It is estimated that at least 85% of mothers have expressed their milk at some point during the first 4 months of breastfeeding their babies.(1) Expressing breast milk during the breastfeeding relationship can look many different ways for families. Some people combine nursing and pumping and other folks are exclusive pumpers.

• Breastfeeding is feeding your baby breast milk. Although historically breastfeeding described a baby getting milk directly from the breast, the growing number of people who pump their milk for their babies demands that we change this outdated definition. Breastfeeding is assessed by the amount of milk a baby has regardless of how they get the milk according to the healthcare recommendations.(2) Breastfeeding can include the baby getting donor milk or shared breastmilk as well as their own mother’s milk when it has been expressed by hand or a pump.
• At-the-breast feeding or direct breastfeeding is your baby drinking milk directly from your breast. 
• Exclusive pumping describes using a pump and/or hand expression to remove your milk to give your baby and not directly feeding at the breast. Some people choose this method to be able to provide their own milk for their baby. Exclusive pumping allows a mom to exclusively breastfeed using a pump and bottle. Some parents may choose to still nurse their baby for comfort directly at their breast.

Many people choose a combination of pumping, direct breastfeeding and giving their baby expressed breastmilk. How your baby receives milk can give important information when challenges arise with breastfeeding. Language used can help your care providers best understand what you are currently doing and be able to help you reach the goals you have for breastfeeding your baby. 

Breast pumps have come a long way. Methods to remove milk have been around for centuries. Over time, different materials have been used for pumping milk and improvements have been made to make pumps more efficient and effective as well as more comfortable and convenient for the user. 

Electric pumps were first developed for hospital use at the beginning of the 20th century and then became more popular for personal use especially as mothers wanted to return to work while continuing to feed their baby their own milk.(3) The latest advances in pump technology has expanded and gives mothers the choice of exclusive pumping regardless of if they are returning to work or staying home with their child. 

How often to pump depends on how old your baby is. Establishing your milk supply generally means you need to pump more often versus pumping for an older baby. As your milk supply regulates, usually around 6-8 weeks postpartum, you will begin to have a good idea of how often you need to pump to have the right amount of milk for your baby per 24 hours.

Newborn babies 

Newborn babies eat every 2-3 hours. In the beginning, your pumping schedule should follow the pattern of when your baby eats. This signals your body to continue to make milk at the rate your baby is eating. Plan on pumping 8-12 times each 24 hours. Each pumping session will be 15-20 minutes on average. The times you pump should be spaced out evenly throughout the day and night. You may want to pump closer to every 2 hours during the day and stretch the nighttime sessions to every 3 hours for a little extra sleep during the night.

Middle of the night pumping

Middle of the night pumping is very important especially in the beginning while you are establishing your milk supply. Prolactin is a hormone responsible for milk production. Because of its own circadian rhythm, it is naturally highest during the night. Removing milk during that time when prolactin is naturally elevated can help establish a strong supply, set daytime milk production and even increase milk supply.

How much milk do you need to pump?

Babies eat about the same amount of milk from the time they are about 1 week old until at least the introduction of solid foods. Even around 6 months of age, solid foods are complimentary to your milk so their need for your milk does not decrease dramatically until they are eating more solids. The amount of milk your baby will take  per 24 hours is 19-30 ounces with the average being 24 ounces. Using a paced bottle feeding method gives your baby more control over how much they drink at each feeding. This method also allows them to pay attention to when they are full and stop eating. Babies who are not pace bottle fed may overeat and not give you an accurate measure of how much milk they need to reach satiety.

• There may be times your baby eats more often. You can increase your pumping frequency to accommodate and match their increase. 
• Power pumping is another way to boost production. By pumping on and off for one full hour, you elicit more let downs and signal the body to upregulate your supply. 
• If you’re finding you are producing more than your baby needs after your supply has been established, you can reduce the amount of times you pump by spacing your pump sessions further apart. 
• Some people are able to reduce or cut out the middle of the night pump session, but most people find their milk supply is best maintained by keeping the middle of the night pumping a part of their routine.

• Choose a breast pump that best meets your needs. Many people love the convenience and flexibility of a hands free pump like the Imani wearable pump from Legendairy Milk. Hands free pumping allows you to take care of your baby or other children and still pump your milk for your baby.
• Silicone Collection cups are compatible with many breast pumps turning them into a hands free experience. Silicone is a softer material and can make pumping more comfortable and some people find it helps them get more milk out.
• Get a flange fitting consultation. The correct flange size will maximize the amount of milk you are able to express and give you the most comfort. Incorrect flange size can lead to lower milk output, plugged ducts and painful pumping. If you have been using the wrong size shield and have sore or damaged nipples, express some of your milk onto the nipple and areola to quickly soothe discomfort and heal damaged skin. Coconut oil is another option to help heal cracked skin while you work on correcting the cause.
• Get a pumping bra to help hold your flanges/shields in place while pumping.
• Create a pump station so you have everything you need at your fingertips when you pump. You may want your bottle of water, a snack, pumping spray to lubricate your breast shields for more comfortable pumping, phone and charger, blanket and a photo of your baby.
• Instead of washing your pump parts after every session, store your parts in a plastic bag in the fridge and wash them all at least once a day.
• Use a heat pack and do very gentle stroking or tapping on the breast before pumping to get milk ready to flow. At the end of each pump session, hand express to get the last drops of milk out. This helps to maintain supply and can help increase supply as well.
• Have a bag for pumping on the go. You will want to have extra pump parts, a car adapter for your pump and a cooler with ice packs for storing your milk while on the move and any breastfeeding supplements you are taking. Check out this blog post for Traveling while pumping.
• The Pitcher method of storing milk can save time and room in your fridge or freezer. It is an alternative to storing each session of milk in its own breast milk storage bag. Label the pitcher with the first day milk was pumped if you collect more than one day's worth of milk in a pitcher (follow proper storage and preparation of milk guidelines). Cool freshly pumped milk before adding it to your pitcher. After your pitcher is full and you prepare your baby’s bottles, wash and sterilize the pitcher thoroughly.
• Allow your pump to run a little longer after pumping at least once a day to clear condensation out of the tubes.

Pump parts need to be replaced to keep your pump working its best. Worn out parts can reduce the suction of your pump and you will not get as much milk out which over time can reduce your milk supply. Check your pump manufacturer's guidelines for specific recommendations. Below gives you an idea of when to change the parts if you exclusively pump:

• Duckbill valves - every month. Some pumps have a valve membrane instead of duckbills. Valves and membranes need to be replaced every 2-4 weeks.
• Backflow protectors - every 3 months
• Flanges/shields and connectors - every 6 months
• Tubing - every 6 months
• Replace any part sooner if you notice cracks, tears or they become worn out sooner.

Exclusive pumping benefits you and your baby when feeding directly at the breast is not what you choose or is not an option for you. It can be hard work, but is worth the effort. There is not a lot of research about exclusive pumping, but it is beginning to get more attention. If you decide to exclusively pump, it may be helpful to join a support group to share experiences with people who are feeding their baby the same way as you and to exchange challenges and successes of exclusive pumping.

Footnotes:

1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3134520/
2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5802247/
3. https://pubmed.ncbi.nlm.nih.gov/23095190/

Resources:

https://exclusivepumping.com/category/exclusive-pumping-101/

https://www.cdc.gov/nutrition/infantandtoddlernutrition/breastfeeding/pumping-breast-milk.html

https://psmag.com/economics/unseen-consequences-pumping-breast-milk-94181

https://pubmed.ncbi.nlm.nih.gov/26487378/

https://kellymom.com/mother2mother/exclusive-pumping/

https://pumpingmamas.com/replace-breast-pump-parts/

https://texasbreastfeeding.org/node/193