Written by: Elissa Lauber on July 2, 2023
In this post I'll tell you the tips and tricks I learned about pumping breastmilk for my twins.
The first thing I want to highlight is that not everyone is able to breastfeed or pump milk for their preemie(s), and that is absolutely NORMAL. Do not feel guilty! Even 1 drop of colostrum for your baby or babies is an amazing gift. Second, there is a lot of information to know. I will do my best to share what I've learned, but I doubt I'll be able to cover everything. Let's dive in.
Pumping
As soon as your baby or babies is/are born, a lactation consultant should visit you to give you tips. To be honest, the amount of knowledge I got from one consultant to another when I was in the hospital varied a lot, so if you don't feel like a lactation consultant has been helpful, ask a nurse to recommend a different one.
Pumping: The Basics
The most important thing to do if you are committed to pumping breastmilk for your baby or babies is to start within a few hours after labor (if, of course, you are able!) or whenever you can. It was recommended that I pump every 2 hours with one 4-hour break overnight for at least the first month to establish my supply. I was given a hospital-grade pump, and told to get started.
Tip. Set a recurring alarm for yourself on your phone so that you don't miss a pumping session.
Why does staying on schedule matter? Put simply, you are trying to mimic how often a newborn baby or babies need(s) to feed.
Personal Story: My husband and I had just brought our oldest (full-term) son home from the hospital (born on Monday, discharged on Thursday), and were at his first pediatrician's appointment on Saturday. My husband and I were scared/nervous, and I was struggling to get the hang of breastfeeding. I brought this up to the pediatrician, and she immediately gave me the business card of a lactation consultant she knew. I called the lactation consultant after the pediatrician appointment, and she was able to come to our apartment that day. The lactation consultant gave me a lot of great advice, which I'll share, but one of the most important pieces of information she gave me is that when it comes to breastfeeding or pumping Demand = Supply. With most things we typically think about how Supply drives the Demand for the product, but it's the opposite with breastmilk. You must Demand your body make milk in order to create the Supply. Therefore, if you want to provide breastmilk for your baby or babies, you must be on the pump consistently.
When pumping, there are few things to remember.
1. Make sure you have the right fit
First, you want to make sure the flange fits your nipple. I recommend reviewing the sizing guide materials on the Spectra website. The information is super helpful. Typically, a standard pump kit will come with a few different flange sizes, which normally range between 24mm and 27mm. However, do not despair if this small range of sizes doesn't fit you. You can specially order flanges between 21mm and 36mm. Your best bet for finding these speciality sizes is to either search Amazon, or search directly on manufacturers' websites.
2. Make sure your parts are in working order
Second, you want to make sure all of your pumping parts are in working order. If you plan to pump breastmilk part- or full-time, you will need to check for small tears, holes, etc. in your equipment often. The Balanced Boob website has a lot of great information about replacing pumping parts, and I recommend you visit there.
According to The Balanced Boob, here is a general replacement guide by part:
Valve Membrane: 2-8 weeks to 3 months
Duckbill Valve: 1-4 months
Backflow Protectors: 3-6 months
Breast flanges: 6 months
Tubing: As needed, immediately if you notice moisture/mold
3. On the pump: Start fast pulls/low suction and move to slow pulls/high suction
Third, when pumping you start fast pulls/low suction to imitate how a baby or babies nurse. You will most likely be in this fast pulls /low suction phase for a few minutes until you feel your "letdown," or when the milk starts to spray.
Note. You may feel a sharp pain (i.e., pins and needles) in either or both breasts when your letdown starts. Once you are in letdown, switch the pump settings to slow pulls/high suction. Pump until you are no longer releasing much milk and down to a few drops.
Personal Story: I hesitate to even share that I was an over-supplier, but I don't want to ignore those of you reading this who may be similar to me. IF you are making a lot of milk (think 10/15+ oz in less than 10 minutes on a pump) within the first week of pumping, your lactation consultant may recommend curbing your supply sooner than one month. After the first week or so of exclusively pumping for my twins, I was making 95+ oz pumping in 10-11 sessions a day. The hospital lactation consultant suggested that I slowly reduce the (1) time I spent on the pump (I spent about 10-15 minutes each session at first), and then (2) the number of sessions (I started at about 10-11 sessions). After the first few weeks, I dropped to ~8 minutes on the pump 10 sessions a day. After 10 months of exclusive pumping, I was completely exhausted and per the recommendation of my therapist, who could see I was incredibly sleep-deprived, I dropped to ~8 minutes on the pump 7-8 sessions a day. I was able to keep up with my twins' demand by producing ~60-70 oz a day.
Note. I exclusively used a hospital-grade breast pump, because it was WAY easier for me to keep my supply up and it significantly reduced the amount of time I had to spend pumping on a less powerful, insurance-covered pump. I rented the hospital-grade pump for approximately $60 a month. I figured the cost of formula would be significantly higher than $60! If you decide you want to rent a hospital-grade pump, ask your healthcare provider for a preferred vendor list. My twins' NICU gave me a list of vendors in the surrounding area.
Note. I ended up ordering 8 oz pumping bottles because I had such a large milk supply. If you pump more than 5 oz per breast per pumping session, consider 8 oz bottles. I personally used the Medela Breastmilk Collection Storage Feeding Bottles w/Lids.
4. On the pump: Dinner and Dessert
Fourth, when pumping, you will need to decide if you are going to pump both breasts simultaneously, or if you will pump one breast per session (rotating between sessions). Note. It was much easier and way more comfortable for me to pump both breasts simultaneously when I exclusively pumped for my twins. However, if you want to give your breasts a break and rotate which one you pump for each session, remember this catchy phrase, "Dinner and Dessert." I still laugh when I think about the lactation consultant saying this to me. What she meant was that when breastfeeding you should primarily feed your baby off of one breast (i.e., Dinner), and want to top off baby by feeding for just a minute or so from the other breast (i.e., Dessert) each nursing session. You then rotate which breast you feed your baby or babies Dinner/Dessert for the next session. This just keeps your supply up. So, I recommend doing the same thing when pumping if you decide you only want to pump one breast per session. Spend 85-95% of your time pumping one breast, and then switch to the other breast for the other 5-15%.
Note. IF you decide to pump one breast per session, consider using a haaka Milk Collector or something similar to catch milk that will drip from the other breast. Additionally, consider using an app like Pump Log to track your pumping sessions.
5. Breast care tips
Finally, while pumping or breastfeeding is an incredible gift you can give your baby or babies, it is also incredibly physically demanding. Nipple fissures are really common and super painful. Please be sure to see a healthcare provider if you experience nipple fissures as they could be from Thrush. The BEST remedy I've ever found for this is All-Purpose Nipple Ointment (APNO; also referred to as Newman's), which your doctor will have to prescribe and be filled at a compounding pharmacy. Unlike with other nipple ointments, it is safe to keep on your nipple(s) when pumping. In other words, you do not have to wipe it off before a pumping session.
Storage
There is a lot of information to remember about breastmilk storage, so I'll do my best to go over the basics! If you remember nothing else, please check with your NICU on how they prefer you store breastmilk. My twins' NICU gave me storage bottles and labels, and asked that I put the date/time I pumped the milk.
1. Breastmilk
Generally, the 4-4-4 rule applies to breastmilk storage, although you should periodically check the CDC's Breastfeeding website for updated recommendations. The 4-4-4 rule is simple and says that you can keep breastmilk out on the counter for 4 hours, in the fridge for 4 days, and in the freezer for 4 months. Note that the CDC now says that frozen breastmilk is best when used in the first 6 months, but can last up to 12 months in a deep freezer.
2. Pumping Parts
When I first started exclusively pumping breastmilk for my twins, I washed my pumping parts (i.e., flange, duckbill valves, bottles) after each session. However, somewhere during my pumping journey, I learned that you can actually refrigerate your pumping parts for up to 24 hours before you need to wash them. This saved me considerable time each day, and is such a helpful tip. The CDC recommends you rinse your parts before refrigeration, and to store them in a plastic bag.
Note. IF your preemie or preemies is/are immunocompromised, you should consider washing your pumping parts after each pumping session. Read the CDC's Breast Pump Cleaning Guidelines for additional tips.
3. Fridge Milk Storage
Another helpful tip I learned when exclusively pumping was that if your breastmilk has cooled to room temperature or after it has cooled in the refrigerator, you can mix it with milk from other pumping sessions into one 24-hour batch. From there you can create bottles for your baby or babies, and freeze what you don't use into bags and label by day. Read suggestions on batching breastmilk in this article about How to Combine Fresh, Room Temperature, Refrigerated, and Thawed Milk from VeryWell Family.
Note. If you decide to do the 24-hour batch method, I highly recommend Dr. Brown's Baby Formula Mixing Pitcher for storing your breastmilk. This pitcher is obviously intended for mixing/storing formula, and works great for that, too.
Note. For breast milk storage bags, I personally liked Mommy's Precious because they were made to hold 8 oz.
4. Freezer Milk Storage
When freezing your breastmilk, consider if you need the bags to lay flat or not. Personally, I didn't care if the bags laid flat because I wanted to use as few plastic bags as possible. I froze my milk in batches of 8-10 oz (Note. I went over what the bags said they would hold, and that worked fine for me). However, many people prefer to freeze in smaller batches (i.e., 4-6 oz) that are more typical for what a feeding session would be in what is called the Brick Storage Method. I recommend you do whatever makes sense for you! One helpful thing I've seen others do is to buy larger Ziplock bags or storage containers to "batch" their breastmilk by week or month. This makes it easier to rotate milk based on pump date, so that you don't have throw out any expired milk.
Personal Story: In the beginning of my pumping journey, my twins were only eating a few ounces of breastmilk a day, so I had a huge surplus. During that time I found it most efficient to put my milk into freezer bags directly after pumping sessions. I then labeled by Date/Time. We also bought a deep freezer for a few hundred dollars.
Note. We saved a lot of $ by buying a freezer from the dent/ding shop of the appliance store to store my frozen milk.
5. Thawing Frozen Milk
When you want to use frozen milk, you can store the frozen bag in the fridge overnight to thaw or more quickly thaw the frozen milk in a warm water bath. Either of these work really well! Just remember that once milk is completely thawed (i.e., no ice crystals left), you will want to use the milk in 24 hours. Additionally, once milk is at room temperature, it needs to be used within 1-2 hours. Remember, you can't refreeze breastmilk that has been thawed.
Other Tips
1. Regulating your milk supply
When your milk comes in, you may suffer from engorgement. I was incredibly swollen with my eldest son. Here are some tips depending on if you're trying to increase or decrease your milk supply.
Under-Supply
Do Kangaroo Care/Skin-to-Skin. Place your baby or babies on your chest regularly to encourage your milk supply. If you are not near your baby or babies, look at pictures or watch videos of him/her/them. Note. The benefit of skin-to-skin for your baby or babies is huge. Please do skin-to-skin with your baby or babies as much as possible regardless of your milk supply.
Stay Hydrated & Fed. The American College of Obstetricians and Gynecologists (ACOG) states that breastfeeding requires an extra 450-500 calories a day. You should aim for at least 128 oz of water per day or more if you are pumping for multiples.
Warm Compress. Consider using a warm compress 10-15 minutes before pumping (Tip. You can also take a shower). This widens your milk ducts and makes it easier for you to express milk.
Over-Supply
Ice. In between nursing/pumping sessions, considering icing your breast(s) and kneading/massaging lumps in your breast(s) upward away from your nipples. You don't want to inadvertently tell your body to create more milk by pushing milk out. Note. You can also consider wrapping your breasts tightly or in cabbage leaves to decrease your milk supply.
Warm Compress. Consider using a warm compress 10-15 minutes before pumping (Tip. You can also take a shower!). This widens your milk ducts and makes it easier for you to express milk.
Take Ibuprofen (or another NSAID). Take a NSAID to help decrease the swelling in your milk ducts and to help manage the pain.
2. Get your milk tested
Our local children's hospital offers free breastmilk testing, which I discovered when one of my twins was hospitalized shortly after coming home from the NICU. The lab was able to tell me the composition of my milk (i.e., Calories, Fat %). While your baby or babies is/are in the NICU, I recommend asking if you can have your breastmilk tested, or calling your local children's hospital or a nearby milk bank to see if either places offer this service. The benefit of doing this is that you will know how much you need to fortify your breastmilk.
Note. If your baby or babies is/are premature, you will have to either fortify your breastmilk or do a few formula feeds per day. Fortifying refers to the process of adding calories, and/or vitamins/minerals to your breastmilk. Some NICUs choose to fortify every feed, and others simply do a few formula feeds per day. Personally, I loved that we only had to do 2 formula feeds (i.e., NeoSure) per day. Every other feed was 100% breastmilk. It was way simpler for me to make 2 formula bottles and ~10 breastmilk bottles per day (per baby!) than to fortify all ~12 feeds per day. Per the results from having my breast milk tested, we found out that I was making really high calorie/fat milk (34.7 Calories, 15% Fat), so we didn't have to do higher-calorie formula feeds.
Note. It is often hard for a preemie/preemies to tolerate formula, so you may have to switch brands to find one your baby or babies can tolerate. Remember, these formula feeds are very important, because as my children's pediatrician explained to me, my twins would have gotten these vitamins/minerals in utero from me if they had been full-term. If I'm remembering correctly, I believe we did 2 NeoSure feeds per day for 6+ months.
3. Consider becoming a milk donor
My twins' NICU shared with me that over 60% of mothers with babies in the NICU do not make enough breastmilk to exclusively feed them. IF you are lucky enough to make an abundance of breastmilk, please consider becoming a milk donor. For me it was a fairly simple process of filling out a questionnaire, disclosing the medications I was taking, and getting bloodwork done. Become a Milk Donor: Human Milk Bank Association of North America: Become a Milk Donor
Personal Story: After I had my twins, I became a milk donor and donated ~3900 oz to the Mountain West Milk Bank, and an additional ~1000 oz to several friends at work. In total, I donated ~4900 oz. It's one of my proudest achievements.
Overview
Remember, when it comes to pumping breastmilk, any amount you provide your baby or babies is a wonderful gift! Whatever you decide to do is the RIGHT decision for you and your family. I've linked some helpful resources below for those interested.
Find a Milk Bank: Human Milk Banking Association of North America: Find a Milk Bank
March of Dimes NICU Feeding Tips: Feeding Your Baby in the NICU
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