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Archive for April, 2013

When I meet with expectant parents who have hired me to be their Doula, I give them what may seem like a very odd warning coming from a breastfeeding advocate: avoid pumping.

Pumps can be great tools.  I use mine almost every week as I drive to school, as many drivers on Toronto’s roads can confirm.  I am by no means anti-pump.  But pumps, like any other birth or breastfeeding intervention have a time and place and if not used correctly can do more harm than good.  The trouble is that the buzz about pumps seems to have elevated them to the level of a panacea for breastfeeding problems.

“Should I start pumping to make sure I have enough milk?”

“My nipples hurt so my doctor told me to pump.”

“She wasn’t gaining weight so they told me to pump.”

“I was tired/depressed/you name it, so they told me to pump.”

Pump, pump pump.  And whenever someone asks me if they should pump, for whatever reason, I always reply with “And then what?”  Invariably, I get a blank stare.  It’s absolutely vital that if you’re integrating pumping into your breastfeeding relationship that you have a clear plan for what you need to achieve and how to make it a part of your long-term feeding goals, not an impediment to them.

Know when not to pump.

There are times to pump and times NOT to pump.  It may not be what a mother wants to hear when she’s in pain from sore or cracked nipples, but the only way to fix the majority of breastfeeding challenges is AT THE BREAST.  Compare your new nursing relationship to a fledgling romantic relationship for a moment.  If you’ve just met the man of your dreams and you send your sister on all of your dates, do you think he’s more likely to marry you or your sister?  She may be very inferior to you, but he won’t know that because he doesn’t know you.  Unless your baby is completely unable to feed at the breast, whether from severe mechanical latch issues or due to separation, then it’s important to develop your feeding relationship at the breast.

Feed the baby, not the pump.

But let’s say that you are pumping, the next key is to make sure that you’re feeding the baby first and not the pump.  It sounds ridiculous, but believe me it’s not.  If you’re pumping exclusively due to a separation, this is straightforward enough, but most women I encounter are pumping in conjunction with feeding at the breast and it can be incredibly easy to mismanage this kind of situation.

Example number one: you’re told to pump after feeds to increase supply.  So let’s say it’s your first daylight feed of the day.  Baby starts to nurse at about 7 a.m.  By the time you let her finish the first breast, change her diaper and offer the second breast, she dozes off so you enjoy the quiet for a couple of extra minutes.  Then you hand her to dad or doula while you go pee and grab a super quick shower.  You sit down and hook up your pump and you’re ready to boost your supply!  Except, hang on, it’s 8:30 now.  If your baby is only a few days old, then he’ll be ready to eat again very soon.  Probably the second you’re done pumping, and maybe even before you’re done.  We know that breasts are never truly empty so technically this won’t actually cause a problem.  You can put baby to your recently drained breast and the milk will come.  The thing is, it is also true that when the volume of ready-and-waiting milk is low, the flow can be very slow.  Baby fusses and since you are already nervous about how much milk you do or do not have, and because you’re a new mama and hearing your baby cry for milk hurts your heart, you feed her the milk you just pumped.  Since you just pumped it, you may not think to pump again right away…  Repeat this several times a day and your breastfeeding relationship can easily turn into a bottle-feeding relationship at the same time that you deride yourself for not making enough, even though you are, you’re just feeding it to the machine instead of the baby.

Example number two: you’re told to pump every three hours.  This recommendation usually comes when mom and baby are having intermittent separations, like mom sleeping at home while baby remains in the hospital, but I’ve also seen it advised for supply increase, in between feeding the baby on cue.  So let’s say you’re with baby and again she has her first morning feed at 7 a.m.  You’re good about pumping right after she eats, so that’s at 8 a.m.  You continue on with your morning and babe eats again at 9 ish and then falls asleep.  Now it’s 10:45 and you’re just hooking up your pump because it’s almost been 3 hours, but baby wakes up cuing at the exact same time.  So often I see moms try to hand the hunger-cuing baby to dad or grandma or me to hold while she pumps because, after all, she’s been told that pumping is what will boost her supply!  The trouble is that baby’s natural feeding interval has been unnaturally stretched for the sake of maintaining the recommended pumping interval.  Pretty soon you can get a baby who is slow to gain.  Meanwhile, the pumping that was supposed be added on top of nursing in order to boost supply has actually just replaced the feeding at the breast.  Mom is trying so hard to do the right thing, but the outcome can be the opposite of what she wants.

Have a plan for your pumped milk.

If your instructions to pump are coming from someone who does not have lactation training – read: most family physicians and paediatricians and even (as I’ve sadly discovered) many midwives in Ontario – then they often don’t give you any instructions about how to deliver the pumped milk.  That’s because they don’t know any way to deliver the milk other than by bottle.  The truth is, if you want to resume your breastfeeding relationship, then you need to deliver the milk in a way that protects that relationship.  My personal favourite is to use small feeding tubes because they can be used at the breast or, if necessary with a finger.  But there are many ways to deliver milk other than bottles and it’s important to explore those options.

Understand the demands of pumping.

Like with so many things, the media has a tendency to distort the reality of pumping.  It’s often made out to be the secret to getting your pre-baby freedom back.  Movies show moms sleeping blissfully while their partner drags himself out of bed to pull a bottle of pumped breastmilk from the fridge.  Moms who pump, we’re told, can leave the house for hours without a care in the world.  It is absolutely crucial to understand that feeding the baby pumped breastmilk is still feeding the baby with your body and it places just as many, if not more, demands on your body as feeding at the breast does.

The first thing to know is that pumps are much less efficient at withdrawing milk than skilled breastfeeding babies are.  And even with the best pump, not all breasts will release milk readily.  So pumping often takes longer than breastfeeding.  Sure, you may have slightly more flexibility about the pumping intervals, but that’s a scheduling benefit, not a time savings.  And when I say slightly more flexibility, I really do mean very, very slightly.  The number one question moms ask me is “Can I pump during the day so someone else can do the night feed.”  Technically, the answer is yes, but there is a long list of caveats.  The first being that, as I’ve said, when you’re mixing feeding at the breast with pumping, you have to be very careful to feed the baby, not the pump.  And it’s important to know too, that most moms don’t actually sleep through that feeding time.  When that baby that you love so much cries, it will make every molecule in your body vibrate.  Warming bottles takes time and during that time, baby is likely to be crying, waking you up, not to mention stressing you out.  Even if you do manage to sleep through it, your body has been awake making milk for that feed.  So it’s possible you’ll wake up an hour later anyway but with full, sore breasts.  If this is happening before your supply is established, it’s very likely to signal your body to make less and less milk.  Believe me, I know it’s important for mom to rest, but there are so many better ways to achieve that than skipping feeds.

I don’t mean to paint a horrifying picture, many moms do manage to pump, either exclusively or when separated from baby.  Like I said at the start, I’m one of them.  After returning to work when Lady Fair was 6 months old, pumping was a work-day reality for me.  So let me paint you a real picture of what it’s like to be pumping when you’re away from baby.  When I get in the car to rush off to a birth, I take a gigantic enormous bin with me, full of the stuff I need.  More than half of the contents of that bin are not for the birthing mama, but rather for pumping and storing milk.  Sometimes I take more luggage into a birthing room than the woman who is giving birth.  And even though I pack and check my kit ahead of time, things go wrong.  I’ve had to recharge my pump in a birthing room before.  I’ve had to dump perfectly good milk down the sink because I ran out of freezer bags to store it in.  I’ve had to dump perfectly good milk down the sink because I dropped part of my pump on a scuzzy hospital visitor bathroom floor and didn’t trust that the subsequent milk wasn’t contaminated (blech!!).  I’ve had to do my best to focus on supporting my client while remembering not to put my right arm down because my work duties didn’t allow for regular pumping breaks and now my super-producing breast is engorged.  Only the one breast, mind you, so I’ve also had to walk around in public with one boob that’s twice the size of the other!  And probably my personal favourite, I’ve had strangers walk in on me pumping because I forgot to lock the door.  Oops!  It’s absolutely wonderful that I can provide breastmilk for my babe while I’m away and when it’s all said and done, these little hiccups make fun stories, but while you’re doing it, it’s challenging, and it’s important to be realistic about that.

So what am I supposed to do if pumping is out of the picture?

Really, there’s nothing magical.  Know that most of the time, you and your baby only need each other to breastfeed successfully.  Focus on feeding frequently and supply will follow.  Focus on finding a comfortable position and chances are, a good latch will follow.  Surround yourself with people who know about and value breastfeeding and confidence will follow.  And if you do need to intervene, do it with a clear plan and good support.

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