4 Reasons Milk Is Not Coming Out When You Pump & How to Fix It

Pumping breast milk is a HUGE topic in lactation in the United States (fortunately less so in other countries that have better paid leave and less of a Big Pump $$$ influence). Pumping can be a good thing (we can provide milk to babies when separated from them), but it also can result in incredible amounts of misinformation, stress, and unnecessary anxiety for parents.

There are INNUMERABLE and overwhelming amounts of pumps on the market today (and continuing to expand, thanks to Big Pump). The various branding and “newness” can be extremely confusing to sort through. From a very fundamental level, this is what to know:

There are 4 basic types of breast pumps:

1. Manual/”hand” pump: Good for releasing just a bit of milk with extreme engorgement, or for someone with extremely ample milk production who needs to step away for just a bit and make a quick 2-3 ounce bottle. Otherwise, this is fairly time intensive to use regularly.
2. Battery-Operated pump: Pumps like the “Elvie” or “Freemie” that don’t require a plug-in outlet.
3. Standard electric pump: The “gold standard” pump that is most efficient and most effective at removing milk. This is what moms need for regular, frequent pumping — particularly if you are on the lower end of production and need to keep the stimulation high (battery-operated is just not strong enough, though they can be fine for moms with high production).
4. Hospital grade electric pump: Countless pumps market themselves as “equivalent” to “hospital grade.” But unfortunately, there is no equivalence to the pumps that cost upwards of $2000 and are meant to be serviced by professionals and utilized by countless patients for years (e.g. the “Medela Symphony”). If you have a NICU baby, this likely will be provided to you. Otherwise, if you have very low production and are trying to increase it, this may be worth renting for a month or two to see if it helps.

I tell patients to get the simplest, easiest to use pump and try to minimize usage if their baby is otherwise latching and they are not separated. Pumping has developed into a complicated adjunct to breastfeeding, when in fact it should be very simple (why make anything harder than it already is?).

Kimberly Seals Allers, a fantastic journalist and maternal-infant health advocate has said that “we are a pump nation” and instead of advocating for better pumps, we should be focusing on appropriate paid maternity leave.

However, for moms who need to pump breast milk, here are answers to some common questions:

Why is milk not coming out when I pump?

4 reasons you are getting little or no milk during pumping

1. You need a different breast pump: Not all pumps are created equal with regard to quality and effectiveness. See above, re: hospital grade pump rental to help troubleshoot. The hospital garde Medela Symphony pump is EXTREMELY easy to use compared to other pumps, and far more powerful.
2. Your breast pump or pump parts need basic adjustments: In terms of understanding which settings are optimal, some pumps can be complicated to use. The internet can lead you astray, so it’s best to work with a lactation consultant or breastfeeding medicine physician if you have any questions. In terms of flange sizes, I tell patients the right size is the size that is comfortable and removes milk effectively. Using an excessively small or excessively large flange that hurts can cause tissue trauma and other complications. Because of wide variation in tissue elasticity (particularly pronounced in nipples), two patients with the “exact same” measurement may need very different flange sizes. Nipples also can vary considerably during the course of a day, in different temperatures, and at different timepoints postpartum. Nipple measuring can also be very subjective based on who is measuring you. So it’s going to be most useful to trial some flanges within an approximate size range and determine which one(s) work best, rather than relying on a certain “number” as a rigid guide.
3. You hate pumping: This is most often the root of the issue. Maybe you’ve not become completely comfortable with pumping yet, or perhaps you had a rocky start postpartum. This can lead to considerable stress and anxiety when you start pumping. In particular, if you have a ton of milk, your baby is gaining well, and you just can’t pump milk volume, that’s just the mind-body connection and your body not loving the breast pump. It’s also extremely difficult to decouple biology/physiology (baby at the breast) and try to equate pumping as a normal activity for human mothers. In non-western cultures and in the past,
4. You’re not feeling a “letdown.” This is intimately related to point #3 “you hate pumping.” The extreme focus on “letdown” in the lactation world has literally created a problem out of nothing. It’s exactly like difficulty achieving orgasm — the more you focus on it, the worse it becomes. The solution here is to take all the pressure off (easier said than done, I understand) and remind yourself that you’re doing the absolute best you can, your baby will get fed regardless, and there’s no “magic intervention” that will make this better (particularly an expensive oxytocin nasal spray — more Big Lactation $$$ influence there that will only make you need more and more of the product with less and less effectiveness).

Below are some additional considerations for pumping:

Here are some additional considerations for pumping

• If you have overproduction of breastmilk, do not pump to relieve engorgement or keep breasts empty. This just stimulates more milk production. If you are pumping to replace a feed at the breast, pump only what baby needs for that feed (e.g. 3 ounces).
• Pump no longer than 15 minutes. Pumping frequently for short pumping sessions is better than pumping long durations (which can cause decrease blood flow to the nipple, pain, and even breakdown of the skin into wounds). Pump every 2-3 hours during early postpartum; this can be adapted as your milk production stabilizes. Some women can pump much less frequently, and some require continued frequent pumping.
• Avoid “power pumping.” This is when women are instructed to pump for 10 minutes, stop, pump again, and then stop for a period of an hour or more. However, this method only temporarily increases prolactin levels in the body and generally is miserable for moms. Instead, it usually is more reasonable to have normal duration pumping sessions frequently throughout the day.
• Do not use an extremely small flange if it hurts. Small flanges can cause breast and nipple trauma (the idea of tying a rubber band around your finger tightly) if used with high suction for long periods of time. It is not a problem if your areola pulls into the flange, as long as it doesn’t hurt and you’re getting adequate milk removal. Infants also pull the areola into their mouth when they are nursing. The main message is there may not be a picture perfect flange situation at all times. The key is no trauma and no pain.
• Use normal suction levels. Otherwise you risk trauma from too high suction.
• Avoid coconut oil and other lubrication. Using coconut oil and other lubricants on your pump parts can cause Montgomery Gland obstruction (wipe off lubrication after pumping if you do use it) as well as enable people to turn up suction to dangerously high levels. Your body was meant to have some traction against a pump motor and to sense if suction is too high. It’s a basic principle of friction and physics.
• Wash pump parts at the end of the day and refrigerate parts between pumping. Breastmilk is not sterile and parts do not require sterilization for average full-term babies.
• Store breast milk in separate bags that contain only the amount of milk an infant would drink. In other words, if your baby drinks 3 ounces of breastmilk in a bottle, don’t portion 10 ounce bags for storage – store pumped milk in 3 oz portions per bag.
• Warm stored breast milk at room temperature or in a warm bowl of water. The CDC and Academy of Breastfeeding Medicine have official guidelines regarding breastmilk handling, but an unofficial approximation is the “Rule of 6”: 6 hours at room temperature, 6 days in refrigerator, and 6 months in the freezer (one year for deep freezer).

Still struggling with pumping little or no milk?

If you are struggling with pumping enough milk and the steps above have not helped, be sure to reach out to a breastfeeding medicine physician, lactation consultant, or your healthcare professional who can perform a comprehensive evaluation of you and baby.