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September 09, 2019
Great question, and one prior to my 4th baby I was totally clueless about.
Exclusive expressing or exclusive pumping (same thing) is the process of breastfeeding your baby solely with breast milk via a bottle with the breast pump providing the means of getting the milk from the breast.
For exclusive pumping mums, there is no direct attachment at the breast, and hence no direct breastfeeding with your baby.
Breastfeeding and occasionally pumping in addition to breastfeeds or pumping after a breastfeed and then feeding the pumped breast milk is not the same as exclusive expressing. It is most definitely a form of pumping, especially if you are using the breast pump numerous times a day in addition to breastfeeding (because that is also HARD work and you go mama!) but exclusively expressing mums for the most part, have no direct breastfeeding.
The answer to that question falls into two categories.
Mums who are exclusively pumping because they have no choice other than to pump and mums who are consciously making a choice to exclusively pump. Both are explored below.
The first category is mums whose baby can't/won't latch at the breast.
This means, that their baby can not for a raft of reasons latch and feed from the breast. Some of these reasons are:
- Tongue and lip tie resulting in poor latch and inefficient milk transfer
- Medical reason (e.g cleft palate)
- Premature babies
- Bottle preference - babies who develop a preference to the bottle (even after tongue tie correction or maybe mum had to pump due to nipple damage and then baby developed bottle preference and refused the breast)
- Multiple mums - one baby will attach, one won't, mum might have to make a tough call on how she manages etc...
There is a raft of other reasons that mums also have the decision to breastfeed taken away from them. For this category of exclusive expressing mum, your breastfeeding relationship taking this form can be devastating. When you expected to direct breastfeed and then the only way you can feed your baby breastmilk is by pumping, it is an extremely emotional and confronting experience. Acceptance can be a long road and the grief can take a while to process. Most mums who end up exclusively pumping, fall into this category. The other category is mums who make a conscious decision to exclusively pump.
If you are in any Facebook groups where a new mum asks about exclusive pumping as an option to feed her baby, most of the comments are from mums who didn't consciously decide to pump. And it is things like 'don't do it', 'I would never choose this' 'it is double handling', 'it is extremely hard work' and all those things are so very true. So. Very. True. I personally (after having direct fed previous babies) would never have chosen this pathway. I felt locked to the pump, I couldn't just go out with my boobs and baby, I had to not only be consciously prepared with breast milk to take in a bottle, but I also had to be thinking about being home for my next pump, or if I was out, how I was going to manage. Many days I felt lonely and isolated, declining social events because it was just too hard. I also felt like I missed out on my baby, something else was feeding her while I could pump. It also made it extremely stressful when bub cries and you are attached to the pump, the one thing she wants, you are extracting, but I couldn't just pick her up, flop a boob out and away we go (like I was used to). That was very very upsetting.
Those early days are extremely hard. And I felt like giving up so many times. But it does get easier. As time went on, I got in a groove, and when I had increased my supply and was only pumping 3 times a day, it was extremely manageable. Don't get me wrong, I still mourn my lost direct breastfeeding relationship with her, but I take the positives out of the situation: I am still able to provide her with my precious liquid gold, and for that I am eternally grateful.
Mums who decide to pump.
I digressed from the story, however where it was going with my Facebook group lead in, was that out of those posts where most mums are saying 'Don't consciously decide to do this!' There is a handful of mums who have chosen to exclusively pump from the beginning of the breastfeeding journey and listening and talking to them gives you a different perspective.
For the mum who makes the decision to pump, there is no comparison to how much easier direct feeding would be, because they have made the decision to exclusively pump. Direct feeding was never going to be an option for them. It is a different mind set when you aren't begrudging having to pump and imagining what could have been. You have no other option when it is your decision because you have weighed up what is right for you and the pump is the best decision.
I would encourage any mum to talk to a IBCLC before making the decision to exclusively pump if direct feeding is an option.
Either way - exclusive pumping is hard work, a breast pump isn't as effective at removing milk as a baby. For this reason, the exclusive pumping schedule is rigorous and has to reflect how often a baby feeds (and often more as you need to pump longer or more frequently to remove and hence produce enough milk.)
- A good quality hospital grade breast pump (Spectra or Medela are the most well known, I personally use and love spectra - they are closed systems, which means milk can't go into the pump, medela is open system). Spectra's hold their value because they are closed systems, I personally wouldn't purchase a 2nd hand open system pump. Hospital grade is important because you put a lot of hours on the motor. Non hospital grade are designed for occasional pumping, not full time pumping.
- Correct flange size - this can impact output and also wrong size can cause nipple damage (pumpables have a great ruler and free fitting room.)
- New parts, if this is a subsequent baby and the pump has been in storage replace things like tubing and duckbills (or whatever valve you have/prefer ti use) and check flange size this time round. Nipples can change flange size even within the pumping journey of the same baby, so different pregnancy - definitely check it again.
- Milk collection bottles and bottles to feed bub
- Heat packs - warm breasts make more milk, gel packs used before pumping or put over the flange while you pump all help.
- Know the signs of mastitis and what to do. Pumping mums still get it!
- A pumping bra - a good quality pumping bra that allows you to go hands free and feed bub and or walk around and get things done if baby is asleep, all help making this journey a lot easier. They hold the flanges so you don't have to.
- Skills in hand expressing and knowing how to do breast compressions.
- A cover to hide the bottles - if you are getting stressed by how little or slowly the milk is filling - don't look! Cover the flange, put netflix on or look at your baby. The stress created about worrying about milk is not conducive to oxytocin, which you need for let downs!
- Pictures/videos or bub near you if not asleep. A pump is a little more clinical, cold and hard compared to the warmth and smell of a baby, so have things on hand that make you smile and feel happy - again it is all to do with letting the oxytocin flow!
- A positive attitude- you guessed it, that love bug of a hormone oxytocin is best suited to positive vibes and happy spaces.
- Supply boosting foods (lactation cookies) and teas. That kind of goes without saying, you are on our website after all! But why pumping mums (exclusive or casual) often need them more is explained below.
When you first have your baby, your milk supply is hormone driven. Without getting too technical, the removal of the placenta causes a drop in the hormones oestrogen and progesterone, which triggers a rise in prolactin (the milk making hormone). Without an order of how much to put in the tank, your breasts will generally produce more milk than you need to make sure the tank doesn't run out. As the breastfeeding relationship establishes - the production of breastmilk changes from hormone driven to supply/demand (what is removed is what is replenished). This change can happen from 6-12 weeks, which is why exclusive pumping mums are advised to not cut back on pump sessions in those first 3 months, even if you are getting an abundance of milk. Mums will often think they can cut down on pumps in those early months, because they are producing so much milk and then if they do cut down, when they hit the cross over, their supply drops, because they aren't pumping enough and the signal is now what is removed is what is made.
The other thing pumping mums also experience is a drop in supply when it swaps from hormone to supply/demand even if they haven't reduced pumps. The reason for this is below in the supply section!
So back to schedule. The below is a pretty universally accepted pumping schedule. Different people will change it up (reduce pumps prior to recommended time) but I definitely stuck to it at the beginning. I did cut back pumps pretty quickly, I had to for my own sanity, however I also had full access to our range of breastfeeding teas, lactation cookies, breastfeeding malt and lactation brownies so was well supported from that side of things.
The thing is, this is suggested, and I would always air on the side of caution and do more pumps than less. Everyone is different and you will work out your own groove.
For me, 3 pumps per day was my sweet spot, it is where I produced the maximum amount of milk a day (and was freezing 500ml excess a day) and that was at 7 months. When I dropped to 2, my supply plummeted, I couldn’t maintain on that, it took 10 minutes longer to get my first let down and my output wasn’t that great. So tread cautiously when you are getting down in numbers. I also dropped the middle of the night pump (MOTN) a lot sooner than the schedule recommends.
This section deserves its own title, because it is one of the biggest struggles of exclusive pumping – maintaining and building enough supply to exclusive breast milk feed your baby.
Firstly, I just wanted to mention (as I have in a previous blog post), I know that my pump output isn’t an indication of my body’s ability to make milk. However when it is the only mechanism you have to remove your milk, then your supply can take a hit because a pump isn’t as effective as a baby in removing milk (well it is for a baby with a poor latch!). I have seen exclusively pumping mums get offended by the ‘pump isn’t as effective as a baby comment' and I understand why they do, but the intention is to demonstrate the exact message of what I am trying to convey here – don’t be disheartened or think that your body isn’t capable of making milk, it is, you just need to learn how to work with your situation and equipment. And when you understand what is going on and how you have to adapt and change to it, then you are most definitely able to exclusively breastfeed your baby with pumped milk.
Mums often experience low supply when they are exclusively pumping for a few reasons:
The reason it drops in the two situations explained above relates to the ‘oversupply’ that occurs in the hormone driven period. I use that word lightly, I don’t mean over supply as in you are drowning in a pool of milk and pumping litres a day – some mums might, but I mean an oversupply as in, you are making more milk than your baby needs in a day. For most mums they won’t even recognise that as oversupply, it is will just be their norm and they have an adequate milk supply and they won’t know any different. That oversupply that happens in the early days relates to the hormone driven supply that happens after birth. Your body goes, well I don’t know how much milk you need so here, have a bunch load. That means the pump doesn’t have to work as hard to get the milk out because it is there ready to be removed, so you don’t need to pump for long lengths of time, you could have the incorrect flange size and drop a few pumps and you still have good supply. When it changes to supply/demand, if that input in terms of length of pumps (and let downs you are getting) or pump being set up correctly isn’t adequate, then your body gets the message that the amount of milk it was making was too much – because the amount of work that the pump is doing isn’t equating to the amount of milk your body was producing so it cuts down your supply. Hence when mums often go, ‘help, I am around 6-8 weeks and my supply dropped’. So what can you do?
As an exclusively pumping mum things you can do to increase supply:
Power pumping (or cluster pumping) has one purpose - increased demand and milk removal to increase your milk supply. Power pumping is effectively repeating cluster feeding behaviour which is when a baby is frequently on and off the breast like if they were direct feeding.
Power pumping repeated at the same time over a 2-3 day period will increase your supply. It can take a few days to see an increase in milk output though, because your body needs to get the message and learn that it needs to make more milk.
You can power pump at any time of the day but late at night or early morning is when your prolactin levels are highest which makes for a great time to do it. Late at night off the back of my last pump is my preferred time to power pump, just because everyone is in bed, it is silent, relaxing and I know that I can go to bed after it is done!
Power pumping replaces a normal pump out of your schedule, hence why I normally did it off the back of my last session, so pump as normal, then power pump on and off with the timed segments.
This diagram is how you pump and rest to double power pump. As a power pump replaces one pump, I pump at my 11pm pump, which is normally 20-30 mins so I use that as my '20 min' pump in the schedule, then rest, then pump etc... as per the schedule.
It will take a few days for you to see an increase from power pumping, so don’t be disheartened if you don’t see an increase the next day.
Rotating milk when you are exclusive expressing
What milk you feed your baby is a very interesting topic when you exclusively express. Some mums label milk in bottles with date and time of pump and put it in the fridge and only feed milk corresponding to the same time of day so if you pump morning milk, then you would give bub morning milk from yesterdays pump. I never do that – I just put it in bottles and have it on rotation in the fridge. I like to have a good 500ml in the fridge at any one time, some mums are only a pump ahead or the next pump is what they feed (either by choice or due to supply). Some mums once they get a bit of a stash going using frozen milk to feed bub and immediately freeze the pumped milk. Some mums do this every couple of months so they are ‘rotating their stash’ and not letting the milk in the freezer get too old (breastmilk will last 12 months in the deep freeze and at 12 months it doesn’t go off, it just loses nutrients the longer frozen). Again, I never rotated stashes, I do like to feed fresh milk at least once a day, so time a pump when bub is asleep and when she wakes up she has the fresh body temperature milk. I will do this a couple of times a day if she is sick to ensure she is getting all the relevant antibodies my body is making to protect her and help the sickness pass quickly.
Storage of breast milk
If you don’t freeze any breast milk, don’t be disheartened. Being one pump ahead or mix feeding can be hard if you are wanting to exclusively breast milk feed, but every drop is so precious and absolutely vital and important to bub, so any volume you pump and feed is amazing.
If you do get to the stage where you are pumping and freezing, you will need some good quality breastmilk bags. There are heaps on the market, but swisspers (especially when they are on special at Chemist Warehouse) are good value and a big pack.
Just make sure you date and put the volume on the bag and seal it properly (they have a double seal to prevent leakage). A little trick is to gently squeeze out the air when you are sealing and lay the milk flat to freeze. It makes milk bricks, saves space and makes them easy to stack in the freezer.
When you are defrosting milk, always put it in a clean container or a ziplock bag to defrost. The bags can split or leak and you don’t want to lose any precious breast milk! I had never had a bag split, even after seeing lots of horror stories and thought I was pretty lucky, but after the stories did the zip lock in the bowl in the fridge and sure enough, one time the actual breast milk bag was empty, thank goodness I was able to save the milk! So don’t risk it!
I will leave it there for the exclusive pumping post, please feel free to email me if you do have any questions about it and just remember, regardless of how long you decide to exclusively express for, any amount of time and any volume of breast milk is amazing. It is a hard slog but you can do it! Join the FB group, trust me you will be glad you did!
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