PUMPING

Pump anatomy

  • List of parts – refer to section before
  • include comment about prevention/maintenance spare valves (don’t want these breaking!)
  • Are breast pump parts interchangeable – yes, can get adaptors eg. Bottle thread changer

Pump gear & setup

  • how to pump - setup
  • List the equipment - more than just a pump, bottles, warmers, sterilisers, nipple pads, lanolin - so where to start? 
  • for home
    • trying to increase supply
    • Most comfortable
    • Power pumping?
  • for work – eg elvies, freemies QUIET
    • How to feel most comfortable pumping at work
    • Pumping at work hacks
    • Pumping at work cleaning parts
    • Storing milk at work

The thing about pumping is that it’s not just the pump. It comes with all sorts of accessories required to store, clean and feed milk to your baby. 

Your nursery room is likely going to start looking a lot less like a Vogue interior, and more like a backyard chemistry lab. 

One trick to keeping your mind calm and your body calmer, is to have it all organised. It’s one of those situations where giving everything a place, and having lots of containers and tubs can really take the edge off. 

Here’s a list of the types of accessories you might need: 

  • Pump (and all its bits like flange, valve, tubing etc) - see section x for a diagram. 
  • Container of pre-cleaned pump parts (get your carer to have this ready for you) 
  • Container for your used pump parts 
  • Container for your breast related things, depending on how you’re finding pumping and feeding. This could contain anything from nipple ointment (to spread on the nipple before and after pumping to reduce friction), nipple pads (for placing in the bra against the nipples to soothe them, and stop from leaking through to your shirt), breast heat/cool packs (variety of shapes and sizes of packs to offer comfort in cooling or warming the breast), nipple shields (super thin silicone sheaths that some people use to protect the nipple breastfeeding or sometimes help make it easier for the baby to latch). 
  • Container for all the feeding parts. Bottles, teats. Our biggest tip here is to buy double what you think you need. It’s nice to have spares handy when washing gets waylaid between pumps. 
  • Container with cleaning equipment. Bottle brushes, teat brushes (you want to get right in there and scrub the gunk out), detergent, clean paper towel for air drying on, air drying rack, microwave sanitiser kits, UV sanitiser kits. 
  • Personal sanity and wellness. Water bottle, cups of tea, books, snacks, music, phone (although it’s probably not helping). 

Each woman has a different experience with pumping. If you’re unlucky, you might need all of this, but chances are you won’t. Here’s how we think about the bare minimum you’d need depending on your circumstance. 

Container

Light pumping 1x/day or less

Lots of pumping

>3x/day

Exclusive pumping >5x / day

Pump and parts

y

y

y

Pre-cleaned pump parts

y

y

Y - get two or three sets of everything to save washing if you can afford it

Used pump parts 

y

y

y

Breast related things

depends

depend

depends

Feeding things

A couple bottles and teats

Half a dozen bottles and teats

As many bottles and teats as you can afford and store

Cleaning equipment

y

y

y

 

How to clean your pump

  • how to pump - cleaning
  • Do you have to?
  • Why cleaning is important
  • Why sterilise breast pump parts
  • Typical method – the basics
  • Sanctioned cleaning methods vs what gets done – disagreement and changes
  • Other methods
  • Cleaning at night
  • What if you forget? Will the milk be affected?

How to start pumping

When to start

  • Diagram of when to start pumping
  • When to start pumping while breastfeeding a newborn
  • How to start pumping – depends on why colostrum, establish supply, maintain supply, stash, work
  • How to pump – when to start
  • Pumping – when to start
  • How to pump – restart

How to pump your first time

  • how to pump – general
  • How to start pumping
  • Fit
  • Settings
  • Step by step
  • how to pump - getting letdown
  • How breast pump is used
  • How breast pump
  • how to pump - with piercing
  • how to pump – general

 

Which suction level to choose

https://aeroflowbreastpumps.com/blog/breast-pump-suction-strength-the-facts

How long to pump

  • For more detail on pump schedules, including schedules for building supply, maintaining supply, work, weaning and more, head here.
  • When to breast pump and how long
  • We don’t recommend a particular time to pump for because the amount of time women pump is highly variable and depends on their anatomy, how fast their milk flows, how many letdowns they have (if at all) and the reason they’re pumping (e.g. to feed or for spare).

How often to pump

  • When to breast pump and how long
  • For more detail on pump schedules, including schedules for building supply, maintaining supply, work, weaning and more, head here.

How much milk you might get

  • Milk volumes breastfeeding (studies) – and how that’s different from formula and cow’s milk. You’re not measuring milk volume if feeding directly at breast so difficult to make comparison (weigh the baby).
  • pumping - how much milk
  • how to pump – volumes
  • refer to section on how to pump efficiently, and troubleshooting inefficient pumping
  • What’s “normal”, how much milk should a new mother be producing?
  • Volumes fluctuate between:
    • Women
    • Breasts
    • Day of week
    • Times of day
  • Why does it vary?
    • Timing of last feed
    • Stress levels
    • Time away from baby. Pumping often feels like you’re less empty than when with baby – can even see volume collected less over time if you’re away from your baby for a while.
    • Working or not working
  • Clinician comment
  • What are milk volumes?
  • Why do they matter?
  • How much should a new mother be producing? (Guide #1) Oversupply / undersupply / foremilk / hindmilk
  • Pumping often feels like you’re less empty than when with baby – can even see volume collected less over time if you’re away from your baby for a while & working or not working - what might hinder milk volumes
  • Supply drops for various reasons

How to store milk

Storage options

  • how to pump - storage
  • how to pump - safe storage
  • For home.
  • For work. Cooler bags
  • For out.
  • Where to store?
  • Storing hacks

Once you’ve pumped, you want to store the milk.

If you’re at work, you also need to be able to carry it home.

 

Here are some suggestions for storage, and their pros and cons

 

Option

Example

Pros

Cons

Disposable bags

 

no need to wash

can pump directly into them

 

 

bad for the environment

Bottles

Avent milk storage cups.

organised, safe storage and transport

better for environment than disposable bags

don’t fit into bag

have to wash, and sanitise

take up lots of freezer space

longer to defrost than bags

 

Re-usable bags

Silicone milk storage bag

Organised, safe storage and transport

Better for environment

Fits into bag, can be stored laying down or standing up

Some don’t have easy way to mark on dates

Freezer trays

Milkies freezer tray

Organised

Once frozen can transfer to zip lock in freezer

Need to collect in something between expressing and pouring in the tray

 

 

Milk safety

If you find yourself pumping, you’ll need somewhere to store your breast milk.

Like many issues around breastfeeding, it can be difficult to figure out what you’re meant to do (and what you’re not). You may find you have questions about both the safety and the quality of your milk after storing.

In this section, we’ll break it all down for you.

Before we start, here are a few notes on our sources of information.

  • All the information we share below comes from the United States Center for Disease Control (CDC) or the research papers they refer to about milk safety. You can find their guidelines on storage and thawing of breast milk here.
  • The CDC recommends techniques for storing and preparing milk based on clinical guidelines developed by the Academy of Breastfeeding Medicine[1].
  • These guidelines are based on research for babies who are full-term and at home. If you find yourself in the NICU or your baby is pre-term, your healthcare team may recommend additional precautions.

What the guidelines say about milk safety

Ok, so how should you express, store, thaw and feed your baby safely according to the CDC guidelines?

It can help to think about it in steps:

  1. Preparing to express milk
  2. Storing your milk
  3. Thawing your milk
  4. Feeding your baby
Steps 1: Preparing to express

Before expressing, make sure you have washed your hands. If you are using a pump or re-usable milk storage bags, make sure they’re clean. You can find instructions from the CDC on how to clean and sanitise all your equipment here.

Step 2: Storing your milk

Pour your milk into clean, food-grade bags or containers. Make sure you use containers that are intended for breast milk. They should have tight fitting lids or seals, and they shouldn’t contain BPA (which can leach chemicals into the milk). Food-grade silicone options are great because they don’t contain plastic or BPA.

Label your milk with the date and amount (if it helps you plan, but not if tracking volumes is stressing you out).

As soon as you’ve finished expressing, you can store your milk for:

  • 4 hours at room temperature (e.g. on the counter)
  • 4 days in the fridge
  • 6 months in the freezer (although 12 months is also ok, but quality is best at 6).

When storing your breast milk in the freezer, make sure you keep it towards the back to avoid temperature changes from opening and closing the door.

Other tips that might help:

  • If you don’t think you’ll use within 4 days, it’s better to freeze straight away to maintain the quality of your milk.
  • Leave a couple of centimetres at the top to allow for milk to expand when it freezes
  • If you’re travelling, store your milk surrounded by ice packs in an insulated esky for up to 24 hours. You’ll need to find a fridge or a freezer as soon as possible after that!
Step 3: Thawing your milk

To thaw your milk, take the oldest out first (first in, first out) and either put in the fridge to thaw overnight or put in a container of lukewarm water. Don’t use the microwave as it can destroy nutrients and create hotspots which can burn your baby’s mouth.

If you’re thawing in the fridge, you need to use it within 24 hours from when it has thawed. If you’re thawing using warm water, you need to use it within 2 hours.

Never refreeze your milk after it has thawed. 

Step 4: Feeding your baby

In the movies, people heat milk and test it on their wrist before feeding to the baby. You don’t actually have to heat milk – cold or room-temperature milk is ok to drink!

However, you may find that it just seems nicer, and your baby seems to respond better to warmer milk. If you want to do that:

  • Place the sealed container (make sure it’s sealed) in warm (not hot) water. Never heat on the stove or in a microwave (see step 3 above).
  • Test the temperature on your wrist

Before you feed your baby, give your bottle a little swirl, to mix the fat (sometimes caked on the side) into the milk.

If your baby doesn’t finish the bottle, start your timer, and use it within 2 hours, or discard.

Don’t want to read through all of this again?

Below is a table from the cdc.gov website explaining the time windows to safely store your milk.

Guidelines are fine, but they don’t answer my questions

In practice, we follow the guidelines, but sometimes guidelines don’t contain the detail and tips that can make all the difference to your efficiency or stress when you pump.

Here are some extra tips that might fill in some gray areas you have questions about.

Can I put the pump in the fridge, in my cooler bag?

Yes. You don’t need to worry about damaging the pump in cold temperatures. The fridge is usually 3 to 6 degrees. Most pump manufacturers say their pumps should be stored between x and y. So, you’re good.

How to make sure your milk is safe to drink

  • how to pump - milk safety
  • how long can you keep pumped breast milk
  • how long can just pumped breast milk stay out
  • how long can my breast milk stay out after pumping
  • how long can pump breast milk stay out
  • how long can pump milk stay out
  • how long can pumped breast milk be left out
  • Can I put the pump in the fridge, in my cooler bag? Yes. Fridge is usually 3-6deg, most pump manufacturers say that their pumps should be stored between x and y. So you’re good.
  • Different milk colours 
  • pumping problem - hard lumps in breast milk
  • Freezer vs fridge
  • Use-by dates! 
  • Storage guide from Dr Milk

  • There's not actual evidence to support many of the recommendations commonly given in books and on websites in regards to breast milk handling and storage. The recs we make here are perhaps slightly more evidence based (when possible), experience based or common sense. Many of the milk handling rules commonly reported are derived from formula safety and arbitrarily applied to breast milk.
  • sniff/taste tests for any questionable milk is always wise. Spoiled milk is foul.
  • FORMULA (for comparison):
    • all formula should be discarded within one hour of baby starting to drink
    • ready to feed and concentrate liquid formulas are good after opening for 48 hours in the fridge
    • prepared powder formula is good 24 hours in the fridge
  • FRESH MILK:
    • In general, freshly pumped milk is good at room temp at least 6-8 hours, possibly up to 24.
    • Milk in the fridge is good 6-8 days. Extras can be frozen at any point. There may be some benefit for potential of longer term storage of frozen milk to freeze extras around the third day in the fridge. The bacterial nadir for refrigerated milk is on day 3.
    • It's fine to mix fresh pumped milk with cold milk in cooler or fridge. (Adding large volume of warm milk to frozen milk is not recommended.)
    • It's also generally considered safe to take a bottle out of the fridge and let it warm to room temp for a few hours before feeding.
    • The only exceptions may be moms with "high lipase" issues...the time in the fridge at which smell/taste issues appear varies widely. Scalding may be recommended by some (sooner than above time estimates) if baby refuses to drink the affected milk. There is no evidence to support the affects of "lipase" on refrigerated of frozen milk or to support scalding. Please ensure all other reasons for milk refusal are ruled out before starting to scalding all milk. The majority of bottle refuses are likely refusing the bottle, not the milk.
  • FROZEN MILK:
    • Frozen milk should be used within about 24 hours of complete thawing.
    • Milk can be stored in a regular freezer at least six months and in a deep freezer at least a year.
    • Milk doesn't magically expire on a certain day. It could get a little freezer burn or oxidize more and change the taste. I have used milk 18+ months in the deep freezer without issue and no signs of freezer burn. Even milk with a little freezer burn is still superior to formula. Published "limits" for length of freezer storage are because that's as long as the studies went. There is nothing that says frozen milk is "bad" after a certain date.
    • The less air in with the milk the less likelihood of freezer burn, oxidation, acquired freezer flavors, etc. Fill bottles almost completely leaving only small headspace, especially if long term freezing is expected. Squeeze all air out of bags before freezing. This is easier with some brands of bags than others.
    • It's ok to refreeze partially thawed frozen milk as long as ice crystals remain. This is true for all frozen foods, not just milk. It's a food safety issue, not specifically a breast milk issue.
  • LEFTOVERS:
    • All milk handling rules about discarding partial bottles and reusing milk are formula based and don't have much evidence to support any particular position. Because there are so many "if then" scenarios, this is a hard area to study. Those publishing guidelines therefore use an abundance of caution and give very conservative recommendations.

 

Feeding your baby

How to prepare

How to feed

  • How to feed with syringe (early on)
  • How to feed with tubes (struggling w latch)
  • How to feed with a bottle
  • SWIRL OR SHAKE:
    • “There is no evidence that shaking milk is harmful. This is where some common sense comes into play. If shaking denatured proteins significantly, then those of us who run, exercise, play sports, ride rollercoaster rides, etc would be damaging our bodies and our milk. This is definitely not the case.
    • Shaking is the quickest way to incorporate the fat back into the milk. Getting the fat into the milk is very important for baby's growth and development. “
  • Warming milk
    • “not medically necessary - can be given warmed, room temperature or direct from the fridge however some babies do have a temperature preference. Warming is something to try when you introduce the bottle
    • slight warming makes it easier to incorporate the fat back into the milk
    • warmed excessively has lower fat content and other components may be damaged.”
  • How to pace a feed
    • “If using a bottle, ensure the care giver is giving paced bottle feeds. This helps to replicate the flow of milk with a breast feed and ensures the baby does not develop a bottle preference, as well as ensuring we respond to their signs of being full.  Renee Keogh (RN, IBCLC) has made an excellent video demonstrating how to do this available at: https://possumsonline.com/video/about-paced-bottle-feeding-renee-keogh

How much to feed

30-37mLs/hr that you’ll see mentioned here quite a bit  The volume of breastmilk they drink doesn’t change with age or weight, it stays the same between 1-6mths of age, and then actually decreases very slowly!

  • pumping - how much milk does a baby need
  • pumping - how much milk to feed
  • pumping - how much milk to feed
  • pumping - how much milk to feed baby
  • pumping - how much milk to feed back
  • “Milk supply from month 1 - 6 is the SAME! (-ish) Human babies eat human milk in the same volume at one month through 6 months of age. Then the volume of milk needed goes DOWN not up because of introduction of solid foods. WHAT???? Publications from 1999, 2003, and 2008 showing that the volume of milk produced at 1 month through 6 months is the same (small +/- 30-60 cc in 24 hrs). The metabolic *burn* of an infant slows down and lessens (as the growth chart flattens) in that same time frame. Breast milk fed babies require fewer calories to grow over time; however cow milk fed infants do require escalating volumes of milk to meet their higher calories to grow over time. When you metabolize your own species' milk, it's a very efficient process - so your kcal/kg/day goes DOWN as infant grows. So the same volume of milk feeds a 10 pound one month old as a 20 pound one year old! Calories are relatively consistent in the milk if averaged over a 24 hour period. We are all trained in medical school on tables of dietary requirements that increase with weight in first year of life, but that data is all from cow-milk fed infants. A stay at home Mom knows that her breasts have not doubled in size (with double the volume) for her one year old versus her one month old :) So stop using any weight based volume calculators for your human milk fed infant...... normal volume 24-30 ounces per 24 hours (1-1.25 ounces per hour) is the same from month 1-6. From 6 months to a year, the total daily volume gradually drops to an avg of 18 ounces per 24 hours at 12 months of age. This is normal and not low supply. We recommend 2 cups (16 oz) of milk at 12 month well check..... which is exactly how much human milk most mothers make! “ – dr milk

 

Common problems

  • pumping problems - nipple confusion
    • Babies may fuss with a bottle to start with if they are used to feeding at the breast. Try not to panic, your baby will understand that you are not available and will take what they need.  The carer should not force the bottle, but to continue to try the bottle every now and then.  You can trust that when the baby is hungry or thirsty enough they will drink.

Replacing parts

When should I replace pump parts?

Pumps have a lot of parts. Some are designed to last a really long time, like the pump itself and the hard plastic part that houses the motor. Others are not, because they need to be soft and stretchy to work and are therefore fragile, like the valves or backflow protectors.

Why replace parts

There are two reasons to replace your parts.

First, if you’re starting to feel less suction from your pump, the culprit is often a degraded part. All pumps have slightly different designs, but it could be a tear in the duckbill valve or just a weakness in the valve membrane. Replacing it can be a quick fix to have your pump suction back, and possibly even your milk volumes.

Second, as materials degrade, they can crack or split or get a rough surface. This can be a lovely place for bacteria to grow, but it can also leach chemicals from the material into the milk. This is why you want to check that the products you’re using on your skin or coming into contact with your milk are high quality, like medical-grade or skin-safe because they are designed, manufactured and tested so they do not leach unsafely. Learn more about that here. 

When to replace parts

Each pump manufacturer will have specific information on their parts, but in general, the softer the part, the more often you have to replace it.

Part or attachment

Replacement

 

 

 

 

 

 

 

 

 

Disposing of your pump

  • Where donate breast pump
  • How to dispose of safely and for environment