THE WHAT AND WHY

Exclusively pumping - a method of feeding by which the mother solely feeds her baby breastmilk that she has expressed via an electric pump - is an alternative to direct breastfeeding that still confers nearly all of its benefits while accommodating a wider variety of situations that might have otherwise necessitated starting formula. Mothers who must return to a work environment that is not conducive to nursing or who have babies with latch trouble such as tongue-tie, for example, are ideal candidates for exclusively pumping. 

Pumping has some distinct advantages over breastfeeding. You don’t have to count wet diapers to know if your baby is being adequately fed, your breasts are never mistaken for teething toys, and there is no pleading with your kid to please be hungry because you’re engorged and leaking. Gone is the need to be stuck in the house for those who would otherwise be too self-conscious to nurse in public, and Daddy can feed and bond with the baby, too. The biggest advantage, though, is the time saved by not being at the mercy of “on-call.” You can tackle something without that nagging expectation that you’re going to be interrupted as soon as you get involved. And, Hallelujah, you can get a nearly normal amount of sleep!

Convinced? Well, the sticker shock for the set-up may ruin it for you, but keep in mind that even with the best equipment, it comes out to less than a year’s worth of formula. Now let’s see what you need.

THE SHOPPING LIST

• A high-speed electric dual pump – the absolute best is the Medela Pump in Style Advanced, with the Original Pump in Style being second. They differ in that the PIS Advanced actually mimics a baby’s sucking patterns, which triggers the letdown reflex sooner and reduces pumping time. I’ve tried Ameda and Isis; the PIS was the closest to the hospital pump in power and cycles per minute. The Medela PIS Advanced retails for about $370, but I’ve occasionally seen it on sale at Amazon.

Extra tubing, valves and membranes. You need a redundancy plan – if even the most miniscule piece of the operation ceases to function, you run the risk of dropping pumping sessions, which can be uncomfortable at best and ruinous to your whole dairy business in the worst-case scenario of your local dealer being on back order for the replacement part.

• A “hands-free” kit, such as the Medela Pumping Free Hands-Free Breastpumping kit – for about $12, you can hook yourself up and read a magazine while pumping instead of having to clutch your horns for fifteen minutes straight, several times a day.

• If you have very large breasts, you will want to buy larger breast shields than what come standard in the kit.

• Several nursing bras that are compatible with the hands-free kit, about $40 each from Medela.

• Nursing pads (disposable or washable), because you will still occasionally leak, and they feel good against sore skin.

• A lanolin balm, like Lanisoh Lanolin, for if you get sore; after the first few days of pumping, nipple irritation shouldn’t be a problem, so this is just insurance.

Breast milk storage bags or the Medela breast milk storage and feeding set, rigid lidded containers of cloudy plastic and a permanent marker, for freezing your supply.

• Several nursing bottles of your choice – see below under Storage for more on how to choose bottles.

• A 12V vehicle power adapter, Quick Clean accessory wipes, and a cooler so you can be away from your home for more than a 3-4 hour stretch or go on a road trip, etc.

• Optional, but so worthwhile: a stand-alone freezer. It stays colder than the one attached to your fridge, there is no jockeying for room amidst the peas and ice cream, and it’s easier to “file” the bags upright (more on that later).

THE BASICS

• Follow your pump manual’s instructions for assembly, operation and maintenance.

• For the first couple of months, schedule a 15 minute pump session for every 90 minutes to 2 hours. This sounds like a lot, but the major GOLDEN RULE OF EXCLUSIVELY PUMPING is ALWAYS EXCEED THE DEMAND OF THE YOUR BABY. Newborns eat about every 2 hours – you need to express slightly more than that amount. The key to this whole gig is the basic economic rule of supply and demand, because the more your body thinks your kid is taking, the more it will push to make. This rule will not change throughout your breastmilk-feeding career. It is in fact what you use in reverse to “wean” off of the pump when it’s over. As your baby grows and can hold more in his/her stomach at one time, you will have more time between feedings. The average interval once you hit your stride is every 3 hours during your waking day with only one session in the middle of your sleep cycle. This is an average – if you’re freezer is bursting with banked milk, you may be one of the lucky women who can drop the session in the middle of the night. If your kid is having a growth spurt or you’re hard-pressed to keep up, you’ll have to shorten the time between sessions.

• The corollary to the Golden Rule of Exceeding Baby’s Demand is that frequency of pumping is infinitely more crucial to supply than duration. It is far better to pump every 3 hours for 10 minutes than every 5 hours for 20 minutes. Always think to yourself what your baby would be doing if he/she was very hungry – he/she would be trying to get fed more often, not wait extra hours in between attempts and just try longer. A good rule of thumb for knowing how long to pump at each session is to keep pumping for about two minutes beyond when you see that milk is no longer being expressed.

THE HANDLING

• To freeze your milk, first determine how many ounces you have in your “batch,” divide that number by how many minimum ounces your baby consumes at one feeding (you can always thaw more if needed), and pull that many storage bags out. With your permanent marker, you want to write how many ounces the bag contains and the date of freezing. It is way easier to write on an empty bag! Now, over a collecting bowl (in case of spills or bag mishaps) pour the amount of milk in, seal and check for drips or leaks. Lay flat in the freezer until solid and then transfer to your cloudy plastic container, which further protects the nutrients. Freezing flat first will allow for easier “filing” by date, and it will allow for rapid, even thawing under warm running water.

• You should really try to freeze any breastmilk that you don’t plan on feeding within a day of expressing. It won’t “go bad” in the dairy sense for about 8 days, but the sooner it is frozen, the less it loses nutrients. The one-day rule applies to thawed milk, too. In the interest of preventing waste, it is just as convenient to pull a bag of milk directly from the freezer for a feeding and run it under warm water to immediately serve.

• You don’t want to make a habit out of it, but breastmilk can hold up in terms of bacteria and nutrients for about 8 hours at room temperature, so if you see that your husband fed baby half a bottle and cavalierly left about 45 minutes’ worth of your booby drama (you WILL start looking at every drop in terms of how many minutes it took to make it) out on the coffee table, you can still replace the nipple for a clean one, refrigerate it and use it at the next feeding.

• It is not necessary to warm the milk to serve – your baby is not going to have a preference – and it can actually kill some of the beneficial properties in it. If you insist on warming it, don’t use the microwave because it can heat unevenly and a hot spot may burn your baby’s mouth.

• Please make certain that your plastics, from storage to feeding bottles, are free of Bisphenol-A (BPA) which is usually found in Polycarbonate, and Polyvinyl Chloride (PVC or just vinyl), as they are known toxins with hormone-disrupting properties. The plastics deemed safe at this point are made of polyethylene or polypropylene. How on Earth are you going to know? The bottom of the bottle or container will have a recycling code number on it: 1, 2 and 5 are “safe.” Medela and Evenflo use safe plastics, and Evenflo also makes tempered glass bottles. Another great choice is Born Free. Also, choose the slowest flow nipples your baby will tolerate for feeding so as to more accurately duplicate the breastfeeding process.

GETTING COMFORTABLE

• Set up a regular location in a private area of your home with a comfortable chair, side table to hold your pump, your laptop, or some magazines or a book, a beverage, and a timer.

• For some women, reading parenting magazines – or even this site! – or looking at a photo of their baby facilitates triggering their let-down reflex.

• An MP3 player is a great way to cancel the noise of the pump – after a few weeks of hearing that constant wheemp-whomp, wheemp-whomp, you will start having dreams involving marching troops and drumline drill bands!

• Use a timer instead of a clock, and turn the timer away from you so you don’t just stare at each minute slowly ticking away. Also, try not to stare at how slowly the collection bottles seem to be filling up – excruciating.

• When pumping away from home, bring a throw blanket or a nursing cover for your privacy; even if you’re in a lockable room you’ll feel more secure. Bring all of the packable elements of your regular routine, and take a few minutes before starting to do some relaxing breathing.

WHAT ABOUT BONDING?

Many women who turn to EPing after having hopes of breastfeeding worry that they and their baby are at a disadvantage when it comes to bonding. If this is a concern to you, rest assured that feeding time can still be extremely intimate. You or anyone feeding your child should hold him/her and engage eyes, make it sweet and relaxing and never rush. Additionally, when you feed your baby at home, undress on top and have some skin-to-skin contact. If possible, encourage your baby to put your nipple in his/her mouth. This will not only satisfy some of your baby’s sucking needs, but it will enable your body to tailor antibodies to him/her. It is actually possible to give your baby immunity to strains of colds and flu that you’ve had without his/her needing to have gotten sick.

Also, obviously, feeding time is not the sole opportunity to bond with your child! Plus, when your baby is fed through a bottle, anybody close to him/her can get in the act – Daddy, siblings, grandparents – and he/she can really feel the love.

TROUBLESHOOTING

Nearly all of the problems you can encounter with exclusively pumping are common to breastfeeding in general, and some are actually lessened because you are pumping, such as engorgement from waiting for baby to feel hungry – the pump is always ready when you are. But here are some common hitches and their remedies.

• If you do experience engorgement from having been kept away from your pump, oversleeping, having to bring your unit in for repair, etc., get into your pumping gear (including the horns – everything short of turning the pump on), make some warm compresses (hot water bottles are really good, and I’ve actually seen doughnut-shaped gel packs specifically for this, but they look like they’d get too hot or burst) and hold against your breasts for about ten minutes. They may leak quite a bit – hence suiting up beforehand – and now brace yourself as your turn the pump on. Ouch, I know, but this is the only way. Also, since your body has now received the signal that it made too much milk, you will have to add one or two extra pumping sessions a day for a week or so to convince it otherwise.

• Warm compresses with pumping also remedies plugged ducts; as an added preventive measure, gently rub your nipples with a washcloth in the shower.

• If you have both engorgement and plugged ducts along with flu-like aches, get thee to the doctor as you may have mastitis and could require antibiotics.

• If you aren’t producing enough milk despite keeping up with your pumping schedule, the first thing to do is always to add extra sessions. You may not notice an increase for several days, but be persistent. Also:

- Avoid antihistamines, caffeine and alcohol as they dehydrate and you need fluids to make milk.

- Eat oatmeal for breakfast – it is a mild galactagogue (milk increaser).

- Take an herbal galactagogue such as fenugreek seed (Nature’s Way is a reliable brand), which is an herb used to make imitation maple syrup. It is exceptionally safe, but could be a problem for insulin-dependent diabetics as it lowers blood sugar. Be warned that you must take upwards of 6 capsules a day and it may be anywhere from 3 days to a week to see results. Also, while this is a very effective remedy, you and your kid are going to smell a bit like an IHOP.

- NOTHING is going to replace adding more pumping sessions – that must be done regardless. You can drop the galactagogues once you’ve re-established your supply, but do not drop sessions!

Another tip - if you plan to pump even occasionally, shop for all of the equipment, bras and accessories while you’re still pregnant. That way, you will find a store you trust for future supplies and, more importantly, you will have everything ready to take with you so you don’t lose precious hours or days in the event of something unforeseen, like a c-section, baby needing to stay under observation, premature birth or a number of other scenarios. The first 72 hours after giving birth are crucial to breastfeeding/pumping success; if you can get your business up and running within a couple hours of birth, you are unlikely going to have to play catch-up with your supply. By the third day or so, if you haven’t gotten started, your body figures there aren’t any takers and proceeds with dismantling the dairy, and you’re going to have a hell of a time trying to meet demand.

Finally, if this is not for you, or you give it a try and pumping doesn’t work out either, don’t beat yourself up over it and don’t let anyone else! You tried to give your child a bonus advantage that didn’t pan out, that’s all. You are not condemning your baby to stupidity and obesity just by feeding with formula; if you were, nearly all of our grandparents would be fat morons and not “the greatest generation."  If you need a morale boost, take a look at my rant, "The Choice Between Feeding Her Baby Breastmilk or Formula is Mom's Alone."