We hope that the changing season finds you well. We are pleased to release this issue by announcing the formation of a new Facebook support group for Breastfeeding USA that allows us to help even more breastfeeding parents: Breastfeeding USA: Exclusively Pumping Support.

The use of breast pumps in the United States has steadily climbed in recent years. No longer only used for premature babies in the NICU, or because of parent and baby separation due to work or other factors, parents are increasingly feeding exclusively pumped breast milk to their children either by choice or out of necessity. Increased access to breast pumps and the variety of brands and types of pumps on the market has also played a role.  

Breastfeeding USA maintains that pumping and feeding expressed milk is breastfeeding! You are welcome to visit and join the new group here:

https://www.facebook.com/groups/828712901343906

To read more about the reasons some parents exclusively pump, and to find helpful resources, check out this article on the Breastfeeding USA website: https://breastfeedingusa.org/content/article/exclusive-pumping

Sincerely, 

Erika Costanzo, and Alaina Moon, Breastfeeding Counselors

By Dana Saccomano, Breastfeeding Counselor

Antenatal expression refers to the harvesting and storing of colostrum during the final weeks of pregnancy.  A pregnant person might choose to do this if their baby is going to need extra nutrition or special care after birth. One scenario in which this might be a consideration includes if a lactating parent is diabetic and anticipates the onset of milk to be delayed. Another is if a separation between parent and baby is anticipated right after birth, such as a NICU stay for baby. A pregnant person who is considering antenatal expression of milk should consult with their healthcare provider before expressing any milk, as this may increase the risk of preterm labor in some people. The articles below explore this practice and the viewpoints surrounding it.

Antenatal Expression Links:

https://breastfeedingusa.org/content/article/expressing-milk-birth-tool-use-special-circumstances

https://www.breastfeeding.asn.au/bfinfo/antenatal-expression-colostrum

https://www.llli.org/breastfeeding-info/colostrum-prenatal-antenatal-expression/

By Alaina Moon, Breastfeeding Counselor 

As a breastfeeding parent who works outside the home, I answer many questions about how other parents can successfully breastfeed while working. One frequent concern is the discrepancy between how much the parent is pumping versus how much the baby is taking from their caregiver while they are separated. If this happens, parents are understandably frustrated when they cannot match the number of ounces the baby guzzles from the bottle each day. They may worry that their supply is low, and start supplementing with their frozen milk or formula. This, combined with the pre-existing stresses of working and parenting, can lead to premature weaning, against the parent’s wishes. 

Fortunately, knowledge on this subject can equip a parent with the confidence to pump successfully while working. One such tidbit is the fact that the typical baby will take between 1 and 1 and ½ ounces of human milk per hour of separation from the nursing parent. This means that a baby in daycare for a 10 hour stretch will take between 10-15 ounces of breastmilk over the course of the day. Any more than that should be considered overfeeding. 

But what happens when the baby is consistently taking more than the expected amount from their caregiver? The first thing to look into is whether the caregiver is familiar with paced bottle feeding. The paced bottle feeding method mimics important elements of breastfeeding, and can make alternating between the breast and the bottle easier for the baby and parent. 

The hallmarks of paced bottle feeding are:

The baby is fed according to hunger cues, rather than on a fixed schedule. 
The baby is fed in an upright or semi-upright position. 
The baby is allowed to take the nipple into her mouth, and to spit out the nipple to breathe or look around as often as necessary. 
One feeding should last 10-20 minutes with frequent pauses, to more closely mimic the rhythm of breastfeeding.
The feeding is finished when the baby no longer wishes to take the nipple or falls asleep. It is not necessary for the baby to finish the entire amount offered. 

Even if the caregiver is not able to institute all of these practices, doing any of these things will make the transition from breast to bottle and back to breast again easier for all involved. When paced bottle feeding is used the timing and amount of human milk most similar to what a baby would take at the breast is offered, which will satisfy the baby without overfilling their stomach and burning through the parent's freezer stash. 

Further information

How to bottle feed the breastfed baby. From kellymom.com.

This article also contains a link to a helpful,one-sheet PDF that can be printed and shared with child care providers. 

Paced Bottle Feeding.

This video from the Michigan Breastfeeding Network provides a visual demonstration of paced bottle feeding.

By Dana Saccomano, Breastfeeding Counselor

The Affordable Care Act (ACA) requires all health insurance companies in the United States to cover the cost of a breast pump, either to rent or to own. Types of breast pumps covered include manual pumps, hospital grade pumps, and double or single electric pumps, including hospital-strength pumps. Depending on the model selected, pumps can be portable, rechargeable, battery-operated, wearable and even blue-tooth compatible! 

Hospital grade breast pumps are typically used in hospital settings by multiple users. They can cost upwards of $1000, and can be quite heavy. This type of pump is often used to help a lactating parent establish their milk supply after birth in the event that the baby cannot feed directly from the breast or chest. 

Double electric breast pumps are the most popular choice for lactating parents. They boast efficiency, affordability, and a variety of styles that include wearable pumps, wireless pumps, battery-operated pumps and, more recently, blue-tooth compatible pumps. Most lactating parents acquire one of these types of pumps through their insurance. They vary greatly in price depending on their specific features. Some double electric breast pumps offer hospital strength suction but are meant for personal use. They are much lighter and easier to transport than hospital grade pumps.  

Manual pumps include hand pumps and silicone milk catchers. These types of pumps can be useful in the event of a power outage or when traveling without consistent access to electricity. Some parents use these very successfully when combined with hand expression, and even prefer these over double electric pumps.  

Everyone's needs and preferences are different when it comes to breast pumps. Factors such as reasons for use, anticipated frequency of use, convenience, ease, and affordability are all things parents should consider when selecting a breast pump. Each insurance company has individual specifications concerning what they will cover, and each parent should consult the details of their insurance plan when selecting a pump.

By Erika Costanzo

The PUMP for Nursing Mothers Act (PUMP Act) (H.R. 3110) will expand protection of the Break Time for Nursing Mothers Law (from 2011), to nearly 9 million women of childbearing age - or 1 in every 4 - that were unintentionally excluded from existing legislation. This is also an amendment of the Fair Labor Standards Act of 1938. If passed, there will be increased protections for working women to express and provide breast milk for their babies and children in the United States. The PUMP Act is currently in the final stages of approval, having just been passed in the House of Representatives and awaiting a trip to the Senate floor, as of the time this was written.  

For up-to-date information from the United States Breastfeeding Committee, please follow this link: http://www.usbreastfeeding.org/page/providing-urgent-maternal-protections-(pump)-for-nursing-mothers-act

For  background information about this legislation, please see this article: https://maloney.house.gov/media-center/press-releases/maloney-celebrates-pump-for-nursing-mothers-act-passage-in-education-and

To read the bill , click here: https://www.congress.gov/bill/117th-congress/senate-bill/1658/text

by Lauren Franzen

When anticipating a return to work or separation from baby, many nursing parents wonder how many times they will need to pump to get enough milk for baby and maintain their supply. The answer will actually be different for every person. While there is no universal “magic number”, Nancy Mohrbacher uses that term as a teaching concept to help parents predict what their own personal magic number will be when it comes to pumping. This refers  to the number of times they will have to pump or breastfeed daily in order to maintain their current rate of milk production. More pumping or breastfeeding sessions will lead to an increase in supply, while fewer sessions will lead to a decrease.  

The way to determine the magic number is to consider breast fullness and storage capacity. Mohrbacher cautions that parents should not wait to pump until their breasts feel full.  Research has found that full breasts actually slow milk supply, in part because the engorgement creates a feedback loop, telling the body that too much milk is being produced. The more completely a breast is drained, the more quickly milk is made. This is similar to how a newborn will cluster feed; draining the breast frequently and completely signals the body to increase milk supply. 

Breast storage capacity refers to how much milk the breast can store. Unrelated to breast size, this has more to do with how much glandular and fatty tissue the breast has. There can be wide variability between individuals, with some mothers feeling full when their breasts have 2.5 oz in them and others able to hold much more than that. That means that those with smaller storage capacity will need to pump more frequently than those who can store more. 

To figure out one’s magic number, it can be helpful to use the first morning pumping session of the day as a gauge of what breast storage capacity might be. Morning is typically when milk production is highest and (sometimes) follows a gap after  last feeding. A parent  who is able to pump high volumes in the morning may not need to pump as frequently as one whose morning pump session yields only a few ounces. Another indicator is to think about how often baby feeds on days when the nursing parent and baby are together. For example, if baby typically feeds three times between 9am and 5pm, a good assumption would be that three pump sessions during a nine-to-five workday will yield what baby needs. 

Oftentimes the magic number will need tweaking over time as baby’s feeding and sleep habits change. For example, it is common to experience a drop in the amount of milk pumped during the day when baby starts sleeping through the night. This is because the loss of the night breastfeeding session has changed the magic number, and the parent may need to add another pumping or breastfeeding session to bring the milk supply back up. Understanding the basic principles of breast fullness and storage capacity can help parents adapt in order to maintain, increase, or decrease production. Most importantly, it can help eliminate a lot of the guesswork for pumping parents and imparts greater confidence in being able to meet baby’s needs. 

Source:

Mohrbacher, Nancy. (2011). The Magic Number and Long-Term Milk Production. Clinical Lactation, Vol 2-1, 15-18. <https://dhss.delaware.gov/dhss/dph/chs/files/resmohrbachermagicnumber2011.pdf> 

In 2016 I gave birth to a baby boy as a gestational carrier for an international family. Even though his parents decided that they would feed their baby formula, I decided that I would pump for the benefits to my health, and with the intention of donating to others in need of human milk. The decision to pump after my surrogate pregnancy was a no-brainer for me! I had had a beautiful breastfeeding journey with three of my four biological children, and I naïvely thought pumping would just come naturally. I learned that I couldn’t have been more wrong!

Before I get ahead of myself, let me take you back to the night of this baby boy's birth. My labor with him was like nothing I had ever experienced before. My water broke, and contractions were coming one after another with no break in between. It was the middle of the night and I made the decision to get an epidural, which unfortunately failed, resulting in a harder labor than I have ever experienced. My labor lasted 27 hours. I had made plans to pump or hand express within the first hour of his birth, as I knew how important that was for establishing a strong milk supply. But the only thing on my mind after such a long hard labor was glorious sleep. That’s exactly what I did. 

The first time I was able to hand express was 12 hours after the birth. I was pleased to get 10 milliliters of milk. Over the next couple of days I dedicated myself to pumping every three hours, even through the night. By day five I was engorged and hardly collecting any milk. I was confused about what was going on. In hindsight, I realized that despite all my knowledge about breastfeeding a baby, I knew almost nothing about pumping! This started my deep dive into the exclusive pumping community. Some of these moms, like me, were gestational carriers  pumping milk for donation. Some who had lost their babies and decided to pump for donation. Other moms were feeding a combination of pumped breastmilk and formula. Right away this wonderful group of women helped me determine that my pump suction was on too high, and my flange was the incorrect size. They helped me develop a schedule for pumping, and gave me all the tips and tricks for expressing the most milk! By six weeks postpartum I was pumping 30 to 35 ounces of milk per day, and over the course of five months I donated 4000 ounces of human milk to milk banks and local moms in my community.

My exclusive pumping journey opened my eyes to the support exclusively pumping parents need, and I am proud to say I am one of the moderators of Breastfeeding USA's newest national Facebook group, Breastfeeding USA: Exclusively Pumping Support. I hope to help others on their exclusive pumping journeys. Pumping is breastfeeding!

You can do a quick Google search and find lots of advice on how to pump more milk for your baby, but my advice to you is find a tribe of women who support you and your goals for your family. Listen to their stories of motherhood and how they supply their baby with human milk and share yours as well. We are all in this together!

By Dana Saccomano, Breastfeeding Counselor

Courtney Hayes is a Breastfeeding Counselor,  wife,  music lover, and  stay-at-home mother of 3 boys. She lives in Gilbert, Arizona with her husband and three children - Jude (four years), Layne (two-and-a-half years), and Morrison (nine months).  She is eager to share her exclusive pumping journey, which involved pumping for her medically-fragile first born.  She went on to have two more breastfeeding journeys that did not include exclusive pumping. These experiences inspired her to become a Breastfeeding Counselor for Breastfeeding USA.  

When Courtney was pregnant with Jude, her 20 week ultrasound diagnosed a congenital heart defect.  She and her husband made the decision to travel to Children's Hospital of Pennsylvania  for the birth of their son, and the open heart surgery he would need after birth. Jude was born at 39.5 weeks. They stayed in Pennsylvania for a month after the birth.  

During her pregnancy, Courtney was hoping to breastfeed, but admits she did not know a lot about it. After Jude’s diagnosis, she started doing research and joining online support groups. She learned about the benefits of human milk and the possible detriments of formula for babies who have open heart surgery.  This helped her solidify her decision to breastfeed. She hoped to breastfeed directly, but she learned that many babies with heart defects have challenges with eating. Her next best option would be exclusive pumping. She started researching pumps to be prepared for the possibility that she might not be able to latch her baby directly. She went into postpartum without any feeding expectations, other than the goal of giving her baby her milk, because she knew this was the best thing for him. 

During her pregnancy she met with a lactation consultant about breastfeeding. Her lactation consultant instilled in Courtney a passion for breastfeeding as she helped prepare her for breastfeeding and pumping. The information and tips she received from her lactation consultant helped start her down the right path.  Courtney learned more about the benefits of human milk for her baby with a congenital heart defect, which solidified her goals and gave her confidence to provide human milk for him. Her birth plan included breastfeeding or pumping right away, as she knew that would be very important for establishing a strong milk supply. 

After Jude's birth she was able to hold him for 30 minutes. After that, he needed medical care so she pumped for the first time. The plan had been for Courtney to give birth at Children’s Hospital of Pennsylvania so she could stay there and be close to her baby during his open heart surgery, but circumstances changed and she gave birth at a different hospital. Jude was moved to Children’s Hospital soon after his birth. Courtney remembers feeling fearful about their separation and her baby’s stability. She also remembers one amazing nurse who helped her get set up to pump right away. 

Courtney pumped religiously, every three hours. Because of her strong prenatal breastfeeding education, she knew to keep pumping, whether milk was coming out or not. She knew the nipple stimulation would send her brain the signal to make milk. She and Jude had skin-to-skin contact whenever possible to encourage milk production. Courtney saved colostrum in tiny bottles so her baby could have his mouth swabbed with a milk-dipped q-tip to receive the benefits of human milk before he was able to eat. 

Jude had his open heart surgery at four days old. He was not allowed to breastfeed or take a bottle for those first four days because it would have been too taxing on his heart. He received nutrition through an IV during this time, in addition to mouth care with Courtney’s colostrum. A feeding tube was placed right after Jude's surgery ,through which he was able to receive Courtney’s milk. He tolerated the feeds well, which is not always the case with babies with congenital heart defects . They started to work on latching directly to the breast and bottle feeding, but discovered that Jude had additional complex feeding issues. They eventually found out he had a cleft soft palate, which made him unable to create suction to take a bottle.

After Jude’s cleft palate diagnosis, Courtney knew breastfeeding him directly would be impossible. Instead, she vowed to pump for him and his fragile immune system. Pumping gave her a sense of control in a very out-of-control situation. Her husband was a big help in this endeavor. He was right there with her, helping clean pump parts.  

Courtney exclusively pumped for 15 ½ months for Jude. After she was done pumping, Jude continued to receive Courtney’s stored milk until he was 18 months old. She went on to have two successful breastfeeding journeys with her two subsequent children.  In large part because of her experience pumping for a medically-fragile child, she hopes one day to become an International Board Certified Lactation Consultant to help families on their feeding journeys. She has a special place in her heart for families with medically fragile babies, as well as those who exclusively pump, as she feels those families need more support than they usually get. She is one of the moderators for Breastfeeding USA's newest Facebook support group, Breastfeeding USA: Exclusively Pumping Support.

Co-Editors in Chief: Alaina Moon and Dana Saccomano

Editors: Dana Saccomano, Lauren Franzen, Alaina Moon

Writers: Erika Costanzo, Lauren Franzen, Alaina Moon, Dana Saccomano, Mallory Burden

Layout: Sara Strum