Beginner's Guide!

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Registered: 10-14-2010
Beginner's Guide!
Sun, 11-18-2012 - 8:47pm
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    Here it is--don't know what happened!  I had my second baby a few weeks ago and have been a little crazy with a newborn and a toddler and haven't been on the board as much as normal.  Here is the guide that Eowyningreen created a few years ago, reorganized and with my updates.  I hope it is helpful to everyone!

    Exclusively Pumping – A Beginners Guide
    Welcome to the weird and whacky world of pumping breastmilk. Whatever your reasons for doing so (be they a baby who refuses to breastfeed, a baby who can’t breastfeed e.g. because of a cleft palate, personal preference, being a surrogate mother, or a heap of other reasons), congratulations! You’ve chosen what is not an easy path, but is certainly a worthwhile one and by pumping, you are making sure that your baby gets the best possible start to life.


    Note: This guide is there to help you with getting started with pumping and to answer some of the common questions you may hit along the way. It is drawn together from responses on the ivillage Exclusively Pumping Discussion Board and from other books and internet resources. It is not written by medical professionals and should not be taken as such. If you have urgent medical questions about your health and that of your baby, please speak to your healthcare provider.

    Table of Contents: 

    PART 1: Getting started and making your life easier (includes info about how often to pump, types of pumps, how much you can expect your baby to eat, how to go about supplementing if needed, and how not to go insane)

    PART 2: Milk Management (storing, freezing, rotating freezer stock)

    PART 3:  Supply Issues (how to increase or decrease your supply)

    PART 4: Physical Issues for Mom (clogs, thrush, mastitis...)

    PART 5:  Dropping pumps

    PART 6:  Pumping while on the go (driving, flying)

    PART 7 :   Not going nuts/Dealing with people who think you are nuts

    PART 8 :  Pumping and Weight Loss

    PART 9 :  Weaning from the pump

    Part 10:  Things that EP board members wished they had known when they started pumping


    PART 1: GETTING STARTED AND MAKING YOUR LIFE EASIER

    Q: How much should I pump?
    A:  8-12x a day, for a total of at least 120min per day  In the early days, it is recommended that you pump every two to three hours (so between 8 and 12 times per 24 hours). You should also make sure at least one session is between 1am and 4am. At first, most people need to pump for at least 15 minutes per session (or 5 minutes past the final drop). Pumping past the final drop sends signals to your body to produce more milk! Some women do very well and can get a supply really well established on 8x 10-15 minute sessions. Others can pump for 8x 40minute sessions and still struggle to get enough.
    In general, most people pump for at least 120 minutes per 24 hours and this guideline will stay the same once you drop pumps. So for instance, when you’re on 4 pumps per day, you’d expect them to be 120/4 = 30 minutes long each.


    Q How much should I expect to get?
    There is a wide variation on what is normal for pumping moms. Everyone reacts differently to the pump. Some find themselves with a huge oversupply and some find that they can barely pump enough and have to supplement with formula. There is no telling who will fall in which category.
    In general, most ladies will have work to build up their supply. After your milk comes in (generally between 2-10 days postpartum), you will be able to pump milk, but possibly not a supply that will meet your baby's needs. Many EPing mothers have to supplement in the beginning, some are able to stop supplementing after the first few weeks, some will always need to supplement. There is no set time frame for reaching your maximum production, but the most significant increases are generally in the first 12 weeks when your hormone levels are at their highest

    Time Post Partum

    Average Milk Pumped (see detailed description below table)

    4 weeks

    25oz

    8 weeks

    32oz

    12 weeks

    36oz

    16 weeks

    38oz

    20 weeks

    37oz

    6 months

    33oz

    9 months

    30oz

    12 months

    25oz

     

    In September 2008, we did a board survey, with nearly 100 respondents... "Average Production" came out as follows:
    At 4 weeks
    .

The mean production is 25oz, although this is skewed by some HVPs - the modal group is 15-20 oz and nearly half of us are producing less than 20oz at 4 weeks.
    At 8 weeks
    The mean production is 32oz, but the distribution is fairly even around the mean - a quarter of us are producing less than 20oz at this point and another quarter are producing more than 45oz!
    At 12 weeks
    


The mean production is 36oz, and again this is very evenly distributed, with the middle 50% of the data ranging from 25 - 45oz
    At 16 weeks
    


The mean production is 38oz and it's still very evenly distributed
    At 20 weeks
    


Mean production is 37oz, and the modal group is 30-35oz
    At 6 months
    

Mean production is 33oz and the modal group is 25 - 30oz.
    At 9 months
    


Mean production is 30oz
    At 12 months
    

Mean production is 25oz
    As you would expect, the majority of us are Average Volume Producers (Produce what your baby needs, maybe with a small surplus) - 44%. 18% of us are Low Volume Producers (Produce less than your baby needs) and 38% are High Volume Producer (Produce a lot more than your baby needs)

    Q: How much should I expect my LO to eat?
    There is a wide range of how much you can expect your LO to drink in the course of 24 hours. Some babies may take as little as 19 oz per day, some as much as 30 oz or more. A baby’s intake will start out a little smaller at birth, and will gradually increase. After the first two or three months, your baby’s consumption with level out, with only a small increase in the amount they take . After 6 months, you may see a gradual decrease in feeding amounts, as solids become more of a factor in your baby’s diet.
    It is important to note that breastmilk is not the same as formula. Formula babies generally consume a greater amount during the day (formula is not absorbed as efficiently as breastmilk). Do not use the formula calculators you find on the web, or those on the back of the formula packet, as a guide to how much your LO should eat!
    Growth spurts during the first 6 months are quite common – and will usually last a few days at a time. If your baby suddenly wants 35 oz per day, give it a few days to go back to normal before you start to consider that a normal feeding amount.
    How much milk a baby will take at a feeding depends on the child. Some prefer smaller more frequent snacks; others can go longer between feedings. Follow your babies lead as much as possible. Whether you decide to feed your child on a schedule or on demand is a personal choice. Both methods have their own pros and cons.
    It is possible to overfeed a bottle fed baby – even with expressed breastmilk. If you see that your baby is taking above the recommended range, try offering a pacifier after a feeding and try to avoid using the bottle as a method of comforting your baby every time they fuss. Babies need to suck – and sucking on a bottle is generally less satisfying for them than the breast – so they tend to suck longer. If your baby is truly hungry, he/she will let you know and you can offer additional milk. Another way of ensuring your baby does not overeat is to use the slowest flow nipple that your baby will tolerate. The age guidelines on the nipple packages are misleading – many babies use slow flow nipples well beyond 3 or 6 months old.
    According to our September 2008 survey, our baby’s consumption of breast milk does increase as the baby gets older, peaking at an average of 31oz at 20weeks and then decreasing slightly as baby starts solids.

    At 4 weeks, the modal group is 20-24oz and the mean consumption is 21oz
    At 8 weeks, the modal group is still 20-24oz and the mean consumption is up to 24oz
    At 12 weeks, the modal group is now 25-29oz and the mean consumption is 27oz
    At 16 weeks, the modal group is 30-34oz and the mean consumption is 30oz
    At 20 weeks, the modal group is 30-34oz and the mean consumption is 31oz
    At 6 months, the modal group is 25-29oz and the mean consumption is 29oz
    At 9 months, the modal group is 25-29oz and the mean consumption is 28oz
    At 12 months, the modal group is 20-24oz and the mean consumption is 26oz
    Of course - remember there us a huge variety - so don't try to force your baby to be average! ;-)

    Q:  How does supplementing work?
    Many women do have to supplement with formula. There are two ways of doing this;
    You can mix the BM and Formula in one bottle for one or as many feeds as needed (e.g. you might just add one ounce per feed of formula). This has the benefit that the flavour of the formula will be reduced, so your LO is more likely to accept it first time. That said, formula can only be kept for an hour after coming in contact with your LO's mouth, while BM can still be used for at least a day or 2. So if he didn't finish the bottle, you will have to throw the remainder away. To counteract this, some women put the BM milk in one bottle and let their LO drink all of that, then follow up with a different bottle of formula if their baby is still hungry.
    Alternatively, you can just pick one or two feeds a day to be formula feeds – if your LO is happy with the taste of formula, this may well be the easiest option as it means no dumping BM and not extra bottles to wash up!

    Making Life Easier
    1. Go hands free - make a hands free bra using an old sports bra or buy one like the self expressions bustier or halter.
    2. Make sure you have the right sized horns - many on here couldn't survive pumping with out pumpinpal horns www.pumpinpal.com
    the right sized horns can help you build your supply, help you empty faster, and avoid clogs.
    3. Get extra sets of your pump parts so you don't have to wash them constantly. Also, get lots of bottles (at least as many as your LO has feeds in a day). 

    4.  You can also rinse your parts and store them in the fridge to reuse them, thus reducing the number of times you have to wash them.

    5.  Pump while your baby eats.  He or she is likely to be happy while eating, and you can put him or her in a seat right next to you.

    6.  Set up a pumping station with everything you need when you pump (pump, parts, water, magazine, tv remote, boppy, binky, whatever else…)

    Q: What kind of pump should I buy/rent?
    A: There are generally 4 types of pumps:
    . Hospital Grade
    . Professional Grade
    . Mini-Electric
    . Manual

    If you are thinking about EPing long term (i.e. more than a couple of weeks), you need to seriously consider one of the first two types (i.e. a double, electric pump). While we have heard of a few (and I mean few) Mums that have managed to EP long-term with a single electric pump, or even a manual, they are a rareity and most ladies who try it are not able to establish their supply and keep pumping long-term.

    As for whether to get a hospital grade or a professional grade pump, that’s entirely up to you. Some people say they pump better with one, some with the other, but many ladies have managed to pump long-term (i.e. over a year) with both.

    If you’re not planning to EP for a long time, it may be more cost effective to rent a hospital grade pump. You can check out both Medela and Ameda direct, for details on how to hire their hospital grade pump:

    http://www.medela.com/ISBD/countries.php
    http://www.ameda.com/

    If you decide you’re going to buy a professional grade pump (which will be more cost effective if you plan to pump for more than about 5 months). The most popular professional grade pumps are;
    Medela PIS/PISA
    Ameda PY
    Lansinoh

    If you’re in the US, and the expense of the pump is an issue for you, you may consider consulting with your local WIC office. If you qualify for benefits, they may be able to provide you with a hospital grade rental for free. You can also discuss your pump needs with your doctor - some insurance companies will help with the cost of a pump if it is 'prescribed' to you.

    PART 2:  MILK MANAGEMENT

    Q: What are the guidelines for storing and using breastmilk?
    A:   It is always best to use freshly expressed milk…
    Fresh breastmilk can safely stand at room temperature for at least 6 to 8 hours and need not be discarded if your LO doesn’t finish it in the first feeding
    Remember: In contrast, formula must be refrigerated and discarded after the first feeding attempt because it contains no antibodies or infection protection factors.
    Recommendation for use and storage of expressed milk do vary on where you find them, so you may find figures that are shorter or longer than those given here. If in doubt, you can smell and taste the milk – you’ll know if it’s off!
    Type of Storage Temperature Maximum recommended storage time
    Room temp (66-72 degrees) 10 hours
    72-79 degrees:  4-6 hours
    Refrigerator: 5-8 days
    Freezer compartment Variable, due to frequent door opening 2 weeks
    Freezer (Separate door, as part of fridge) Variable 3-4 months
    Separate Chest Freezer -19 oC/ 0 oF 6 months +

    Using Refrigerated Milk:
    The cream will rise to the top of the milk during storage in the fridge. Gently swirl milk to mix (some resources will expressly tell you not to shake BM, as this breaks down some of the component parts – how scientifically correct this is, is open to debate).  If the fat is stuck to the side of the container, try running hot water over the container to melt the fat. 
    Some babies, especially as they get older, will be happy to drink milk cold from the fridge. If not, you may like to warm it for them.
    To warm milk – Place milk into a container of warm (not boiling) water, or just rust run under a warm tap. Alternatively, use a bottle warmer.
    Note: NEVER microwave human milk or heat it directly on the stove.
    If you do warm your BM, remember to check the temperature before giving it to your baby.

    Q: How do I freeze milk? 
    A: To avoid waste and for easier thawing & warming, store milk in 1-4 ounce portions. Date milk before storing. Milk from different pumping sessions/days may be combined in one container – use the date of the first milk expressed.
    Standard glass or plastic bottles (or any type of leak-proof food storage containers) are acceptable for storing mother's milk, as are disposable bottle liners or "mother's milk" bags. The best materials are glass or food-grade polypropylene or polybutylene (hard) plastic. Polyethylene bags (bottle liners) do not preserve nutrients and immune properties as well as glass or hard plastic.
    It is worth checking your on whether your baby will readily accept your freezer stash early on in your pumping career. The smell and taste of BM can be altered during freezing, due to the action of lipase. If your BM is high in lipase, you may find that once frozen it smells and tastes metallic, soapy or a little like vomit. Many babies will accept frozen BM, but if your baby refuses it, you can try the following:
    • Try freezing it in different types of container
    • Store BM in the middle of the freezer – not close/ touching the walls
    • Change your thawing method
    • Reduce the length of time you are storing it
    • Scald your milk before freezing it (Heat milk to about 180 F (82 C), or until you see little bubbles around the edge of the pan (not to a full, rolling boil), then quickly cool and store the milk) (Scalding the milk will destroy some of the antiinfective properties of the milk and may lower some nutrient levels, but this is not likely to be an issue unless all of the milk that baby is receiving has been heat-treated)
    Using your freezer stash

    How do I thaw breastmilk?
    A: Thaw slowly in the refrigerator (this takes about 12 hours – try putting it in the fridge the night before you need it). Avoid letting milk sit out at room temperature to thaw. For quicker thawing, hold container under running water - start cool and gradually increase temperature.

    Note: Previously frozen milk is more fragile than fresh BM, so may only be kept in the refrigerator for up to 24 hours after it has finished thawing. Do not refreeze. If you have warmed frozen milk, it is recommended that you use it within one hour.

    What does “rotating freezer stock” mean?
    A: While milk in a stand alone freezer is good for 6-12 months, after 3 months most of the fat has broken down. It is still significantly better than formula at this point. However, if possible using the milk by 2-3 months is better.
    You may well find that you use some of your freezer stash if your baby is growing through a growth spurt or if you get ill. Some women also hold on to their freezer stash so they can drop pumps earlier.
    If you find you don’t ever need to delve into your freezer stash, it is a matter of choice whether you use some frozen and immediately replace it with fresh, or whether you decide to donate it (see too much milk section) or whether you just dump some.
    In general, a stash can be a useful backup, but it shouldn’t be something you stress about building up!

    Q:  When do I need to “Pump and Dump”? 

    A: Pump and dump means expressing breast milk and then disposing of the milk usually by dumping it down the drain. There is quite a bit of disagreement, most likely due to unknowledgeable doctors, over when a woman really needs to pump and dump due to medication. If your doctor advises you to stop breastfeeding while on medication, first ask for an alternative medicine that's safe for your baby. Some doctors are overly cautious, so you might also want to check with a lactation consultant for up-to-date information on the safety or risk of a certain medication and whether it's found in breast milk. It might well be possible to take your dose of medication immediately after nursing, wait until just before the next dose is due, and then nurse again.
    The following page has some very useful information about taking medication and breastfeeding;
    http://www.askdrsears.com/html/2/t028500.asp
    The other time you might want to pump and dump is if you have been drinking alcohol. The general rule of thumb is that by the time you are no longer feeling "tipsy" it is okay to feed your baby. Alcohol does not go into your milk and stay there. It goes in and comes out. If you feel ok, then most of the alcohol is out of your milk. If you have any doubt, pump and dump one time and that should be fine. Obviousy, if you are planning a heavy drinking session, you may want to pump and dump a couple more times.

    More general page on medication, drugs, alcohol and breastfeeding;
    http://www.breastfeedingonline.com/meds.shtml

     

    PART 3: SUPPLY ISSUES

    Q: How can I increase my supply?
    A:  Pump more, power pump, try herbs   If you want to increase your milk supply, the best thing to do is to pump more – if you were BFing on demand and your baby wanted more milk, they would be nursing!
    Obviously though, you want to stay sane – so adding lots of extra pumps might not be an option! And in some cases, it doesn’t work anyway…
    Power Pumping
    The first thing you can try is Power Pumping. This helps to stimulate cluster feeding. Try pumping for 10 minutes, resting for 10 minutes, pumping for 10 minutes, resting for 10 minutes etc Do this for about an hour. Some ladies I have heard of, do it in front of the TV and pump every time the advertisements are on! You won’t see an instant increase, but if you keep it up for a few days, you should start to see an increase!
    Herbs
    If you are planning to try any herbs, you can check out Kelly Mom for recommended dosages, more information and for possible side effects.
    http://www.kellymom.com/herbal/milksupply/herbal_galactagogue.html
    You can start off at a lower dose and then gradually increase it until you see your supply increasing.
    The most commonly used galactagogue (thing that increases milk supply) are:
    Blessed thistle (or milk thistle) stimulates milk production, especially in combination with red raspberry leaves. Blessed thistle is also an antioxidant. Use up to 4 capsules, 3 times a day.
    Fenugreek is the most common galactagogue and lactation herb. Fenugreek can be taken as herbal tea twice or thrice a day. Use up to 4 capsules, 3 times a day. Fenugreek is also considered a uterine stimulant, so do not use this herb if you are pregnant.
    Fennel seed stimulates milk flow and relieves gas and coli
    Hops has been used to increase mother’s milk (which is why they say to drink beer while nursing)!
    Alfalfa is a good supplement to another galactagoue (e.g. blessed thistle) as it is rich in vitamins and minerals, including iron, calcium, and Vitamin K (the blood coagulant vitamin). Use up to 4 capsules, 3 times a day.
    Red raspberry Leaf is also a good supplement to another galactagoue, as it is high in vitamins and minerals. Soon after birth, it will also help the uterus to recover and regain its size and shape quickly. Take as a tea, up to six times a day.
    You can also try blends of herbs, e.g. http://www.motherlove.com/
    Oatmeal
    Many ladies swear by oatmeal as a way of increasing supply. Take a bowl of it every morning… Or if you prefer – make flapjacks!

    Domperidon and Reglan
    These are both prescription medications that actually are not for increasing milk supply. They are generally prescribed for gastrointestinal disorders. However, one of the side effects is spontaneous or excessive milk flow. While excessive milk flow in a mother who is producing adequate milk supply might be a problem--excessive milk flow is not so excessive if you're starting out with a low supply. Many doctors are not aware that these medications can be used for breastfeeding mothers--but a good lactation consultant or even your baby's pediatrician should be able to prescribe them for you. You can also order Dom without a prescription from www.inhousepharmacy.com. Some women have experienced depression and/or anxiety as a side effect from taking Reglan, so most women on the EPing board that do take one, opt for Domperidon.

    Q: What if I have too much milk? 
    A: Some tips for dealing with the oversupply:

    • Between feedings you can discourage blood flow and milk production by applying cool compresses to the breasts. Leave them on for 30 minutes and off for 60 minutes before reapplying. Keep repeating this procedure until you get the desired results.

    • You can also try cool green cabbage leaf compresses to the breasts, they are thought to reduce milk supply (no science on this one yet). Change them every 2 hours or when they wilt, whichever comes first. Apply for one day then watch for results the next day, reapply every other day until desired results are seen.

    • Avoid unnecessary breast stimulation, such as using breast shells (plastic domes some women use inside the bra to hold the cloth off of sore nipples)

    • Sudafed (the kind that you have to ask the pharmacist for) decreases supply in most women.

    Herbs that can lower milk supply:

    Sage
    To use dried sage (Salvia officinalis) for reducing milk supply, take 1/4 teaspoon of sage 3x per day for 1-3 days. You can mix the sage in vegetable juice (for example, V-8), but it won't mix well into other juices. You can also mix it into other foods.
    To use sage tea for decreasing milk supply, infuse 1 tablespoon of dried sage in 1 cup of boiling water (or 20g dried sage in 50 ml boiling water). Steep for 5-15 minutes. Drink 1 cup, 2 - 6 times per day.
    You can use a tincture of sage instead: 30-60 drops of tincture, 3-6 times a day.

    Other herbs that can lower supply include; Peppermint, Spearmint, Parsley, Yarrow, Lemon Balm, Oregano and Sorrel. Sage, peppermint, spearmint, lemon balm, oregano, and cabbage leaves can all be incorporated into a pressed oil to make massage oils for milk suppression.Peppermint essential oil has been used traditionally for decreasing milk supply. It is unikely that normal amounts of Peppermint tea or mint sweets would have an effect on supply, although some women have successfully used the very strong peppermint candies (for example, Altoids® Curiously Strong Peppermints) for decreasing milk supply (a few per day aren't likely to affect supply, though)

    See Kellymom for more on herbs to decrease supply…
    http://www.kellymom.com/herbal/milksupply/herbs-oversupply.html

    Also you need to SLOWLY reduce the amount of milk removed from the breast. So if you normally pump 20 ounces STOP pumping at 18 or 19 ounces and hold there for a few days if no problems (plugged ducts etc.) then you can back down another 1-2 ounces and repeat until you are pumping what you need and just a few ounces more for "back up". It is NOT an overnight process, but the supply can be managed
    Donating Milk
    In the USA, if you're looking for a milk bank, try this link: http://milkbanking.net/ You type in your zip code and it gives you different options for milk banks closest to you. Many of them will come to your home to collect milk and will probably also give you storage equipment and often a pump.
    If there is not a milk bank in your immediate area, two options that do mail shipping are the International Breast Milk Project, http://www.breastmilkproject.org/, and private donation through Milkshare, http://milkshare.birthingforlife.com/.
    In the UK, check out http://www.ukamb.org/about.html for details about donating your milk to premature baby units in hospitals.
    Note: although a mother's milk is ideal for her own baby, extra care needs to be taken with tiny or sick babies. Milk banks don’t accept milk from women who smoke or use illegal drugs and all potential donors have to be tested for infections that may be passed on through the milk. In addition you cannot donate breastmilk if you have received a blood transfusion since 1980. These are sometimes less restrictions if you donate your milk privately.

     

    PART 4: PHYSICAL ISSUES FOR MOM

    What kind of physical problems arise during EPing? 
    Kellymom has a wealth of information on different breastfeeding related Mummy-problems;
    http://www.kellymom.com/bf/concerns/mom/index.html
    Clogs
    Clogged or plugged milk ducts are just what they sound like — ducts that have become blocked, inflamed, and sore. They are caucsed by the milk failing to drain properly and
    the first sign of a plugged duct may be a small, hard lump that's sore to the touch, or a very tender spot in your breast. Some women also notice redness on their breast. You might also feel achy, run down, and feverish, which could be a sign that your clogged duct has become infected.
    Tips for getting rid of clogs…
    Pump, pump, pump! (Or, if you’re baby will do it, get them to nurse)
    Try the “comb trick”. Running a comb down you boob as firmly as you can take.
    Take lots of hot showers and apply warm compresses before pumping.
    Some ladies have reported that adding a little more salt into their diet helps with clogs.
    If you are prone to recurrent clogs, you can try taking Lecithin, which is a food supplement that seems to help some mothers prevent blocked ducts. It may do this by decreasing the viscosity (stickiness) of the milk. You should be able to find Lecithin in places like health food shops - try a dose of 1200 mg four times a day.
    Also, if you keep getting clogs, check you have the right sized horns and a properly fitting nursing bra – otherwise it could be these that are contributing to your problem.
    Mastitis
    Mastitis is a condition that causes the breast tissue to become inflamed. Mastitis usually affects only one breast, causing it to become painful, red and swollen. Some women may also experience flu-like symptoms, which can include fever, chills or aches. There are two main types of mastitis:
    • Non-infectious mastitis, which is typically caused by breast milk remaining within the breast tissue (milk stasis), and is due to a blocked milk duct or problems with breastfeeding, and
    • Infectious mastitis, which is caused by bacteria.
    Left untreated, non-infectious mastitis can progress to infectious mastitis. This may be due to bacteria infecting the milk that remains in the breast tissue.
    Infectious mastitis requires prompt treatment in order to prevent more serious complications such as an abscess in the breast.
    More information on clogged ducts and mastitis
    http://www.drjacknewman.com/help/Blocked%20Ducts%20&%20Mastitis.asp

    Thrush
    Yeast infections, or thrush, are quite common in breastfeeding women. If you have thrush, you may experience;
    • A burning pain in your nipples and possibly deeper into the breast
    • Redness and shininess of the nipple
    • Itchiness
    • Cracked nipples that won’t heal
    If you have thrush, it can be transferred to your baby through the breast milk. Symptoms in your LO, include;
    • Pulling and fidgeting while feeding, latching on and off the breast frequently.
    • White patches in the mouth that cannot be wiped off.
    • A red-raw nappy rash.
    • Being more windy than usual, and difficult to settle
    If you think you have thrush, you should see your doctor. Gentian violet is a good first course of action, but depending on the severity of the infection you may need to start oral medications as well.
    If you do have thrush, you should;
    • Change breast pads frequently
    • Wash your bras daily in hot water
    • Sterilize your pump kit, collection bottle and feeding bottles after every use
    • Don’t use any products that keep your nipples moist, as this can encourage yeast to grow.
    • It is fine to feed your baby expressed milk While you have thrust, however, it is advised not to freeze it for later use (or if you do, mark it and use it mixed with non-thrush milk)
    Blood In Milk
    Blood in your breast milk can be pretty scary if it happens. There are a number of possible reasons for it, but it is fine for you to feed your baby “bloody milk”. The following link has some useful information on possible causes of blood in your milk.
    http://www.loveyourbaby.com/blood-in-breast-milk.html

    General nipple pain
    If not caused by one of the above, you can still have general nipple pain. Try the following;
    • Turn down the suction on your pump
    • Make sure you have properly fitting horns
    • Use a lubricating product such as olive oil or lanolin before you pump

    Other sources of pain can be Reynauld’s phenomenon and eczema, but these are worth checking out with your doctor!

    In general, to take good care of your nipples you should;
    • Change breast pads regularly
    • Wash your clothes in mild detergent
    • Wash bras regularly
    • Don’t use soap on your nipples
    • Allow your nipples to air dry
    • Leave some BM on your nipples after pumping

    PART 5: DROPPING PUMPS

    Q:  How do I go about dropping pumps?
    A: Once you’ve hit the 12 week mark, it is generally safe to start dropping pumps. You can drop pumps earlier (some women do drop to 6 or 7 pumps before the end of the 12 week marker, but you should beware of dropping to many pumps early on!)

    When deciding which pumping sessions to drop, you need to think about both your supply, your schedule and your sanity! Also, you need to remember the 120minute guideline – dropping pumps doesn’t mean less time on the pump, it means less frequent pumping, but for longer each time!
    Most women drop the night pump first, but if you’re having problems with supply, it help to keep it in, since that’s still when prolactin levels are highest…
    When you drop a pump, you may see an increase in supply, a decrease, or no difference – again, every woman is different! It is likely that, if you have a large storiage capacity (i.e. big boobs), you might see a slight increase when you drop early pumps – since you have longer to produce the milk (your breasts are continually producing milk!)
    I’ve given some example schedules, but you need to think what works for you! E.g. are you a SAHM? Do you work, but have your own space in which it’s easy to pump? Or do you work, but really struggle to pump at work?
    There are a couple of ways to drop pumps:
    1) Drop ‘cold turkey’. You just cut out the pump you want to drop. You may well then re-space the other pumps a bit. This seems to work well in the early days (e.g. when dropping from 8 to 7 pumps)
    e.g.1
    Want to drop the 3am pump, so have longer for sleeping…
    Old Schedule (8x): 6am, 9am, 12noon, 3pm, 6pm, 9pm, Midnight, 3am
    New Schedule (7x): 5am, 8:30am, 12noon, 3pm. 6pm. 9pm, Midnight
    Note: Early on, it is advisable not to go more than 6 hours without pumping, so it might be best to bring your first pump of the morning slightly earlier, once you drop that middle-of-the-night sessions.
    e.g.2
    Want to drop another pump, and would like a bit more freedom during the day and maybe a bit more sleep. So drop the 3pm pump, but respace daytime pumps.
    Old Schedule (7x): 5am, 8:30am, 12noon, 3pm. 6pm. 9pm, Midnight
    New Schedule (6x): 5am, 8:30am, 12:30pm, 4:30pm, 8:00pm, 11pm
    One you’re at less than, say 4 or 5 pumps, or if you’re prone to clogs or mastitis, you probably won’t want to try just dropping cold turkey. In this case, there are two different ways to drop pumps.
    2. Dropping pumps by reducing the time
    Keep all your pumps at the same time, but slowly reduce the amount of time you are pumping at the session you want to drop.
    e.g. Old Schedule (4x): 6am (40 minutes), 11am (40minutes), 4:30pm (40minutes), 10pm (40 minutes)
    Want to drop the 4:30pm pump… So every couple of days, reduce it by a few minutes.
    Day 1 and 2 of dropping: 6am (40 minutes), 11am (40minutes), 4:30pm (35minutes), 10pm (40 minutes)
    Day 3 and 4 of dropping: 6am (40 minutes), 11am (40minutes), 4:30pm (30minutes), 10pm (40 minutes)
    How quickly you can reduce the time, depends on you! If you start feeling uncomfortable or are getting clogs, stick at that time for a while and don’t drop any further until you’ve got rid of them!
    Once you’ve got down to, say 15 minutes, you can probably drop the pump and then, if necessary, re-space the other pumps.
    3. Dropping pumps by bringing closer
    The other way to drop pumps is to gradually bring two sessions closer together.
    e.g. Old Schedule (4x): 6am, 11am, 4:30pm, 10pm
    Want to drop to 3 pumps, by dropping the 4:30pm pump
    Day 1 and 2: 6am, 11am, 4:00pm, 10pm
    Day 3 and 4: 6am, 11:30am, 4:00pm, 10pm
    Day 5 and 6: 6am, 11:30am, 3:30pm, 10pm
    Day 7 and 8: 6am, 12noon, 3:30pm, 10pm
    Continue, until they’re close enough together that you can just drop one of them comfortably!
    Remember: When dropping pumps, add extra time to the other pumps. You should be pumping for at least 120minutes per 24 hours

    PART 6:  PUMPING WHILE ON THE GO
    Pumping While driving
    Many ladies find pumping While driving an excellent way to get in an extra pump or two – especially if you have a long drive to work.
    Here are some top tips for pumping While driving. You can buY an in-car adapter for many pumps or you can use a battery pack!
    1) Put pump in front seat next to you, plug it in, put the olive oil on the parts and get everything ready to go (including putting a spare bottle in the cup holder with the lids).

    2) Put handsfree bra on and pull it up and into position.

    3) Cover yourself up with e.g. a hooter hider, a big t-shirt, a skirt etc.

    4) Put seat belt on. Tuck lap part under the bottles and put the shoulder part through the middle of chest.

    5) Drive.......until the bottle fills up. Once you get used to your driving and pumping and how fast you empty, you will know when to check the bottle.

    6) Stop and unhook, or just turn the pump off and wait until you arrive at your destination.

    Pumping and Flying
    Here is the TSA website for rules about flying with breastmilk (for USA):
    http://www.tsa.gov/travelers/airtravel/children/formula.shtm
    It helps to print this out and bring it, in case you encounter a screener not up on the "new" rules. Also, always tell screener you have milk/pump before going through - saves a lot of hassle! Although they "prefer" you not to bring a ton of milk in your carry-on, there is no limit.
    You can take your pump on the flight and it doesn't count towards your carry-on limit because it (and the expressed milk) are considered medical supplies. You can pump on the plane, although you may want to warn the Flight Attendant what you’re doing. Many women recommend getting a Hooter Hider or similar (you could just use a blanket), so you can do it with a bit of privacy.
    Once abroad, Medela have adaptors that you can buy from them for different countries. They recommended not using a generic one, but rather the medala. You can do batteries too, but that is a lot of batteries if you will be gone a week or more.

    General Tips for Pumping and Traveling
    If you’re not sure whether you’re going to get to a sink easily, you can buy special Breastpump and Accessory wipes from Medela.
    You can also by bags for steam-sterilising in a microwave from both Medela and Lindam.
    Many hotel rooms will have a fridge that you can store your BM in – otherwise ask for an ice bucket.

    PART 7:  NOT GOING NUTS AND DEALING WITH OTHERS WHO THINK YOU ARE NUTS

    This is a really good article on supporting EPing Mummies… Maybe worth printing off and giving to partners, colleagues and not-so-good LCs!;
    http://www.exclusivelypumping.com/2007/11/30/supporting-an-exclusively-pumping-mother/#more-8

    To preserve your sanity, remember that the most important thing is number of pumps in a day.  Some can be closer together or further apart.  You need to have a life too!  Whenever possible, try using pump time as “me time”—read a book or magazine, surf the web, watch tv.  Also, breastmilk is great for your baby, but your baby needs a happy and sane mother too.  Do what you have to do to stay sane!   Any milk your baby is getting is better than none, so don’t feel guilty about supplementing.  You are doing the best you can—most people don’t make it as far as you have! 

    PART 8: PUMPING AND WEIGHT LOSS

    Breast milk is ~ 20 calories per oz.
    Need to lose weight slowly to maintain supply - some moms have to carry a few extra lbs. until they wean to keep up their supply - for anyone, no crash diets! WW and other programs have different "rules" for BF moms (no expert on this myself, but have seen it in other posts - maybe someone with more direct knowledge can chime in).
    Moderate exercise OK if you keep hydrated - strenuous exercise will tend to lower supply.
    Pump before doing really "active" exercise or sports that will bounce the girls around (running, aerobics, basketball, etc) and wear a very supportive sports bra - strenuous exercise when your boobs are full or without enough support can increase your chance of mastitis! http://life.familyeducation.com/nursing/postpartum/36048.html?page=3

    PART 9: WEANING FROM THE PUMP
    Q: How do I start weaning from the pump?

    A Weaning from pumping is best done slowly. This allows milk supply to decrease slowly, without fullness or discomfort. In many ways, you can approach it in the same way as dropping a pump, and you can use a variety of methods (pick which one works for you)
    1) You can continue to drop pumps slowly, until you are down to one or two pumps a day. If you are still on a lot of pumps per day, this may be for you! Also, if you are weaning because you are fed up with pumping and/or don’t feel you have enough time, weaning by dropping pumps may mean you suddenly find a place you are comfortable with and want to carry on pumping for a while longer… If you have been a long term pumper, you are likely to have done this anyway. Once you have dropped to one, two or maybe three pumps a day, you may well move onto one of the other two methods.
    2) Try decreasing all your pumping sessions by two minutes every other day. For example, if you normally pump for 20 minutes at each nursing session, then on days 1 and 2 pump for 18 minutes, on days 3 and 4 pump for 16 minutes, etc. You may find that you can pick up the speed slightly, or you may need to go slower than this. Let your comfort be your guide!
    3) Instead of keeping pumping sessions at their regular times, gradually lengthen the amount of time between sessions. As usual, let your comfort be your guide. This will gradually decrease the number of pumping sessions.
    e.g. If you normally pump every 3 hours, try pumping every 3.5 hours the first couple of days, then every 4 hours the next few days, etc. You can also gradually decrease the duration of pumping sessions as you feel comfortable doing so.
    e.g. If you are down to just one pump a day, say at 6am. Slowly move it every couple of days. So Days 1 and 2, pump at 7am, days 3 and 4 pump at 8am etc…
    Which method you choose to wean, will probably depend on whether you work and how busy your daytime schedule is. For instance, if you have set times you are able to pump at work, you will probably want to just reduce the amount of time of each pump. Whereas if you have a fairly relaxed schedule, it might be easier to lengthen the amount of time between pumps.
    Once you are approaching the end, you may find that you can just get by pumping for comfort, or even just hard expressing a bit in the shower!


    There are a few things that can be used to help the weaning process, most notably cabbage leaves in your bra! Have a look under the section on too much milk, for more ideas!
    It's not unusual to feel tearful, sad or depressed both during and after weaning. These feelings should be short-term and are partly caused by hormonal changes. One of the changes that occurs with weaning is a drop in prolactin levels. Prolactin, the hormone that stimulates milk production, also brings with it a feeling of well-being, calmness and relaxation. The faster the weaning process the more abrupt the shift in hormone levels, and the more likely that you will experience adverse effects. Even if you feel entirely ready to wean, you may well feel some sense of loss and sadness. You may feel bad for not giving your LO that golden nectar that is breastmilk and you are bound to feel sad and maybe even a bit guilty, the first time they get ill after they’ve moved on from breastmilk. This is all entirely normal and remember that the ladies on the EPing board are there for you throughout the weaning process!

    PART 10:  THINGS THAT BOARD MEMBERS WISH THEY KNEW WHEN THEY STARTED PUMPING

    Comfort

    *lubricate horns with olive oil

    *I wish I had known I might have to play around with horn size and to just use what is comfortable, not what the guidelines say I "should" be using.

    *-Higher suction does not always mean more output. I never take mine off low.

     

    Time/Sanity Savers

    *rinse and refrigerate pump parts instead of always washing them

    *Watch Netflix movies on computer while pumping

     

    Health

    *Put rubbing alcohol on any cracks or blisters

    *I wish I had known that mastitis can occur without the fever and flu-like symptoms every resource tells you you will have. I had a bad clog over a month ago that was probably mastitis, which has now developed into a full blown abscess. Get any and all clogs checked by a doctor if they don't resolve after a few days, and get on antibiotics asap!

     

    Supply

    *I just wish I had known how important it was to establish my supply in the first 12 weeks. I didn't find this board my first time around until 3 months pp, and the lactation consultants that helped me, while they were knowledgeable about bfing, gave me erroneous advice about how often and how long to pump.

    *Pump 8- 12 times a day regardless of what I'm getting.. to establish supply for 12 weeks.. I started that way too late. I only found the board at 3 months..

     

    Storage

    *I wish I had known to use Lansinoh storage bags and not the ridiculously expensive Medela ones. I also wish I had known about Amazon.com and the subscribe and save feature where I can get 75 bags for $12 and free shipping!

    * I wish I knew about the playtex breast milk storage kit, because it made my life a million times easier than washing the medela bottles every time I pumped! I had to buy 2 packages though.

     

     

    13. General resources

    Books:
    http://www.exclusivelypumping.com/about-the-book/

     

     

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