phone off the hook and lock the door. Have someone else take care of the kids to limit distractions.
*Reading email of course!
3) Letdown Techniques
*make a tape of your baby cooing, crying, whatever special noise he/she makes. Play the tape on a personal tape player/walkman while you're pumping.
*take a blanket or piece of clothing which smells like the baby with you. Take a picture of baby with you.
*Put warm compresses on your breasts right before pumping or take a good hot shower.
*singing some of the some nighttime songs and reciting the same book to myself that I sing/read when Ellie nurses as she's falling asleep. I figured it would help relax me and my body would know that when I'm singing that song and reading that book then it needs to produce milk. It did help
*I've found that if I stop and just slightly rearrange the horns to be a little off center after pumping for 6 minutes or so, it helps stimulate different glands and I seem to get more out.
*Try to pump in a warm location.
*the biggest difference to me in supply has been the discovery that I can bring on more than one let-down when I pump! I don't get a let-down from the pump alone. I rub my nipples til I feel the tingling & then I pump. when it's down to one drop or so, I stop, do the rub thing again until I feel the tingling & then pump some more.
*When I was pumping for my daughter (now almost 2), I had a lot of luck getting more production, more quickly when I applied warmth to my breasts before I pumped. I found something called a "bed buddy", which was a bag of beans, basically, that can be heated and reheated in the microwave, and applied to stiff shoulders and joints. I would heat it up, and apply it to both of my breasts before pumping. Then, while I pumped one side, I would keep it on the other side. The heat "loosened" up my milk, and I got more milk per session than I did without the heat. Be careful, it gets really hot. I'm sure massaging the breasts before and during pumping would achieve the same results, but it really doesn't work as well for me as using the bed buddy.
*You can make an inexpensive heating pad in various shapes just by using brown rice. My doula used a tube sock filled with brown rice on my neck and back when I was in labor. You just microwave it and it provides moist heat. You could sew a container specifically, or just use a sock as she did if that shape would work for you. Be careful, it gets really hot.
4) Frequency and Duration:
*I'm pumping for a hospitalized preemie so that's different than what most of you are doing. However, I make sure I pump or nurse at least 7 times in 24 hours (that means getting up once at night). Since we typically only nurse twice a day, these 5 pumpings are necessary to keep my supply up. I pump for a total of 10 minutes with a double Lactina so the time commitment isn't too bad.
*I pump twice a day for about 10 mins. at each session with an Emeda Egnell double pump. I stop when flow slows down, but doesn't stop completely.
*I usually pump until I can't get anymore milk. Most days it is from 5 - 8 minutes with this same pump (Ameda Egnell) that you rented.
*I pumped until output slowed down. I double pumped with a Nurture III, and it took about 20 mins. I didn't pump more than once at work, because I would nurse as soon as I got to daycare, and wanted to be full (sometimes I leaked near the end of day, though).
*I double pump 3 times/day for about 15 minutes at a time. I stop when my yield is down to drops. I am currently using a Medela Lactina which my employer (the state of Iowa) keeps in a lactation room in my building. Before that I used a Medela mini electric and pumping took longer and was
less effective, I think.
*I usually pump 10 minutes - I have a dual lactina electric plus (medela) so it doesn't take too long. I typically only pump until I can't get anymore - I get less and less as the day goes on.
*Usually about an hour. I use a cheapo battery-operated pump that can't even get a single drop out on its own when I'm horribly engorged, but it works adequately if I pump while nursing. Since bf and pumping are not popular here, that's the best affordable pump I can find in the stores.
*I get 3-10 oz per letdown. I probably average 7-8 the first time I pump with another 4-6 the second. Mondays I get more, Friday less. Less if I don't drink enough water or if I'm overtired or stressed out.
*Twice a day at work, usually at 11 a.m. and 4 p.m. I pump (double sided) for about 15 minutes. This results in a grand total of 5 oz, but then Rafi is 17 months old. At peak production I pumped at work, in the evening and sometimes in the early morning (if I could wake up early enough). Never produced more than 12 or 15 oz/day, though. We did have to supplement a little sometimes.
*Usually 15-20 min. I stop when I get to 8 oz combined or when no more milk is being expressed.
5) Thrush remedies
*HA -- 3 rounds of nystatin, 2 rounds of gentian violet, on 2nd round of diflucan. Water & vinegar rinse for my nipples, boiling everything else... at this point I think the thrush is ahead! but I have high hopes to win this round.
*Gentian violet is strong stuff, and can burn. Try diluting it to .5% or thereabouts. Then put it on a cotton ball or q-tip and apply it to baby's tongue and inside cheeks. If the solution you have is 1%, mix it with an equal amount of water. Do this VERY CAREFULLY, as the violet will stain anything it comes in contact with.
*Low sugar diet. (Fruits are 100% natural sugar too.)
*I also made a point to eat a cup of yogurt (with live cultures) each day
*acidophilus capsules every day during thrush
*I still rinse with diluted white vinegar 50/50 after each nursing/pumping.
*Gentian violet. Strip to waist, paint the nipples and areolas (sp?), using a q-tip instead of the applicator they provide. Then hang out shirtless and braless. The violet washes off the skin with soap and water, but does not come out of clothing, so be careful! I used the violet straight out of the bottle for my painting, but would dilute it to .5% (1:1 solution with water) before using it in the baby's mouth. I used a suggestion offered on another list to get it into the baby's mouth. Painted myself and then let him nurse on the painted nipples. Also pumped that way. Kinda funny to see gray/purple milk, but ped. assures me it's safe. Beware, however, when you pump or nurse to put a rag under your nipples, and to nurse the baby without him/her being clothed, as violet will get everywhere. I tucked an old towel into my waistband when I pumped, because I tend to leak from under the breast and I had light purple milk running down my breasts and toward my waistband. First application worked within two days. I was told that if I applied it to baby's mouth to use it only every 3-5 days for three applications.
*about the gentian violet -- I have had luck getting it out by bleaching the stains. so, when I've had to treat us with it, I either dress us both in something all white or something really dark. *Preventatives against thrush: Going topless or, in the least, going braless. Rinsing breasts with cool water every now and then when it's really hot. Not wearing the same bra two days in a row, unless it's washed with hot water between wearings.
*Boil frequently everything that comes in contact with baby's mouth and your nipples in diluted white vinegar solution 1:4. That means all pump equipment, bottles, bottle nipples, pacifiers, toys, etc.
*Lotrimin type of cream, etc in athlete's foot section. Rub it into nipples four times a day. No need to wash off before pumping/nursing if apx. 15 minutes have passed.
*Lotrimin cream in baby's mouth, scrub it in gently with a soft toothbrush or Q-tip.
*Nystatin/Lotrimin cream on nipples (prescription)
*Oral Diflucan for mom
*Nystatin for baby needs to be scrubbed into the mouth gently with a soft toothbrush or Q-tip. The medication works on contact with the Thrush, not just from ingesting it like other medications. Some docs forget to mention this. Ask the pharmacist when you pick up the prescription.
6) Milk Storage
*From THE WOMANLY ART OF BREASTFEEDING, La Leche League International, Sixth Edition, p. 158-159, 161-162.
"New research has shown that human milk can safely be kept at room temperature (66-72 degrees F) for up to ten hours because of its remarkable ability to retard the growth of bacteria. Milk can be kept refrigerated for eight days. For longer storage, it can be frozen. Frozen milk can be kept up to two weeks in the freezer compartment of your refrigerator, three to four months in a separate door freezer that is opened frequently. It can be kept six months or longer in a separate freezer that stays at a constant 0 degrees F. Once the milk is thawed, it cannot be refrozen; if the freezer defrosts for any reason, the milk must be discarded.
After pumping or expressing your milk into a clean container, transfer it into a glass or plastic storage container, baby bottle, or plastic milk storage bag. Use a separate container to refrigerate the milk each time you pump or express. These cooled batches can later be combined for a feeding or for freezing. You can add refrigerated milk to milk that is already frozen, just be sure the amount you are adding is smaller than the amount already frozen so it does not thaw the frozen milk. Allow room for expansion when filling containers for freezing. Do not tighten caps until milk is completely frozen."
"You can freeze your milk in either glass or plastic storage containers. Some mothers store their milk in plastic nurser bags designed for feeding babies. Freezing milk in these less-durable bags can be risky. It is a good idea to use them doubled to avoid tearing. Squeeze out the air at the top, roll down to one inch above the milk, fasten, and place the bag into a container which will hold it upright until it is frozen solid. These bottle liners are not recommended for long term storage."
"An unopened container of human milk that has been frozen and thawed can safely be kept refrigerated for up to twenty-four hours. It is not known whether or not leftover milk should be discarded after baby has taken some of it from the bottle. Recent studies have shown that human milk actually retards the growth of bacteria so it may be safe to refrigerate unused milk for later use. Thawed milk should not be refrozen."
*From THE BREASTFEEDING ANSWERBOOK:
"At room temperature -
* at 80.6 to 89.6 degrees F (27 to 32 degrees C) - 12 hours (Nwankwo1988)
* at 60 degrees F (15 degrees C) - 24 hours (Hamosh 1996)
* at 66 to 72 degrees F (19-22 degrees C) - 10 hours (Barger and Bull1987)
* at 79 degrees F (25 degrees C) - 4 to 6 hours (Hamosh 1996, Pittard1985)
"In a refrigerator -
* at 32 to 39 degrees F (0 to 4 degrees C) - 8 days (Pardou 1994)
"In a freezer -
*in a freezer compartment located inside a refrigerator - 2 weeks
" in a self-contained freezer unit of a refrigerator - 3 or 4 months (temperature varies because the door opens and closes frequently)
* in a separate deep freeze at a constant 0 degrees F (-19 degrees C)
*From "What to Expect the First Year":
"Plastic containers are better than glass for collecting and storing breastmilk, not only because glass is breakable, but also because disease-fighting white blood cells in mother's milk have been shown to cling more to glass than to plastic, making them less available to baby."
"Refrigerate expressed milk as soon as you can; if that's not possible, use a sterile container, in which it will stay fresh at room temperature (but away from radiators, sun, or other sources of heat) for as long as six hours. You can store breast milk for up to 48 hours in the refrigerator, or chill for 30 minutes, then freeze. Fill containers for the freezer only 3/4 full to allow for expansion, and label with the date (always use the oldest milk first). Breast milk will stay fresh in the freezer for anywhere from a week or two in a single-door refrigerator, to about three months in a two-door frost-free model that keeps foods frozen solid, to six months in a freezer that maintains a zero temperature."
"To thaw breast milk, shake the bottle under lukewarm tap water; then use within 30 minutes. Or thaw in the refrigerator and use within three hours. Do not thaw in a microwave oven, on top of the stove, or at room temperature; and do not refreeze. When your baby has finished feeding on a
bottle, discard the remaining milk."
*From Human Milk Banking Association of North America. Executive Director: Lois Arnold, MPH, IBCLC. 5/93, revised 8/95.)
- Glass or hard plastic are preferred -- baby bottles, Tupperware containers, glass jars, baby food jars.
- Plastic nurser bags tend to leak and can destroy nutrients found in breastmilk. Fat also adheres to the sides of bags, decreasing available calories and fat soluble nutrients. Use of plastic bags is STRONGLY DISCOURAGED. If thin plastic bags must be used, double bag and store bags in a hard sided container to help prevent tears and punctures.
- NEVER use a microwave to thaw or heat milk. Microwaves can cause damage to milk components, and milk heated this way has the potential to burn your baby.
- Never refreeze thawed milk.
- Use thawed milk within 24 hours.
- A few smaller portions (1 or 2 ounces) may also be packaged for when a feeding is not enough or when a breastfeeding will take place within 30 minutes.
*I used to freeze milk in Playtex bags (inside Ziploc bags), but I quit and just pumped each day for the next day. Works well for us.
*I always freeze in bottles, usually 3-4 oz per bottle. I throw out anything older than 3 months. Zachary doesn't seem to like milk that's been stored in the refrigerator for more than 1 day, so I freeze everything.
*I don't mix warm with cold milk.
*I'm one of those who pumps right on top of a previous pumping (warm milk over cooled milk), and I've never had a problem doing that with either of the babies I've pumped for. Don't know if you want to add that to the "save time" section, tho, in case it causes thrush for some.
7) Tips to lessen time it takes to pump
*Set up all equipment as soon as you get to work so you won't have to take the time later
*Purchase a second set of horns and bottles so you can just rinse and store until you get home to wash
*Massage breasts occasionally during pumping to encourage all ducts to empty
*Lean forward slightly so gravity helps out
*Pump one side while the baby feeds on the other - This one requires a level of coordination which I've never mastered. It works better in the early months, before the baby knows what that pump noise is, where the on/off switch is and how to pull the tubes out of the bottles :)
* make sure you have a rental-grade pump
*I wear clothes that have easier accessibility (I don't enjoy sitting there with a one-piece dress draped behind my head & cold nipples seem to cut off the flow anyhow ;-)
*Cloth diaper tucked under the breasts to cover the lap and catch drips.
*Condensation in the tubing of pump and mold buildup are signs of an improper seal in the suction. Wet nipple and aerola before inserting into pump horns and try not to break suction during pumping session. If condensation appears, run the pump after the session is over with just the
tubes connected until dry. If mold appears, rinse the tubing with alcohol, it will kill the mold and dry easily.
* wash the white membranes in a tea ball
* store a bottle brush and a sample size dish soap bottle in a tupperware bowl --> portable sink
9) Pump suction
*I use a lower to medium amount of suction. I don't want to damage my breast tissue with too strong and painful suction.
*If suction is all of a sudden minimal, check to see if each part is put together correctly. Also, check the white membrane valve in the horn. If you wet it before beginning it will seal better and therefore cause better suction to build. (using Medela PIS)
*I start with minimum and move to midpoint. I can't stand the strongest suction.
*A Medela customer service rep. told me the PIS needs to have the suction strength exactly on Low, Med, or High, not inbetween to be most effective.
*I've used my Medela PIS inbetween the suction strength settings and it's worked fine.
*I always use the maximum because I am always in a hurry and I don't have a problem with sore nipples.
*The pump I use has three levels of suction (maybe more, I've never tried anything in between). I start on "minimum" for probably 30 seconds and then go straight to "maximum." If I don't use the maximum setting, I can't pump much.
*I always started on the lowest suction as per the instructions. Sometimes I turned it up to Medium or between Low and Medium once the milk began. I interpreted this to mean that my daughters don't have a very powerful suck. A friend with the same pump began her sessions on Maximum & said that her son had a very strong suck. So it is obviously a personal thing. Another friend told me she could not even handle the Low level of the electric pump. I did find it somewhat uncomfortable, not painful at all, but not something I liked doing. But of course I loved seeing the milk squirt out.
*Used the low suction for first few months, then would start on low and increase to medium after a few minutes.
*Nah - I don't touch it. I leave it at the lowest and it seems fine.
*Strong enough to get some milk out, but not so strong that I can feel the pull. I believe in comfort. :)
*As strong as I could stand it (per my LC's advice). Usually as hard as it would go. My baby sucked harder. Per her advice also, I lubricated the breast cups with vegetable oil. MUCH more comfortable, and it just wipes off with a paper towel when I'm done. Felt more like my baby and was good for production.
*I started with a medium suction control (with the good pump). I found that worked most of the time. When my daughter (baby 2) got older, I found I wasn't producing as much ... after some brainstorming I decided that my daughter's sucking style had changed (to get a second letdown?) so I varied the suction control to match what I thought she was doing. In this case, I set the suction to low for a few minutes and then set it back up to medium.
* I use the highest suction I can tolerate in order to shorten pumping time.
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