Pumping breast milk is a HUGE topic in lactation in the United States (pumping is much less prevalent worldwide, likely due to more maternal leave postpartum in other countries). It’s hard to summarize the wide variety of considerations, questions, and complications related to breast pumping.
A common question is “which type of pump,” but like everything with lactation, this is very much individualized based on how much milk you produce (for example, patients with lots of breast milk can handle less stimulation from a hands-free breast pump such as the Elvie, but patients with lower milk production may need a stronger pump to maintain volume).
There are 3 types of breast pumps to choose from:
- Manual pump – As you can tell from the name, these breast pumps require you to do the work in order to express milk by squeezing a handle repeatedly in order to create suction. These pumps are inexpensive and lightweight making it easy to take on the go but due to the amount of work it takes to use them, they are probably best for occasional use only.
- Battery-Operated pump – These breast pumps are battery powered and are a good option if you need a pump on the go where you may not have access an electrical outlet. They are lightweight, easy to take with you, and can be used for both single pumping and double pumping.
- Electric pump – These breast pumps (sometimes referred to as hospital grade pumps) require access to electricity and need to be plugged in for use. Electric pumps have both single pumping and double pumping options, so you can express milk from both breasts at the same time or one breast at a time. Electric pumps are the most powerful and therefore the most efficient for expressing milk.
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?). In some situations, moms must pump milk (NICU baby, working/away from infant, very low production when baby won’t latch to breast, etc.). However, everyone else should “dump the pump” when possible.
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, there may be times when milk ejection is less than expected or even non-existent which can be frustrating or stressful.
Why is milk not coming out when I pump?
4 reasons you are getting little or no milk during pumping sessions
- You need a different breast pump. Not all pumps are created equal with regard to quality and effectiveness. There is a range of available pump options from low end models to high end models. While low end pumps are just fine for some nursing moms, they are not the best fit for all. It is possible that if you’re using a lower end breast pump, it could be the culprit if you are having pumping problems. To figure out if your pump is the issue, one option is to rent a higher end model and see if it makes a difference. Many hospitals and medical supply companies have hospital grade breast pumps available for rent so that you can try it out first. If you discover your pump is the reason for your problems removing milk and it’s time to invest in your own, check with your health insurance company as some will cover the cost of a breast pump. of them cove
- Your breast pump parts need basic adjustments – You may have no problem when your baby nurses directly from the breast, yet when you try to pump milk, you get little to no milk flow. Many mothers do well using breast pumps while others may not, but that doesn’t mean you can’t be successful. Start by making sure that pump flanges fit correctly and that pump settings are correct. Small flange sizes have become very popular in the lactation world, and it is very unclear why. When nursing effectively, infants don’t just latch to the nipple — they also latch deeply into the areola. It is ok if your areola is also pulled into the pump flange. I tell patients the right size is the size that is comfortable. Using an excessively small or excessively large flange that hurts can cause tissue trauma and other complications.
- You hate pumping – Maybe you’ve not become completely comfortable with pumping yet, or perhaps the early days of your pumping journey started off with a lack of success which now causes you stress and anxiety when you start your pumping sessions. 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. For some women, pumping just feels awkward or uncomfortable which can cause a pumping problem. You really can’t quantify the anxiety component either – it can be huge, huge, huge. If women find they “hate pumping,” they are not going to pump a large amount of breast milk. I understand that some women hate pumping, but there are also nursing mothers who get super into pumping where it’s this source of pride and almost competition. Those are the moms who will just pour out breast milk because they have a personal positive relationship with it (i.e., sense of accomplishment, etc), so it’s really hard when you are decoupling biology/physiology (baby at the breast) and trying to equate pumping as a normal sort of thing. In the past, if a nursing mother didn’t have a lot of milk supply, another mom in the tribe would just breastfeed the baby. We wouldn’t try to force our bodies to do something with a breast pump. There’s a reason why it doesn’t work a lot of the time. However, if you can change the way you think about pumping and look at it in a positive way as a source of pride and accomplishment, this can be helpful at not only easing any anxiety around pumping sessions but also increasing the amount of expressed milk you are able to produce.
- You’re not getting let down. If your breasts feel like they’re full but you’re not able to get the milk flowing out when you pump, it could be that you’re not achieving let down. The let down reflex releases your milk from the milk ducts. This only occurs when you’re either breastfeeding or pumping. Because the letdown reflex is a conditioned response, it is triggered by certain external cues. For nursing moms, those cues are often things such as the sound of your baby crying or suckling. For pumping moms, those cues can be the sound or feeling of your breast pump.
If let down is behind your pumping problem, some moms find watching a video of baby as you start to pump can help trigger the reflex. Other methods to try include using a warm compress on your breasts, listening to soothing music, or using hand expression to see if that helps to bring on milk let down.
If you’re not getting enough milk during pumping sessions, the above factors may be the reason. Take heart that it may not be a supply issue and may be as simple as trying some of the above tips to get your milk flowing during your pumping session.
Below are some additional pumping tips to help you maintain your breast milk supply.
8 simple rules for breast pumping success
- 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. 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.
- Use at least a 24 mm flange. Small flanges cause breast and nipple trauma! There has been a trend in the lactation world recently to use very small flange sizes, and even 12 mm is on the market. It is not a problem if your areola pulls into the flange, as long as it doesn’t hurt. Infants also pull the areola into their mouth when they are nursing. 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.
- Wash pump parts at the end of the day and refrigerate parts between pumping sessions. Breastmilk is not sterile and parts do not require sterilization.
- 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 breast milk in a feeding session, 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 to feed your sweet baby and the steps above have not helped, be sure to reach out to a breastfeeding specialist, lactation consultant, or your healthcare professional who can get to the root of the issue and help you pump more milk.
