Saturday, July 23, 2011

Pumping & Preparing to Return to Work

I'm copying this from my online lactation coursework, because I will only have access for a few more days... possibly... and I hadn't seen anything this succinct, and thought it would be helpful for others.

Two or three weeks before returning to work, begin pumping an hour or so after a breastfeed.
  • Provides familiarity with the pump setup, feel, and clean-up required
  • Gives the mother practice using the pump at a time and place that is not stressful
  • The milk pumped can be stored for emergencies
  • A person, other than the mother, could offer some of the milk to the baby, getting baby used to receiving his breastmilk in an alternative manner when he is in a familiar place
Your goal is to replicate what normally happens as much as possible... 
      • Start by assuming her baby drinks the average volume per 24 hours, which is about 800ml (27 ounces). (note from Abby: isn't it cool/strange that the amount doesn't vary depending on the age or size of the baby??? but apparently it's remarkably consistent.)
      • How many breastfeeds does baby normally have in a day? Divide 800ml by that number. For how many feeds will they be apart? HOWEVER... daytime feeds are usually larger than evening feeds. Leave a little more for daytime separations, or a little less for evening separations.
      • Refine this after she has started working. Does the baby leave more than 60ml (2 ounces) consistently? Does the baby drink all available and remain unsettled? (may not be hunger though!) Vary the amount left until the baby drinks most of what is provided every time.

How long should she pump?
The simple answer is... until she gets the volume of milk required. Milk ejection should occur within about 2 minutes and milk removal after that will be rapid.
A double-pumping kit will halve the length of time required.
Most women will pump all the milk they need within 5 to 10 minutes. There is no reason to continue to pump longer than it takes to get the required volume.
  • How often should the mother pump and for how long?
    • This is another opportunity for you to apply your professional knowledge of lactation physiology and what is normal.
    • Breastmilk storage capacity varies widely between women. Some women may have a large storage capacity, some may have a small storage capacity.
      For example: A woman who has a small storage capacity will probably need to pump as often as baby usually breastfeeds.
      Another example: A woman who has a large storage capacity may be able to breastfeed her baby in the morning, then pump sufficient breastmilk to leave for her baby until her return that evening, with no need to pump while at work.
      Individualize your care for each mother.
Breast Milk Storage
  • At room temperatureIn an insulated container with freezer blocksIn the refrigeratorIn the freezer
    4 - 8 hours24 hours3 days3 months

  • And more helpful info... this is for increasing supply

  • Fact: The more frequently milk is removed from the breast the more rapidly the breast will synthesize breastmilk. The fuller the breast, the slower the breast will synthesize breastmilk.

  • Additional milk removal, between breastfeeds, will increase total breastmilk produced in that period. Use this milk as a supplement later.
    • When is the BEST time to pump?

      Assume a mother has an insufficient milk supply. Her baby latches effectively and drains both breasts well each breastfeed. When will you tell her to pump?
      Immediately after breastfeeding?? This is what is frequently advised. Mother breastfeeds, then pumps and gets only a few mls, or maybe nothing. That's understandable, the baby had just breastfed effectively. Mother feels disheartened - it proves her inability to provide for her baby. Breastmilk synthesis will not be enhanced because the breast was already as empty as possible.
      However, if she waits for an hour then pumps, breastmilk synthesis would have been at maximum for the majority of that time, beginning to slow now as more milk accumulates in the breast. Pumping may produce 30ml (1 ounce) from each breast (depends on individual rate of milk synthesis). The breast will be emptied again, milk synthesis will be back to maximum rate once again enhancing overall volume produced, and the mother will feel positive about her ability to produce breastmilk.
      This is an example of applying our knowledge of physiology to a problem.
    • Pump immediately after breastfeeding IF the baby does not remove all breastmilk from the breast each breastfeed, as may happen in the mornings when volume contained in the breast is greater, or the baby has an ineffectual suck. (And pump again in another hour)

1 comment:

  1. I've been following most of these recommendations over the past few weeks, though I swear I thought milk was good for a week in the fridge but now I don't know where I read that. I have milk from thurs in the fridge that was supposed to be for Monday, now I think I might ought to throw it away!

    I can vouch for the difference waiting an hour after feeding makes - I consistently pump a bunch more if I wait an hour instead of having to pump right after he eats. That's so cool that the amount a baby eats is so consistent!