Episode 64      Tips and Tricks to Make pumping as easy and convenient as possible

I am Lori Jill Isenstadt, IBCLC your host of All About Breastfeeding, the place where the girls hang out. I am just coming off a fabulous weekend where my family and I traveled to DM, I a TO CHEER on my son Jesse and his peers as they walked across the podium to collect their certificates after 4 long and hard years of medical school. It was so cool and quite surreal as we heard them call out Dr. Jesse Isenstadt. Could that really be my son? I know many of you listening to the show are pregnant, about to have a baby and some of you have newborns and small children. In the depths of the newness of it all, of feelig overwhelmed and sleep drprived, I know it can be very hard to imagine you precious baby, all grown up and adult in their own right. For the longest time, I couldn’t either. I think I began accepting the fact that one day my kids were all going to be adults, by the time they graduated HS! Yeah, I know.. I am slow.. it takes me time to adjust…. I don’t like change.. even when it is a good change….I stay too long in the place of….. ohhhhh my baby! You must be saying: her poor kids, right about now. I get it. But just you wait and see! Your time will come soon enough. As I watched Jesse walk across the stage in his cap and gown, I was very sentimental yes, and all the years I spent cuddling with him as a newborn baby and infant came flooding back. I also had feelings of deep pride and joy in the man he has become and the journey he has ahead of him as he continues to follow his bliss and practice medicine, something that gives him much satisfaction and happiness.

Okay, enough of all my sentimentalism… I am here for you today, talking about your return to work, and giving you the best information I have about how to prepare yourself for this next phase. On any given day, in my daily work with mothers, I am asked some of the same questions over and over again. Mothers express a fair degree of anxiety over getting ready to pump and store their milk as their thoughts begin to focus on their return to work.

This is a continuation of my Part 5 Series. My goal is to do the absolute best I can to help make the transition from staying at home with your new baby and now preparing to return to work. The ideal situation is for you to have enough milk stored away for your first day back at work and for your baby to comfortably be taking the bottle. My challenge is to streamline this information so that you have enough to get you started and yet not overwhelm you with this task. I felt the best way to get in all the good need to know info was to break it up into doable chunks. This gives you time to absorb the information, download all the handouts and checklists I am giving you, and put your plan into action. My goal is for you to have this information in plenty of time before returning to work as this will help to reduce any stress or anxiety you might feel about preparing your return to work.

I started with Episode # 62, which I titled: Just Lori – Preparing to Return to Work. I tried to make it fun and added Sirens to the show! Hope you enjoyed my humor! Here is my quick synopsis of Part 1:
The calendar says it is time to get busy – What you need to know to get started pumping and storing your milk.
I laid out a whole plan of how you figure out when you should start pumping, how often you should be pumping, how do you know how much you need to collect and some storage ideas.

Today, we are going to go into more details about pumping and storing and defrosting.
Human milk is a fresh, living substance—not just a ready-to-use food. When you make the effort to provide expressed milk for your baby, you are ensuring that your baby continues to receive ideal nourishment and protection against many diseases. Human milk’s anti-bacterial properties actually help it stay fresh. The live cells and antibodies in the milk that discourage the growth of bad bacteria in your baby’s intestines also guard against bacterial growth when the milk is stored in a container. The interpretation of research on human milk storage varies widely which is why when you ask 10 different people about storage guidelines – What are safe methods and temperatures for storing and defrosting and warmiing, you may get 5 different responses. Let’s not get too hung up on the storage temperature information yet.

Without getting yourself too crazy, some things just need some good old fashioned common sense. Clean hands before hand expressing. Clean all bottles and parts according to the manufacturers guidelines before storing milk in the various containers. Don’t worry too much about what nutrients might be lost in the process of pumping, refrigerating, freezing, defrosting and warming. Yes, the nutritional value is less than if your baby directly breastfed. However, the loss is minimal compared to the alternative. Your milk has several hundred ingredients. Most formulas have less than 50. So you see why I say don’t sweat the loss of a few ingredients. Sometimes we get so bogged down in the details it prevents us from moving forward. Let’s not get too crazy about what kind of containers you store your milk in or if you should swirl or shake before serving. Use clean containers, keep your hands clean, and store in smaller rather than larger increments so you waste the least amount of milk. In todays show we are going to talk about the different ways to express your milk, how you can do this most comfortably and conveniently, what storage containers should you use, storage tips and so much more. At the end, I will wrap up what we have learned and also share with you the handouts and checklists that I am giving you to make this whole process easy and convenient for you. So, let’s get started with Part 2 of 5 shows on pumping and returning to work.

We are first going to take a look at the different pumps you can use to remove the milk.
You have quite a few Choices for removing the milk efficiently & frequently & comfortably. My first piece of advise with this whole topic actually is: KISS – Keep it simple silly. Try hard not to get lost in all the “shiny white objects.” you see displayed on store shelves and on the internet.
Mothers tell me that having too many choices is confusing and makes it take longer to make decisions.

Breast pumps:
Women use breast pumps for many reasons. Many women use breast pumps to remove the milk and keep up with their supply, after they return to work. They use the pump to express breast milk, which is later bottle fed or cup fed to their baby by a caregiver.. However, it is important to note that the amount of milk a woman is able to pump should not be compared to how much milk a baby can get; efficiency greatly varies. As long as you can collect enough milk that your baby will take each feeding, you are doing fine.

Hospital Grade
There are two popular types of electric breast pumps, hospital grade and personal use pumps. Hospital grade pumps are larger and intended for multiple users. Hospital grade pumps are typically rented out as their expense is quite high. They are typically recommended for mothers and babies with medical problems such as premature baby or baby is not able to breastfeed well and build and maintain a good supply, or mom is struggling with chronic breastfeeding issues, perhaps her supply is low or the personal use pumps cause her pain. Typically the hospital grade pumps can fully replace a baby at the breast, if need be. The motor on these pumps can be effective for thousand hours or more compared to the personal use pump of lasting perhaps a few hundred.

Personal use:
Personal use pumps are smaller and generally intended for one user. Electric breast pumps are powered by a motor which supplies suction through plastic tubing to a piece that fits over the nipple. This piece is called by several names – a flange, a horn, a shield are the most common terms.

The portions of the pump that come into direct contact with the expressed milk must be cleaned after each use to prevent contamination. This style provides a lot more suction, making pumping significantly faster, and allows pumping of both breasts at the same time. Electric breast pumps are ideal for when a mother will be pumping daily. Electric breast pumps are larger than manual ones, but portable models are available (e.g. in a backpack or shoulder bag) that allow the mother to transport the pump. Some manufacturers have battery packs or built in batteries to allow portable operation of the pumps.

Single side electric:
Electric pump that can express milk from just one side at a time. If you need to remove milk from both sides in order to collect enough for one bottles worth, this will take you twice as long as using the double pump. These are less than the double electric pumps, which tend to be in the 2-300 range. Single side electric pumps are usually in the low 100’s

Manual:
This will take you twice the time and you will not be able to just hold the bottle and flange in place and let the motor do its job. The manual pump requires that you control the trigger or the piston activity, so you are busy the whole time you are removing the milk. For mothers who want and need the convenience of the double electric pump, I often suggest they purchase a manual one to keep in their diaper bags in the event their pump breaks, they forget parts, they have no electricity. These pumps are the cheapest, usually costing under $50.00

Hand Expression:
And lastly, we have the good ole fashioned way of removing the milk: Your hands. Hand expression is the oldest and cheapest and for some moms, the most productive way to remove the milk. It is kind of funny when I talk to some moms about hand expression. They are like: Ewww, I don’t want to do that. They feel weird about touching and squeezing their breasts in such a way. Some ladies just don’t pay their breasts much attention before giving birth. They have not taken the time to really look at their nipples, the size, whether they are inverted or everted or flat. They may know what bra and cup size they are, but other than that, don’t give it much thought. And then here I come along wanted them to massage their breasts and hand express milk out.

I love talking about it though and I can usually get a mom to at last give it a try. Once they do, and see milk spraying out and how they can control it, they are in the game! Perhaps not all are wanting to hand express, but at least they don’t think it is too weird anymore.

In the very early days of breastfeeding, there is actually lots of good reason to remove the milk via hand expression over electric pump, if you are having any breastfeeding challenges. I will save these details for another show. For now, all you need to know about hand expression is that you need your hand, knowledge about how to hand express and a cup or bottle or bowl to express into.

I am getting a little ahead of myself today by telling you all about the breast bowl. I am a few shows away from releasing my interview with, Mel, who is the creator of the breast bowl, which are absolutely beautiful glass bowls that you can express your milk into.

Breastbowl™ is specifically designed for hand expression of breast milk. It is elegant, discrete, ergonomic, safe, clean and unique. Each breastbowl is hand-made in Canada, with love, by Mel.

Please, please, please do not quit breastfeeding because your pump is killing you. You do have alternatives. Pumping should not hurt you. It should be quite comfortable. It is so important to know this as I know enough moms who have quit breastfeeding and pumping because pumping was like H blank double LL for them. They think this is the way it has to be and they just can’t handle the pain anymore so they quite. Now, I totally don’t blame a mom for quitting when she is in a high level of pain. I just know that it does not have to be this way. If pumping is hurting you and you just grin and bear it, this may mean long term nipple or breast damage. This may mean less milk collected. Need to relax and let oxytocin flow, which is difficult if you are tense and looking at the clock. I like to check:
1. Check flange for size and fit for optimal comfort.

2. Use of the pump – perhaps suction is too high or the speed can be adjusted for comfort.

3. Placing and holding the flanges correctly.

4. The Perfect Latch – Nipple cushion for pumping comfort

2. Milk storage choices:
You have choices in this area also and what you wind up using will be based on individual preference. When it comes to storing your milk, unless you have a sick or premature baby, I am of the mindset to KISS. Keep is Simple Silly. I like for parents to just remember the number “6”
a. You can choose to store you freshly pumped milk on the counter, ( average room temp. not above 80 degrees) if you use it within 6 hours of pumping it.

b. You can choose to store your milk in the refridgerator if you are going to use it within 6 days of pumping it.

c. You can also choose to freeze your milk, in which case, it is okay for a good 6 months in a side by side or deep freezer.

d. You can take freshly pumped milk, put it in the fridge and when it comes to the same temperature as previously pumped milk you put in the friedge, you can then combine them.

You also have choices as to which containers to express your milk into:

Bags:
You will want to use breastmilk plastic bags made just for this use. The pros of these are the convenience to pump into, you don’t reuse them so no washing, and you can lay them flat so you have lots more storage space. The cons to this are they are expensive, rather wasteful because you use once and then throw them away & they still have the potential to leak or tear. You can reduce the loss of milk if the bag tears or leaks by placing several frozen filled bags into one larger plastic container, which will capture the milk if it should spill.

Bottles:

Hard sided containers that are glass or plastic are good containers to use and you buy them once and use them many, many times. Often the whole time you are pumping. So a lot less waste happens with these. The negative side is that they are not space friendly as they take up a lot of room in your freezer.

There has been some research done on the loss of fat when milk is stored in different containers. Here also, I would not sweat it. Choose a container that works best for you. The research I have read states that there is minimal difference between containers. Again, here, don’t over think it.

Ice cube trays:
Ice cube trays are great to freeze milk in. Measure how much each cube is and then when you go to defrost, you will know how many cubes you need for a bottle. There is a product called Milk Trays that freezes your milk in 1 ounce sticks and these easily fit into the mouth of bottles. Do you have to use these? Of course not. It is easy and convenient and quicker to defrost.

This is not an area that you want to play around with too much. Use good quality bottles and bags and don’t chintz on cheap bags that might not stand the test of time. They may leak when in freezer or fall apart when you go to defrost or heat up the milk. Sooo, not worth it.

Don’t fill bags up to the top for several reasons: First one is that until you know how much your baby will probably take, you don’t want to fill up bags and then have waste.= and thawing is quicker. There is no worse sight to a pumping mom who realizes her milk has leaked out of bags that she has pumped.

You also don’t want to fill up to the top because you need to leave just a bit of room for expansion. Put between 2 and 3 oz in each bag, squeeze the air out and then close. If you are freezing in bottles, leave the cap loose before freezing. Once frozen then tighten the lid.

We have now covered the different kind of ways to remove the milk – pumps and had expression. We have covered what containers to collect the milk in and basic storage guidelines.

Let’s talk about the common ways to defrost your milk:
1. To thaw milk • 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.

2. For quicker thawing, hold container under running water – start cool and gradually increase temperature. Previously frozen milk may be kept in the refrigerator for up to 24 hours after it has finished thawing.

3. To warm milk • Heat water in a cup or other small container, then place frozen milk in the water to warm; or • Use a bottle warmer

4. The cream will rise to the top of the milk during storage. Gently swirl milk (do not shake) to mix before checking temperature and offering to baby. If baby does not finish milk at one feeding, it is probably safe to refrigerate and offer within 1-2 hours before it is discarded.

5. Use the oldest milk in the refrigerator or freezer first.

6. The baby may drink the milk cool, at room temperature, or warmed. Infants may demonstrate a preference.

7. It is best to defrost human milk either in the refrigerator overnight, by running under warm water, or setting it in a container of warm water. Studies done on defrosting human milk in a microwave demonstrate that controlling the temperature in a microwave is difficult, causing the milk to heat unevenly.

Do not let milk sit out at room temperature and thaw. Do not refreeze thawed milk. Do not use a microwave to heat the milk. Just like you notice when you microwave food If milk is not drank all up, put in friedge and use for next feeding. If not use then, throw away the milk. These suggestions are again for full term, healthy babies.

Next up: Convenience with using a Hands Free Bra:

1. Hands down the Hands Free Bras are a MUST for moms who are breastpumping more than once a day! it is the ultimate in multi-tasking.

2. These are special bras that you wear that will hold the flanges and bottles in place so as the milk is being expressed, it will flow into the bottles and you don’t have to hold them in place as the bra is holding them in place. What does this mean to you: Freeedom!

3. You can cover the flanges with your babies blanket and not have to stare at the milk being expressed into the bottle. If the volume is not what you expect, or the let down does not happen as fast, moms tend to get tense and this can affect your overall output.

4. You can be listening to music, listening to this podcast.

5. You can be on facebook, or charting/doing some paperwork.

6. You can listen to tapes or do your own private affirmations or meditation while pumping, which can be quite relaxing.

Okay, now we come to my favorite part of this subject. All the little tips and tricks that may not be written in books, but can make your life easier when you are a pumping mom.
1. The refrigerator trick. This is where you rinse your horns and/or collection bottles after each pumping session. You put them in a ziplock bag (or not, this is optional), and put them in the refrigerator. The idea is that since breast milk is good in the fridge for 5-8 days, any residue left on the flanges won’t matter. Then you can wash the parts once at night. I throw mine into the dishwasher (all except the white membranes) and it’s easy, easy, easy!”

2. Nipple Comfort:
To help keep your nipples comfortable. Rub olive oil or coconut oil on the inside of the flange before pumping. This helps to reduce friction. Some moms like using these oils before and they hand express also as it helps keeps the nipple tissue from getting chafed.
3. Milk transfer:
Jessica Shortall from Episode # 20, who wrote Work. Pump. Repeat. who wrote gave me this tip during our interview: Use flanges as a funnel to transfer/pour milk from the pumped container to the storage container.

4. Ultimate in Multi-tasking:
Use hands free bra so you can take pump in car with you and pump while traveling. Even if you are the one driving, all you need to do is set up the pump and turn it on and away you go. to and from office/errands,

5. Also allows you to take care of baby while pumping.

6. The assumption is that your baby will only drink milk that has been warmed up. I encourage you to experiment with your baby at different times. Some babies actually do better and even prefer milk slightly chilled. If your baby does, then this relieves you of spending the time warming the milk.

7. Nancy’s book and interview – Episode #34 where we go into detail about pumping frequency, breastmilk storage and a phrase that Nancy has coined “what is your magic number. Don’t know what I am talking about. Listen to that show and you will learn more details about this. For now though, there are 2 things for you to think about. Your breast storage capacity and your magic number. Because this is different for every mom, the general advise you are given about pumping and milk volume can differ for each mother. If what you are doing is not working well for you, dive deeper into learning about your individual magic number. A link to her show will also be in the show notes.

8. Magic Number: This refers to the number of times each day a mother’s breasts need to be well drained of milk to keep her milk production stable. Due to differences in breast storage capacity, some mothers’ “magic number” may be as few as 4-5 or as many as 9-10. But when a mother’s total number of breast drainings (breastfeedings plus milk expressions) dips below her “magic number,” her milk production slows.

9. Breast storage capacity. This is the amount of milk in a woman’s breasts when they are at their fullest each day and this amount can vary greatly among mothers.

My Wrap Up for this show:

So we have now talked about breastmilk storage guidelines and defrosting and warming guidelines. And I have given you some really cool tips & tricks that you don’t typically see much written about:

Pumping while driving, using flanges as funnels, learning your storage capacity and magic number, the refrigerator trick. You have learned here about 2 things you may never have heard about before. The Perfect Latch the nipple cushion that moves with your nipples for a much smoother ride and the breast bowls that you can hand express into. Be sure to check out the show notes as it will have quite a few links that we have talked about during this show

Just go to allaboutbreastfeeding.biz/podcast and go to show # 64.
If you found this information helpful, please share it with a friend or two who can use this knowledge.

I spend a lot of time during my private consults talking about this very topic, so this show is chock full of information and the beauty of podcasting is that you can listen to this show again to pick up tips you may have forgotten or did not hear the first time.

I am always learning from moms who are in the trenches. If you have some tips and tricks of your own that you would like to share, just send them my way and I will add your info when I update the info on this show. Head on over to allaboutbreastfeeding.biz/contact and put tips and tricks in the subject line. And don’t forget, Part 5 of 5 is where I am going to be answering all your questions. I have been playing around with Facebook Live, so I might just do something like that. Take your questions and answer them Live and you can watch Live or the recorded version

Contact info: allaboutbreastfeeding.biz/contact ,

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