Realistic Expectations for Pumping
By Ali Weatherford
The physiology of lactation is fascinating. Most people don’t know that their body is capable of providing milk early in the second trimester of pregnancy, once all of the hormones have done their work and the breast hardware has been developed. That’s called Lactogenesis I, and that means that if a baby is born prematurely, you can still be ready to make milk. But then there’s another level which starts at birth.
Lactogenesis II
After the baby is born, the placenta will detach and follow the baby out just a little while later. On average, that can take 5-30 minutes, although it can be longer in expectantly managed third stage labors. Actively managed placenta births are standard in most birth settings. That means that a patient is given an injection or IV dose of oxytocin to encourage the delivery of the placenta instead of waiting for it to come out on its own. The birth of the placenta triggers a big hormonal change which initiates Lactogenesis II. It basically tells your body, “OK, pregnancy mode is over, time to shift into milk-making mode.”
The First Few Days
Once your body experiences Lactogenesis II, you are capable of providing more milk to your baby. In the first few days, your baby doesn’t need, and can’t handle much, so you make small amounts. That small amount of milk is very concentrated and specialized though. It’s called colostrum, and it does so many things.
- Supports your baby’s immune function.
- Acts as a laxative to help your baby clear meconium and excess bilirubin to prevent jaundice.
- Provides the right concentrations of nutrients for the early days of life.
During this time, you won’t likely notice any increased fullness in your breasts, leaking milk, or that your baby is taking big swallows of milk. If you try to pump during this time, you’ll likely be very disappointed. You might only get 5 ml or .2 oz of milk per pumping session. Colostrum is produced in very small amounts, and it’s thicker than mature milk. A lot of it will end up as residue in the pump hoses and parts rather than in a bottle. If you need to express milk for your baby in the first few days, hand expression is usually a much more effective way to get it.
The Next Few Days
As long as everything is progressing normally and your baby is spending plenty of time at the breast, there will be a shift around day 3 postpartum. This is the progression of Lactogenesis II. Regular breast stimulation and milk removal, a great latch, and lots of skin-to-skin contact with your baby will trigger the breasts to increase the milk supply. The milk will be less thick, but much more plentiful. The balance of nutrients will change to be more appropriate for your growing baby. You might notice a lot more fullness in the breasts and could even experience engorgement. You might start leaking milk and need to start wearing breast pads to avoid soaking through all of your shirts. I leaked so much that I had to wear layers of breast pads when I went out in public to avoid having embarrassing milk spots on my breasts, but not everyone leaks that much. If you’re not leaking much, it doesn’t necessarily mean you don’t have enough milk. Some people just don’t leak. If you pump, you might still not get very much. It can range, but a normal amount might only be 15 ml or .5 oz per pumping session.
Do You Have to Start Pumping Now?
At this point in your transition, you can probably get a reasonable amount of milk when pumping. However, it’s not necessarily recommended that you start pumping right away. If you don’t need to make bottles right away, pumping can wait. It’s best to let your baby get really good at breastfeeding before introducing a bottle so your baby is less likely to develop a flow preference. And it also might be a better option to wait on pumping to help you as you’re getting a good milk supply established.
If You Need to Start Pumping Now
If you’re planning to pump exclusively, or have a need to make bottles because you’ll be separated from your baby, then pumping now is a great idea. It’s usually best to mimic your baby’s normal feeding routines. Pumping much more than your baby would be at the breast, could lead to an oversupply issue, so you might start out just pumping once a day if you’re also breastfeeding. If you’re not doing any direct breastfeeding, make sure to pump as often as your baby would be feeding from the breast. If you pump less than that, it could cause a low milk supply problem.
Also remember that it’s normal to only pump very small amounts. What you get from a pump is not necessarily indicative of how much you are making or how much a baby gets at the breast. A baby tends to be a lot more effective at removing milk than a pump.
Storing Pumped Milk
Some people feel anxious about needing to pump because they see images and videos of people stockpiling huge amounts of pumped milk in their freezers. This is not a reality for most people, and not necessary. Even if you know you’ll need to go back to work at some point, and you want to have some milk stored, remember that you can wait.
If you want to continue providing breast milk, you’ll have to pump at work. What do you plan to do with that milk? Feed it to your baby! So you’ll be continuously replenishing your stored supply anyway. Most lactation consultants will recommend that you start pumping to store milk about a week before you plan to go back to work. That will give you a head start so you don’t have to worry about pumping exactly the right amounts for the next day. And remember that you’ll also have weekends or days off to do a little extra if you need it.
Pumping Expectations
When you start pumping, you might get a lot of milk right away, or you might not. Some people can get improvement by changing the pump flange size, pumping at a different time of day, pumping right before or right after feeding your baby, or by trying a different style of pump. It can be a great idea to visit with a lactation consultant to come up with the right pumping plan for you.
But the most important thing to keep in mind is that you shouldn’t expect to fill a bottle every time. Even though you might see videos and images on social media showing huge quantities of pumped milk, that’s not the reality for most people. It’s good to manage your expectations. Even after your mature milk comes in, you might only pump 2 oz at a time. That is a normal amount. You might do better one day, then get less the next. It’s normal for it to vary from day to day. You might also notice variations within the same day. You might get more or less at night. Some people notice an increase in the morning. Be kind to yourself, and remember that pumping tends to work better when you are relaxed, and especially when you are letting the oxytocin flow. So have lots of snuggle time and skin-to-skin contact. And sign up for our virtual pumping class! You’ll get lots of great tips and individualized advice.
References
Lactogenesis: The Transition from Pregnancy to Lactation – ScienceDirect
