Evidence-Based Strategies for Supporting Exclusively Pumping Mothers

 

This article was written by:

La Terra Jackson | NCS, CLC, CIMT, BA Psychology and Human Development and

Laura Shiff | Copywriter

Published on January 15, 2019

 

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Exclusively pumping moms need the support of highly skilled and trained lactation specialists with plenty of experience helping moms stay the course. This type of counseling is especially important for mothers who pump exclusively given the high rates of early cessation. Although the journey of an exclusively pumping mother is different than that of one who feeds from the breasts or formula feeds, it does not mean that it can’t be done. There are many ways to support mothers who exclusively pump in order to make the process easier and successful.

Today I want to share of-the-moment, practical strategies that NCS, doulas, and lactation professionals can use to step in and be a great support person for pumping moms. All of these practical tools are backed by research on what pumping moms need most.

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A majority of mothers are increasingly recognizing the importance of breastmilk and all of the benefits it can offer their baby, but for some, feeding at the breast is not an option. It is crucial that we provide support and guidance to these mothers to ensure their experience is positive and successful.

 

Just a decade ago, formula was the only other alternative to breastmilk, but now, thanks to improvements in breast pumps and educational supports for mothers, another more and more common method of expressing breastmilk has become exclusively pumping.

 

Researchers from the University of Sterling used specific search terms related to exclusively pumping breastmilk to find and evaluate 10 different websites at multiple points in time for their content and overarching educational benefits for mothers. Their research found that three common themes emerged: depiction of expressing; reasons to express; and recommendations about expressing.

 

While a lot of the themes were similar on these reviewed sites, practical information about expressing in general was found to be inconsistent and conflicting. This incomplete information proves to be overwhelming for mothers and can lead to the decision to forgo expressing breastmilk altogether. Access to good quality information based on robust evidence is urgently required.

 

Common Terminology

To begin with, there are many different definitions commonly used when discussing exclusive pumping (EP) and they are important to know in order to fully support clients and other EP mothers.

 

Exclusively pumping refers to a woman that uses a breast pump to produce and maintain lactation. There are many reasons why a woman might EP, which will be covered in the next section.

 

Milk expression is the term used to describe any method a woman may use to expel milk from her breast, whether it be manually with her hands or through the use of a breast pump.

 

Hands-on pumping is a breast massage technique that is used to drain the breast more fully each time after a pumping session.

 

Reasons for Exclusively Pumping

There are many reasons for exclusively pumping and they are as varied as the mother and baby themselves. Some common reasons for exclusively pumping include:

• Latching difficulties
• Low milk production
• Maternal illness
• Infant illness
• Infant medical condition (such as a tongue tie, lip or palate clefting)
• Prematurity
• Separation
• A personal choice

 

For a majority of cases, the decision to exclusively pump is one that is not made lightly; she is highly aware of the benefits of her milk and wants to provide these to her baby if at all possible. Unfortunately, many women feel excluded from common groups for breastfeeding or formula feeding mothers, and some are even discouraged from EP by uneducated healthcare providers. This lack of support can lead a lot of mothers to stop EP early, or much sooner than if they did not face some of these issues.

While everyone can agree that there are invaluable benefits to breastmilk, it is important that people agree that it is the milk itself that is irreplaceable, not the method in which it is delivered to the infant.

 

Common Concerns

 

What kind of pump should I use?

It is highly recommended to invest in a good quality, double electric pump. These can be rented from hospitals and the quality of the pump can truly make all the difference in the world.

 

How often should I pump?

On average, a newborn nurses 8 to 12 times in a 24 hour period. Most experts agree that the best way for an EP mother to match this is to pump about every two to three hours. Some mothers may even want to pump a few times at night, especially during the first few weeks of pumping. Understanding how milk production works can be a valuable piece of helping mothers establish and maintain a good milk supply.

 

How long should I pump?

Similar to breastfeeding, it is not necessarily the amount of minutes mothers spend pumping but rather the amount of milk they produce each session that matters. For mothers that exclusively pump, full milk production is considered about 25-35 oz. (750-1,035 mL) per 24 hours. While this volume may take some time to establish, once this number is consistently hit each day the duration or number of pumping sessions can gradually decrease as needed.

 

As a general guideline, experts tend to encourage about 15 to 20 minutes per pumping session to ensure that milk is done flowing and additional letdowns have occurred. It is also recommended to pump for two to five minutes after the last drops of milk.

 

How can I make more milk?

In the early months while supply is still getting established, it is best for mothers not to go longer than four hours in between pumping sessions. While the amount of time spent per session may vary, a good way to help ensure all milk is fully removed from the breast is by using hands-on pumping. As it helps provide more of the fatty hindmilk, this method of hands-on pumping also helps to increase milk supply. Evidence also suggests that EP mothers will have a greater milk supply and be able to produce milk for a longer duration if the baby has latched just one time. Every moment spent feeding baby at the breast is valuable, even if it is just a few days or hours.

 

Tools to Have on Hand

There are some basic tools that are necessary for the EP mother, as well as a few that are also beneficial and add convenience:

• Outside of the pump and all of its parts, it is extremely advantageous to have extra pump parts available. Getting backup sets of bottles, shields, tubing, and valves ensures that parts are always ready to go.
• A drying and organizing system for bottles and pump parts, including a bottle drying rack and some type of containers or bins for pump accessories
• A manual pump in case the electric pump ever has issues or is not available
• A hands-free pumping bra that provides convenience and multitasking during sessions
• A nursing cover with a rigid neckline can also provide convenience for mothers who wish to pump around others and prefer privacy
• An insulated lunchbox or cooler to store pumped milk outside of the house
• A car adapter for the pump when on road trips

ABM Protocol on Handling and Storing Breastmilk

The Academy of Breastfeeding Medicine outlines the proper protocols for both handling as well as storing breastmilk, which is vital for EP mothers to know, and, according to the research, they are actively seeking this information out. In fact, the number one topic mothers searched between 0 and 1.5 months postpartum was how to handle pumped milk and ensure its safety. A further review of the literature showed that EP moms had two specific needs related to storing breastmilk. First, how to preserve the nutrient quality and second, how to prevent bacterial growth.

 

To begin, mothers should thoroughly wash their hands with soap and water each time before a pumping session. This ensures that the lowest levels of bacteria develop during storage. Depending on the desired duration of the expressed milk, there are various guidelines for breastmilk use and storage:

 

Room Temperature:

Freshly expressed human milk may be stored safely at room temperature (10–29°C, 50–85°F) for three to four hours following expression, as long as the technique used to pump was highly sanitary.

Refrigeration:

Multiple studies have demonstrated the safety of keeping human milk refrigerated (4°C, 39.2°F) for 48 to 72 hours. Some experts suggest that keeping milk in the back of the refrigerator can retain its quality for up to five days, however, it is typically advised to use it within three days.  

Frozen:

Freezing expressed human milk (0°F, −18°C) has been shown to be safe for at least three months in the normal freezer. Freshly expressed milk can be stored safely in the back of a deep freezer for up to a year and still maintain the same quality.

 

Ways to Support Mothers Who Exclusively Pump

Exclusively pumping moms need the support of highly skilled and trained lactation consultants with plenty of experience helping moms stay the course. This type of prenatal counseling is especially important for mothers who pump exclusively given the high rates of early cessation. Although the journey of an EP mother is different than that of one who feeds from the great or formula feeds, it does not mean that it can’t be done. There are many ways to support mothers who exclusively pump in order to make the process easier and successful.

 

1. Help them find the right size breast shield. Many women use the wrong size of shield and aren’t sure how to determine the correct fit. As a postpartum support professional, it is invaluable to help newly pumping mothers determine was size flange she needs in order to promote the highest volume of milk and success.
2. Educate EP mothers about the proper ways to prepare and store expressed milk
3. Share information about how their specific pump works, all of its parts, as well as how to clean them
4. Provide resources regarding common concerns about how long to pump, how often, and how to know they are making enough milk
5. Help connect them with other mothers who have exclusively pumped and have seen success
6. Continue to support them both logistically and emotionally as long as they EP

Conclusion

There is a strong lack of representation in the media and even in professional settings for mothers who exclusively pump. By having high-quality prenatal education and positive references and supports, mothers can find that EP is truly a viable option that is beneficial and successful for their life and their infant.

 

Providing Support

I bring two skills to the table that are important in this case: emotional support for women who did not intend to exclusively pump or are struggling with their identity as a mother without breastfeeding relationship. I am also their technical support in setting up and managing the pumping equipment, milk storage, and feeding the baby.

 

Another way to apply your skills to the situation is to offer education for loved ones. Researchers in the Media study found one of the common solutions moms searched for online was balancing pumping with other chores. Outside of being that support person to handle some of those chores, we can identify ways that family members and friends can support EP moms.

 

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References

 

ABM Clinical Protocol #8: Human Milk Storage Information for Home Use for Full-Term Infants, Revised 2017 | Breastfeeding Medicine. (2017, March 31). Retrieved November 24, 2018, from https://www.liebertpub.com/doi/full/10.1089/bfm.2017.29047.aje

 

Becker GE, Smith HA, Cooney F. Methods of milk expression for lactating women. Cochrane Database Syst Rev. 2016;9:CD006170. Published 2016 Sep 29. doi:10.1002/14651858.CD006170.pub5

 

Breastfeeding Without Nursing: “If Only I’d Known More about Exclusively Pumping before Giving Birth”. Journal of human lactation : official journal of International Lactation Consultant Association, 890334418784562. Advance online publication. doi:10.1177/0890334418784562

 

Eteng M, Ebong P, Eyong E, et al. Storage beyond three hours at ambient temperature alters the biochemical and nutritional qualities of breastmilk. Afr J Reprod Health 2001;5:130–134.Crossref, Medline, Google Scholar

 

Foremilk and Hindmilk | La Leche League International. (2017, December 31). Retrieved November 24, 2018, from https://www.llli.org/breastfeeding-info/foremilk-and-hindmilk/

 

Keim, S. A., Boone, K. M., Oza-Frank, R., & Geraghty, S. R. (2017). Pumping Milk Without Ever Feeding at the Breast in the Moms2Moms Study. Breastfeeding medicine : the official journal of the Academy of Breastfeeding Medicine, 12(7), 422-429.

 

Maximizing Milk Production. (2016, December 31). Retrieved November 24, 2018, from https://med.stanford.edu/newborns/professional-education/breastfeeding/maximizing-milk-production.html

 

McInnes RJ, Arbuckle A, Hoddinott P. How UK internet websites portray breast milk expression and breast pumps: a qualitative study of content. BMC Pregnancy Childbirth. 2015;15:81. Published 2015 Apr 2. doi:10.1186/s12884-015-0509-0

 

Neville MC. Anatomy and physiology of lactation. Pediatr Clin North Am. 2001 Feb; 48(1): 13-34.

 

Noyes, S. A Tips and Tricks Guide to Exclusively Pumping. (2017, August 7). Retrieved November 24, 2018, from https://biglatchon.org/a-tips-and-tricks-guide-to-exclusively-pumping-by-sylvia-noyes/

 

Wallenborn, Jordyn. The Impact of the Professional Qualifications of the Prenatal Care Provider on Breastfeeding Duration. Breastfeed Med. 2018 Mar;13(2):106-111. doi: 10.1089/bfm.2017.0133. Epub 2017 Dec 13.

 

Yamada R, Rasmussen KM, Felice JP. Mothers’ Use of Social Media to Inform Their Practices for Pumping and Providing Pumped Human Milk to Their Infants. Children (Basel). 2016;3(4):22. Published 2016 Oct 31. doi:10.3390/children3040022

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