While I was pregnant, I was constantly asked by doctors, friends, family, and even pure strangers, “Are you going to breastfeed?” My response was always, “If I can, yes.” I have a few friends and family members who never had their milk come in, so I was prepared for that possibility.
What I wasn’t prepared for was the possibility that I could lactate, but my baby couldn’t nurse. I wasn’t prepared for facing the decision, “Should I give formula even though I have breast milk?”
The moment my daughter first latched on just seconds after birth, it hurt. I was so overjoyed at finally being done with labor that I didn’t mind the pain of her latch. I thought that maybe it was supposed to hurt. However, by the end of that day, I was raw, burning, and bleeding. The hospital lactation consultants (LCs) brought me a pump to use and a Similac brand bottle for my baby. The pumping and bottle feeding began.
A week later, I learned my baby had a slight tongue tie and a severe lip tie. She had both clipped. By that point, she was so used to the bottle that we had difficulty “getting back to breast.” The pumping continued.
Pumping has been one of the most challenging, frustrating, and lonely experiences of my life. I have almost given up several times. Being a mom to a newborn is hard. Add the stress of pumping, and it can quickly become overwhelming. For instance, look at the time it takes to pump (about 20 minutes every three hours around the clock) plus cleaning all the pump parts and bottles; it takes more time than breastfeeding – time that I could be spending with my baby. I remember the night feedings those first few weeks were terrible. She would fuss every 2 hours, I would heat up a bottle, feed her, burp her, rock her, and once she was asleep again, I would pump for 20 minutes, label the new bottle, and put it in the fridge. By the time I fell back asleep, my daughter was awake an hour later for her next bottle. (I later got smart and started feeding her room temperature milk from the previous pumping session so I didn’t have to warm a bottle.)
Pumping has also made travel extremely difficult. I have so much to pack – the bottles, the pump parts, the pump, the power converter so I can pump in the car, the cleaning accessories. Our traveling and visiting schedule absolutely has to be centered around my pumping schedule, because if I don’t pump, my baby doesn’t eat, and my body gets the message to produce less milk. Pumping reveals more skin than breastfeeding, making public pumping awkward and even more socially unacceptable than public breastfeeding. Plus, I need somewhere to plug in. I need somewhere to wash all the parts and let them air dry. The list of needs when it comes to pumping goes on and on.
And yet, it gets easier. I have been pumping for four months now – for 104 days to be exact – and I have learned ways to deal with exclusively pumping (EPing).
- Timing: I was so confused and told so many things about when to pump. The best advice I received: Pump every time your baby eats, and pump as long as it takes for your milk to go from a spray to a trickle. For me, I pump every three hours for 20 minutes – including at night. Make sure you get the timing right in order to keep your milk supply up.
- Feed Your Baby: If you were breastfeeding, you would be the only person feeding your baby. Because you are pumping, you are still going through all the work – and all the hormones – of lactation. However, if you let others feed your baby often, it can be very difficult on you. For instance, I wanted my visiting family to be able to spend as much time with her while they were with us, so I let them feed her. It was incredibly depressing to hide away in my room and pump all alone while someone else fed my newborn. If you are doing the work of pumping, reward yourself with being the main person to feed your baby, even if special visitors are over. Feeding time – whether by breast or bottle – is bonding time, and you deserve that bonding time.
- Keep Your Baby with You: As mentioned above, when I had visitors over, I would go in a separate room to pump while my visitors played with my baby. Again, this was incredibly depressing and even made me feel jealous of my visitors. Being separated from your newborn every three hours is a lot, and it is a separation that non-EPing moms are not expected to make. I later learned that pumping while your baby is with you increases the lactation hormones, which increases your milk supply. It is perfectly okay to tell people, “It’s time for me to pump, so the baby and I will be back in a half hour.” Or pump in front of your visitors if that works out well. It turned out my visitors were very supportive of this decision!
- Reward Yourself: EPing means you are going to be spending a lot of time pumping. It is a huge commitment. It is a huge inconvenience. Find ways to reward yourself for pumping. (My husband made me a chart to keep track of how many times I pumped. Every 16 times I pumped, I got to go out and get a healthy smoothie.) You may also want to save a special activity for when you are pumping. Perhaps pumping time can be Facebook or Internet time. Perhaps it can be time to color or read. Also, find positives about pumping. For instance, I notice I actually get better eye contact with my baby while bottle feeding than I do when breastfeeding. Not all is lost!
- Get Inside Support: If you decide to switch to formula, that is perfectly okay – as long as you feel it is the right decision for you and your baby. However, if you are determined to keep EPing, you are going to need the support of people around you. Plainly tell your spouse, family, and friends that you don’t want to hear about formula – that what you need to hear is encouragement to keep pumping and praise for how far you’ve come. “Formula” became the “F Word” in my home – not because formula is bad (on the contrary, it saves lives and is a good alternative), but because it felt like all my hard work was pointless and unappreciated when people encouraged me to switch to formula.
- Get Outside Support: Find an EP support group. There are a ton of them on Facebook! Talk with your pediatrician. (Mine gives me a pep talk at each visit!) Talk with an LC. Read books on EPing.
- Education: Research the ways that breast milk is more beneficial than formula. Look at the ingredients in formula and how synthetic they are. Look at the benefits breastfeeding has for your baby’s health and also your health. For instance, breastfed babies have less bacterial and viral illnesses. They have less chance of chronic illness and obesity. They have a lower SIDS risk. Breastfed babies also have less risk of cancer. Breastfeeding also gives babies better nutrition. It isn’t good to eat the same thing over and over, which is what formula does. With breastfeeding, your baby gets a diet as varied as the your diet. Breastfed babies are often less picky than formula fed babies because they have already had exposure to many foods through breast milk. In addition to a variety of nutrients, breast milk changes as the baby grows so that the baby’s nutritional needs are always being met. So while a breastfed baby drinks the same amount of milk, he or she will get more nutrients as the milk changes with the baby. For a baby to get more nutrients with formula, the baby would have to drink more formula.
For breastfeeding moms, the oxytocin released when nursing helps the uterus contract, which reduces postpartum bleeding and helps the uterus return to normal size about a month sooner than those who don’t breastfeed. Breastfeeding moms have stronger bones due to better calcium absorption, and they have less risk of breast cancer and ovarian cancer. They also have less risk of Type 2 Diabetes, which was important to me because I had gestational diabetes.
This is just a small sample of benefits for mom and baby. When I read a huge list, it really encouraged and empowered me to keep going, even when I felt like I could not handle one more pumping session. One book that really helped was The Baby Book by Dr. Sears. The way he described and taught about breastfeeding showed me how important it was, and it encouraged me to fight for it!
(Again, no judgment on the moms who choose/need to use formula! This is not meant to be a guilt-trip to moms who need to use formula.)
- Track with an App: I also find it helpful to use an app to keep track of pumping. I like the MyMedela app. It helps me to see how many times a day and how many ounces per day and per week I produce. It keeps my spirits up.
- Comfort: Since you are spending so much time pumping, make sure you are comfortable. Pumping can sometimes cause painful friction – use an edible lubricant such as Mother Love Nipple Cream, Honest Nipple Balm, or cold-pressed coconut oil. (I was allergic to lanolin and learned that wasn’t uncommon.)
Get a hands-free bra or make one out of a cheap sports bra. Pumping is less frustrating when you have your hands to do things like read or type while you pump.
Most pumps are designed to have you sitting up and leaning forward, which really puts a strain on your back. Try ordering Pumpin’ Pals flanges, which are tilted downwards to help ease your back and also are less painful to the breasts. (Note: some people notice more milk production with Pumpin’ Pals; I noticed much less.)
- Plan for Travel: If you’re going to be traveling anywhere (vacation, holidays, etc.) think about how you will pump on the road or in the air. Think about how you will pack your pump parts. A mesh bag is helpful for when you want to pack up your parts when you haven’t had time to let them air dry. If you’re going to need to pump on the road, either leave early to make extra time to pull over and pump, or have someone with you who can drive while you pump. (Remember that oxytocin is released while pumping, which makes you very tired. Don’t pump and drive.) If you don’t have a manual or battery operated pump, invest in a power adapter so you can plug your pump in while you’re in the car. You may also want to pack a nursing cover to use to give you more privacy. (Note: the fashionable nursing scarf covers don’t cover as well as a traditional nursing cover for pumping.)
- Decrease Cleaning Time: Pumping often means cleaning often. Some women have one set of pump parts. They pump, rinse the parts, put them in a ziplock bag, and put the bag in the fridge. They wash the parts at the end of the day. Others invest in more than one set of parts. They pump, rinse the parts, and put them in a dish bucket of soapy water. When all three sets are used, they wash them all.
- Soap: Use a soap that is low in chemicals, dyes, and scents. I noticed that the Dawn soap I was using left my bottles smelling like soap. When I tried to smell breastmilk to see if it was still good, all I could smell was soap. I have since switched to Seventh Generation Unscented, which is also low in carcinogens and hormone disrupting chemicals according to its rating on EWG.
- Stimulate Lactation and Avoid Painful Clogs: Unfortunately, no matter how often and how long you pump, a pump cannot stimulate the nipple – and therefore, lactation – as well as a baby’s mouth can. You are likely to get clogged ducts, which are incredibly painful and can become infected, turning into a case of mastitis. I EP because my baby can usually only hold a latch for between one and five minutes. Because I get clogs so easily, I try to have her latch every feeding session. Her first three months, there were sessions she didn’t latch at all. Sometimes, I got 5 minutes. Sometimes, if I was really lucky, I got 10 minutes. This helped to keep the clogs away. It also helped to increase my supply. I sometimes produced double the amount on the side my baby last latched on. Now she will nurse at night for her “dream feeds,” which has been very helpful. However, I know this is not an option for many women if their babies are completely unable to latch. I have heard of some women having their husbands help them with this by taking the baby’s job every once in awhile to stimulates lactation and increase supply.
- Increase Your Supply: Aside from mouth stimulation, there are other ways to increase supply. Eat lactation cookies with flax and brewer’s yeast (you can buy brewer’s yeast online). There are several supplements that you can try. Target has them in the pharmacy section near the pregnancy tests. These include fenugreek, blessed thistle, and fennel seed, which can come in the form of capsules, gummies, shakes, or tea. (I have only tried fenugreek, which had the opposite effect for me, and Mother’s Milk Tea, but I couldn’t get past the taste of fennel.) Dark beer has been known to increase supply if you’re okay with the dyes and other ingredients. (If you do have alcohol, some professionals suggest you wait one hour per serving before pumping and/or nursing.) Lastly, try to have your baby nearby, which helps stimulate the hormones that increase lactation. If you can’t, try to have pictures or videos of your baby.
- Avoid Things that Decrease Supply: Poor nutrition and dehydration will lower your supply. Caffeine and alcohol can lower your supply since it dehydrates you. The stress of everyday life can lower supply. Certain drugs (like allergy and cold meds) can dry up supply. Certain essential oils – like peppermint – can dry up supply and not be safe for nursing moms and babies. Also stay aware of whether or not you are dealing with situational depression, clinical depression, postpartum depression, anxiety, and/or Dysphoric Milk Ejection Reflex (D-MER). Counseling can help with these things, and medication can help, too. Zoloft is often prescribed because it is seen as among the safest for pregnancy and breastfeeding. (Note: Zoloft does not treat D-MER.)
- Have an Emergency Formula Supply: It is very stressful when you worry about whether or not you can keep up your supply. Get ahead of this worry by keeping some formula in the house. You may never have to use it, but the backup plan provides peace of mind. You may want to have a few different brands and a few different kinds. (For instance, my baby refuses any powder formula and will only accept the liquid ready-serve. She also has food allergies, so we have to use a non-dairy, non-soy formula. I didn’t have any of this in the house, which made for a very stressful day when I ran out of breastmilk. Thankfully, I have only needed it two or three times.)
- Don’t Waste Milk: Follow milk safe storage instructions. My hospital taught the “Rule of Five” – 5 hours at room temperature, 5 days in the fridge, and 5 months in the freezer (longer if in a deep freezer). Other resources have said room temperature is okay up to 8 hours. Personally, I don’t go past 6 hours. Label each bottle or bag with the date and time you started pumping. (I use a strip of painter’s tape to write on and stick to my Medela bottles.)
Remember that once your baby’s saliva mixes with breastmilk, it should really be used up within an hour or dumped. So if you think your baby will take 3oz and might take 4oz, pour a 3oz bottle and add the extra ounce if s/he still seems hungry after.
- Day/Night Milk: Labeling the time you pumped is also helpful because studies show that milk pumped at night has more melatonin and tryptophan and helps Baby sleep – so it is beneficial to give your baby daytime milk during the day and nighttime milk at night.
- Getting Back to Breast: If you are hoping to “get back to breast,” choose your bottles and bottle nipples carefully. Medela sells a nipple called the “Calma nipple,” which only works when Baby creates the same suction needed for breastfeeding. This supposedly helps the baby’s jaw muscles stay strong enough to return to breastfeeding. I did try this nipple, but my baby was already several weeks old, and she became very frustrated with how hard she had to work her already-loose muscles. This nipple is also incredibly expensive. Unfortunately, we started out using the Medela bottles with the Similac nipples. Even the slow flow Similac nipples make light work for the baby. We eventually were able to switch to Dr. Brown’s bottles and nipples. The bottles helped with the gassiness, and the nipples weren’t quite as easy to use as the Similac nipples. This made my baby have to work a little harder, but not hard enough to get her frustrated. My LC informed me that the Playtex slow-flow nipples really make your baby work hard. I wish I had just started out with these nipples so that my baby’s muscles would have built up before she got used to an easy meal. I suspect she would be able to hold a latch longer than a few minutes had we done this. (*Update: My baby was able to switch to Playtex after using Dr. Brown’s for several weeks. Now she is back on the breast! However, the stubborn little girl prefers bottles during the day and will only nurse at night. *Second update: she started nursing full-time at 18 months old!)
Also, if you’re going to get back to breast, have your baby assessed for a tongue tie and lip tie – the earlier the better. Make sure your pediatrician knows how to diagnose and treat ties. Many don’t. You may need to see a pediatric dentist. My pediatrician knew how to both diagnose and treat ties, but he used manual tools instead of a laser. If I could do it again, I’d go with someone who can use a laser, since it is less painful and heals faster. I also recommend doing stretches to keep the tie from reconnecting as it heals.
For my next baby, I also plan on having a chiropractor assess the baby’s neck for birth trauma. Apparently, that type of birth trauma is very common. It’s what my firstborn is struggling with, and it has made returning to breast very difficult because I didn’t know to do this until she was 7 weeks old.
- Pump at Work: If your workplace is not being supportive of your need to take pumping breaks, print out the law which requires workplaces to provide this time to mothers. Explain that these breaks benefit your coworkers, too. You are passing off your antibodies to keep your baby healthy. If you have a healthy baby, you have less sick days devoted to a sick baby.
Pumping has been difficult – but it has been rewarding and so worth it. I know I am giving my baby the best I possibly can. If you want to do it, you can do it!