Dear Boston Mamas: Nursing & Pumping

Today's Dear Boston Mamas question comes from Jen via Facebook:

Hi Christine, I just had my third little boy. He is a joy. Although I successfully breast-fed my first two sons, I was not successful in getting my second son to use a bottle (which led me to be resentful towards the end), so I have taken your advice and started my baby on a bottle at three weeks. I was wondering about how often you pump and provide bottles to keep up your supply and still be able to nurse? I've forgotten how I managed with my first son.

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Hi Jen,

Congratulations on your third son!

I hope everything -- including bottle feeding -- is going well! Having experienced major bottle battles with Laurel (the parents did not emerge as the winners there...) it is such a huge relief that Violet takes the bottle since it means others can experience the joy of feeding her and connecting with her in that way and also so I'm not so constrained time-wise when I'm out.

I'm happy to provide some 101 on pumping. First, I should say that I'm not pumping to maintain a full day supply. If you're back in the office it's generally a tradeoff to replace nursing with pumping. At present, I'm pumping enough so I can have enough for a bottle (or maybe two) each day + gradually banking in the freezer for emergencies and some upcoming travel that I have planned. But in general, I follow the below protocol and the milk supply balance has worked out great. Pumping was trickier at the beginning, after my milk supply came in (um, rather aggressively!) and I'll address that below, but after about 4 weeks, the supply balance leveled off, which has been lovely.

TIMING LOGISTICS:

When. In general, if you're only going to pump once a day, I recommend pumping in the morning, when your supply is highest. For me this also works out well because Violet usually sleeps through the night so I tend to wake up feeling very full and I like to exercise in the morning (it's good to pump before exercise to prevent leakage/discomfort).

How long. During my hospital stay with Violet I needed to pump to produce extra milk for Vi while she was undergoing jaundice treatment. The nurse told me to pump 15 minutes, no more. For some reason that time recommendation really stuck in my head as awesome, particularly since I had some awful days pumping for Laurel, where I'd pump for half an hour or more and get very little (meaning, I spent a lot of time, didn't get much, and was totally bummed out). So, I pump for 15 minutes only per session, unless I'm super-productive (see next point). If I have low producing days, I don't worry about it -- just disconnect and move on with my day!

Negotiating morning timing, Scenario #1. If I wake up around 6 or 7 am and Violet is still asleep, I pump right away (i.e., before feeding Violet). I usually will get 5+ ounces per side in 10 minutes and it feels rather victorious because the bottles are full and I've finished 5 minutes earlier! Also, I use this hands-free pumping bustier so I can have my hands free to triage e-mail on my phone, comb Laurel's hair, or what have you. Then whenever Violet wakes up (usually by 8 or 9am) I feed her. If she doesn't seem satiated after one side (with both Laurel and Violet, they were both done after one side per feeding) due to the previous pumping, I'll top her up on the other side.

Negotiating morning timing, Scenario #2. If Violet is awake by 6 or 7am (i.e., when I get up), I'll feed her first (on one side) and then pump not too long after after. (If I'm alone with her, I'll put her in her bouncy chair and chat with her while I pump.) This means that I get one full bottle and one not so full bottle. Or sometimes the supply surprises me and the output on both sides is the same, even having nursed not too long ago.

Negotiating morning timing, Scenario #3. As I mentioned, Violet usually sleeps through the night (a huge gift, I know), but there are periodic nights where she'll get up -- usually if she poops herself awake or something. If this is the case, Jon changes her and I nurse her back to sleep (I side lie in the bed and we both conk out quickly). If I have nursed once or twice at night and wake up not feeling super full and have a good supply in the fridge (+ the supply in the freezer), I don't sweat it and skip a day of pumping. It's nice to get a break.

MILK STORAGE:

I'm using a Medela pump. It's handy because the pump parts screw right onto the 5 ounce bottles and then you can attach a storage lid or nipple + collar to the bottle. I keep a few days worth of bottles at the ready in the fridge (freshly expressed milk is good for 5-7 days) and use small adhesive labels (you can get them at CVS or Staples) to date the bottles.

For banking in the freezer I use the Medela freezer bags. I found these a little wonky attached right to the pump so instead of pumping into the bags direct, I pump into the bottles and measure then pour into the bags. I know this defeats the point of having less to wash by pumping directly into the bags, but I find it easier to measure/distribute milk in the bottles, especially if the output per side is very different.

ADDITIONAL THOUGHTS:

To prevent waste, keep an eye on your son's bottle intake and store accordingly. As of a couple of weeks ago Violet would chug 4-5 ounces per feeding, but she's recently shown a preference for smaller (3-4 ounce) feedings spaced closer together. So now I store the milk in smaller increments -- since pumping does not rank atop my list of fun things to do early in the morning, I'd rather wash extra small increment bottles than watch liquid gold go down the drain!

Finally, since your son is so little: I'd say at this point since you just want to go for exposure (i.e., don't need a full day supply every day), just pump enough so you can do a bottle a day -- meaning, you might not need to pump every day. In the early weeks, the flow is so variable and you also don't want to overstimulate to engorgement so I'd say that if there are days where you are really full and it would help bank milk AND release pressure, then pump. But if you've had a day where you've been nursing a ton and you're feeling depleted (in the milk and general energy department) and you've got enough in storage, don't worry about pumping. Then once your supply stabilizes you can get in more of a rhythm.

Congrats again Jen, and let me know if you have other questions!

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Have a question for Christine? Drop her a line! And of course feel free to comment in if you have recommendations beyond those made above.