Go read the Disclaimer again. I am not a doctor. This is not medical advice. Seriously.
I planned to breastfeed my baby, and I knew, because of my financial circumstances, that I did not have to be separated from my baby for long periods of time, so I did not need to plan to pump significant amounts of milk. When I was researching breastfeeding before I had my baby (a very limited activity compared to what I did after I had my baby), I noticed that the breastfeeding websites broke relatively cleanly into two communities: pummpers, and at-the-breast advocates. The at-the-breast advocates would occasionally pump, and they recommended the same manual pump that the pumpers recommended for occasional use: the Avent Isis. I never actually bought one, and eventually one of my sisters-in-law sent me hers, which she said she used on car trips with her son to give him something without having to stop and take him out of the bucket. A friend for whom breastfeeding did not work passed along some spare avent bottles.
At some point, while waiting in the lobby for a prenatal appointment with the midwife at the birth center, I read an article about nipple preference or nipple confusion, which I had never previously heard of. I then did a little asking around and looking around and decided that I didn't want to even risk that happening, which got me interested in early cup feeding. I discussed this all with my husband. He was very supportive, and in no way insistent on getting to feed the baby himself. When his mother visited during the first few weeks, she, also, was not insistent about anything but holding our baby, and was always willing to hand him over to feed. She had breastfed her four children, longer with each child, and wanted very much to support breastfeeding.
I did not intend to pump at all for the first couple months, to be sure that breastfeeding was well-established before complicating it, and because I was concerned about nipple confusion.
I had intended to get the pump out and learn how to use it before going to my martial arts class. However, at the time, Teddy tended to nap for the duration of the class and my commute time to and from, so there was no particular urgency. Child care was very pleasant to hang out with; I just timed my outings to be between feedings.
I first got the pump out when I was trying to fix a case of mastitis on Thanksgiving weekend. It was too complicated for me to figure out at the time, and too painful.
I next got the pump out when Teddy's nap time started shifting around. After a couple of times going to martial arts and coming home to a very cranky baby, I decided I'd better start leaving some milk. I still had no intention of using a bottle. We had successfully given Teddy milk in a small cup (initially in a medicine cup, then later in a tiny metal prep bowl), and child care was willing to play along. But before I used the pump, I made an effort to learn how to hand express. My post-partum doula had shown me how briefly, and I had not-very-good descriptions in books, but that plus some breast massage was enough to get an ounce or so to leave when I next went to class.
Based on that experience, I got the pump out, cleaned and assembled it, and started trying to figure it out. The first tries got about what I had been able to get by hand expression, but with less mess. After I found a really good description of hand expression, I had much greater success with the pump.
Why? Well, between what I knew about powered-pumps, and the gesture my sister-in-law had made when talking about using the Isis, and the design of the pump and the word pump, I had the impression that pumping was involved. It isn't, really.
Really. If you want to get milk out of a breast, you need pressure in the right place of the right kind. Once milk starts coming out, an established, very slight vacuum is enough to keep it coming out (or continued pressure in that place). So in practice, using the Isis is a matter of getting the milk flowing, depressing the handle slightly, and holding it there while the milk sprays. When the spray stops, release the handle, jiggle to make sure the milk goes down into the reservoir, and do it again. When it starts to get hard to get a spray, switch breasts.
I think that many women buy or rent a pump and do not learn hand expression, and as a result their tactics with the hand pump are a little different than mine, in that in order to get let down, they use the pump somewhat rapidly, rather than using their hands to get things started. Nothing else does a good job of explaining the sheer number of stories I have heard and read about women who got stuck in a new place without a place to pump, or where the only available place does not have an outlet and they have an electric pump (of course many of the pumps are now available in battery versions).
Here's a good guide to the kinds of pumps available. It covers every kind I've heard of and a few I had not. Notably, no mention of the possibility of hand expression.
Because I only pump occasionally, I have no particular advice for women who are going to pump for a full time job that separates them from their baby. There are a number of really excellent books about breastfeeding, many of which include information intended for this situation.
That said, it seems clear from commentary in books, on the web and in person, that women who pump all day, several days a week experience a reduction in supply through the course of the week. Frequent night time feedings (made possible by co-sleeping) and breastfeeding at the breast on evenings and weekends are the main strategy for maintaining the bond with the baby. I've run across numerous stories of women who fully intended to pump for enough feedings to return to work full time after the birth but found it impossible to maintain a supply that way. Sources of advice on the topic are starting to suggest finding child care on site or near work so the baby can be brought for at least one breastfeeding at the breast a day. I'm inclined to suspect that while a small percentage of women are physiologically, psychologically, emotionally able to pump enough to be separated from their baby for many hours a day (and motivated to do so), most women are not. Society has a strong interest in the next generation being breastfed; it will reduce many health and other costs that are not borne by the individuals alone. Hopefully, together we can find solutions that make it possible for women who cannot or do not want to be separated from their nursing babies to continue to work.
I did not initially realize how important privacy was when pumping. I did not need privacy to feed my baby, so I did not think I would need it to pump. Over time, I have become more comfortable with pumping when my husband and baby are around, so possibly privacy will become less of an issue in general. But I find I must have privacy for both hand expression and pumping, and given what women tell me in person, say in books and on the web, privacy is absolutely necessary when pumping, far more so than with breastfeeding.
Working while maintaining a breastfeeding relationship can be managed in a number of ways; pumping is currently one of the more typical ones. Advocates of pumping on-the-job emphasize that at least some women can pump and do paperwork or talk on the phone. They also note that in order to maintain a milk supply, one does have to pump about every three hours, four is pushing it, and that pumping requires a private, lockable space with an outlet, a table and, ideally, refrigeration. Again, with the advent of good, battery operated dual breastpumps, the outlet is becoming less necessary, and there are plenty of cooler bags sold to satisfy the need for refrigeration.
Breast milk is both food and medicine. Breastfeeding is a two-way feedback mechanism: the milk is customized for what the baby needs when the baby needs it, but it is limited magic. If the milk is pumped and saved, the antibodies intended for the current cold will be killed in the freezer, and probably won't be as helpful for the baby at some indefinite point in the future. Milk pumped in the first few weeks has one composition; the older baby might ideally want a different composition. Of course, even frozen milk for a baby of a different age is far, far better than formula. But because of these considerations, it is worth minimizing breast milk feeding. Pumping to help other people bond with the baby is a questionable activity. The baby has other needs that can be met; there is no need to buy with expressed milk a bond that can be created without it, particularly when feeding away from the breast might lead to problems with feeding at the breast.
Copyright 2006 by Rebecca Allen.
Created January 29, 2006 Updated March 8, 2006