Pumping/Milk Expression

You can start pumping breast milk as soon as possible after delivery. If the baby is unable to breastfeed directly, initiating hand expression and mechanical pumping early will help establish your milk supply. If your child is currently unable to have oral feeds it is still important to start expressing milk to build your supply and be ready for when they do.

After delivery there is a hormone shift, and the pregnancy hormones will decrease and the hormones that aid in milk production will increase. You can communicate with your body by stimulating the breast to increase those hormones and build a milk supply. Contrarily, if you do not stimulate your breast, you are communicating with your body that you do not need human milk for your child. This means frequent breast stimulation that mimics a newborns feeding schedule is key to success.

In the early weeks postpartum, aim to pump at least 8-12 times per day, including at least once during the night, to establish and maintain your milk supply. This may seem like a lot, but the goal is to mimic a newborn feeding schedule which is every 2-3hours. As your milk supply regulates and your baby grows, you can gradually reduce pumping sessions as needed to meet your infant's supplementation needs.

There are a few different options for types of breast pumps: electric, battery operated, wearable and manual. You can also get single pumps and double pumps. Electric pumps are typically recommended for regular use. They're efficient and offer various settings for customization. These pumps plug into an outlet and will have a better motor than any battery-operated pump. We would recommend a double electric pump. You can also consider renting a hospital grade double electric pump. These pumps provide the best stimulation for milk expression, especially for initiating and building a milk supply. Most insurance companies will reimburse the cost of a rental pump. Wearable and smaller more portable battery-operated pumps have been having an increase in popularity due to the benefits of being portable. These can be good options once your milk supply has been well established for occasional use but not for exclusive pumping or initiating and building a milk supply. Manual pumps can be useful for occasional pumping or when you need a portable option. Choose a pump that suits your lifestyle, budget, and pumping needs.

1. Wash your hands thoroughly with soap and water.
2. Assemble your pump according to the manufacturer's instructions.
3. Find a comfortable and quiet place to pump where you can relax.
4. Start with breast message by doing gentle circular motions around your breast or a rolling motion with each hand on opposite side of the breast. Breast massage should always be gentle and never cause redness.
5. Position the breast shield over your nipple, ensuring a proper fit. To find the proper fit, measure the diameter of your nipple and use a silicone insert or plastic shield in that measurement (in millimeters) for a proper fit.
6. Start the pump at a low suction level and gradually increase until you find a comfortable yet effective setting.
7. Use breast compressions or massage to encourage milk flow. Using a pumping bra can help free your hands for breast compressions.
8. Continue pumping for about 15 minutes per session, or until your breasts feel empty.
9. To maximize milk expression finish with a gentle message and hand expression for 3-5 minutes on each side. Focus on areas in the breast that feel like they are not yet empty.
10. After pumping, store the expressed milk properly in a clean container and label it with the date and time. While in the hospital, your nurse will provide you with hospital labels.
11. Clean your pump parts after each use with soap and water and air dry. Sterilize parts every 24 hours.

Remember, pumping breast milk can take time and practice to master, so be patient with yourself. Reach out to a lactation consultant if you encounter any challenges or have questions along the way. Your dedication to providing breast milk for your baby is invaluable and commendable. Keep up the fantastic work!

More resources:

• Maximizing milk production with hands-on pumping - Standford Medicine

• Fit is important: Ensure proper breast shield fit: The breast shield (flange) should fit comfortably around your nipple, but the flange opening should be the size of the base of your nipple. This will allow the nipple to move freely during pumping without the areola entering the flange opening. See this resource for more information.
• Find a comfortable pumping setting: Start with a low suction level and gradually increase until you find a comfortable yet effective setting.
• Practice relaxation techniques: Stress can hinder milk let-down, so create a calming environment, massage your breasts before pumping, and focus on positive thoughts. Pump close to your infant, look at pictures that make you happy, listen to calming music.
• Use breast compression: Gentle breast compressions while pumping can help empty your breasts more effectively. Using a pumping bra can help you be hands free while pumping and aid in your ablity to do breast compressions.
• Don’t skip out on the nighttime pump! Milk producing hormones are highest at time and getting in the pumping session at night can set you up for a successful day of pumping. To help prioritize sleep, Pump when you are awake with your infant already. If you are away from your infant, pump just before sleep, wake once to pump then pump again immediately when you wake for the day.

More resources:

• Babies in Common

Breast engorgement is a common condition that many new moms experience, usually during the first few weeks of breastfeeding. Essentially, it's when your breasts feel overly full, hard, and sometimes painful. This can happen because your body is still figuring out how much milk it needs to produce for your baby. In the beginning, it might make more milk than your baby needs, leading to that swollen, tight feeling. 

Engorgement can make it a bit tricky to pump properly because the breast is so full and the might have difficulty expressing milk. Pumps are great tools, however they work a little less efficiently when the skin is not soft and malleable. Don't worry, there are ways to manage it! Gentle hand expression or nipple stimulation before pumping can help the milk flow more easily, and cold packs after feeding can reduce swelling and pain. It's also a good idea to pump often to keep the milk moving and prevent the breasts from getting too full. 

Remember, it's a temporary phase, and with a little patience and practice, you will get the hang of it! 

Mastitis is an inflammation of breast tissue that can include infection. Mastitis typically affects only one breast, not both. 

Symptoms of mastitis can develop quickly and may include: 

• Pain or tenderness in the breast 

• Swelling of the breast 

• Redness of the skin, often in a wedge-shaped pattern 

• Warmth of the breast tissue 

• Fever and flu-like symptoms, such as feeling run down or very tired 

The condition can occur when bacteria, often from the baby's mouth, enter a milk duct through a crack in the nipple. This can lead to an infection and the body's immune response causes inflammation. In breastfeeding women, mastitis can also result from milk staying within the breast tissue (milk stasis), often due to a blocked milk duct or problems with breastfeeding technique that prevent the baby from properly emptying the breast. 

Treatment for mastitis usually involves antibiotics to address the infection (if present), pain relievers to reduce pain and fever, and continuing to breastfeed or pump to relieve milk stasis. If breastfeeding, it's important to ensure proper latch and nursing technique to prevent recurrence. In cases where an abscess forms, surgical drainage may be necessary.

Every family that is admitted to CHEO will be provided one pump kit as needed. The pump kit includes \:

• 4 flanges (x2 21mm, x2 24mm)
• 2 personal fit connectors
• 2 valves and membranes
• 2 tubing
• membranes and caps
• 2, 5ml colostrum protectors with caps
• 2, 30ml bottles with caps.
• Additional flange sizes and bottles can be provided as needed. 

Along with the pump kit, you will be provided with a mesh bag, a small bottle of dish soap and a basin to clean and maintain your kits between use.

When admitted to CHEO, there are several locations available to you to express your milk.

If you are admitted to 4East or 5East, there are individual pump rooms located on each inpatient unit. Bedside pumps are available on request and subject to availability.

If your baby is in NICU/PICU: There is a lactation room in the Ronald McDonald lounge (room 3521) on the 3rd floor of the Gary Cardiff Wing located between the two units. In the NICU, there are rolling pumps for you to use at your baby’s bedside. If you are admitted to the PICU, pumps are available on request and are subject to availability.

“The Symphony hospital-grade breast pump with its research-based pumping programs has been developed specifically to support moms throughout their lactation journey: to initiate, build and maintain an adequate milk supply.”

The Symphony PLUS program card contains two different programs for the Symphony breast pump

The INITIATE program mimics the irregular and more rapid sucking and pausing pattern of a term born infant during the first few days of lactation. This program is intended for use in the first few days after birth before secretory activation to support pump-dependent mothers to initiate milk production

The MAINTAIN program is based on the 2-Phase sucking pattern of a term born infant during established lactation. This program is designed to optimize milk output after secretory activation to support all mothers to build and maintain lactation

CHEO will provide you with one pump kit to use with our pumps while you are admitted. We recommend that pump pieces are washed with warm soapy water with every use and placed on a clean towel to air dry. You must sterilize your kit at least once every 24 hours.

If your baby is in NICU/PICU: There is a lactation room in the Ronald McDonald lounge (room 3521) on the 3rd floor of the Gary Cardiff Wing located between the two units.

There is a lactation room located on the 5West (room 5078A, beside the play/family laundry room) for our families who are admitted to the medical-surgical floors to clean and sterilize the pump kits.

Wash your hands with soap and water or hand sanitizer before pumping.

Always use approved containers to store breast milk. Leave at least ½ inch space at the top.

Write the date and time of pumping on the label with a pen.

Apply the CHEO label to the container vertically (as shown). Labels will be provided to you by your nurse.

This milk can be used within 4 hours of being at room temperature. If the expressed breast milk is not going to be used immediately, store it in the refrigerator or freezer.

Do not combine the milk from more than one pump session in the same container. Take enough containers for each pumping session home with you. Ask your nurse how much milk to store in the container

Transport refrigerated milk in an insulated cooler with frozen gel packs or ice cubes stored in zip lock bags or a container with a lid. Transport frozen milk in an insulated cooler with frozen gel packs. Do not add ice cubes as they will draw the freezing out of the breast milk.

These are in hospital guidelines and will differ from home and community guidelines.

If you are having difficulty, we have collected some more resources to help CHEO children, youth and families troubleshoot any minor problems. If these problems persist or if you have questions and concerns, please contact the Lactation Support Team.

If you are not admitted to CHEO, please reference the Community resource section below for further information about how to contact a lactation consultant near you.

• Breast changes and conditions after childbirth - AboutKidsHealth
• Breastfeeding problems: sore nipples - AboutKidsHealth
• "I have sore nipples, what should I do?" - Medela Health (video)
• 5 common breastfeeding problems - Unicef
• Common breastfeeding complications during lactation - SickKids
• Paced bottle feeding - Minnesota Department of Health