Tuesday, July 6, 2010

Increasing Your Output: Tips for Pumping More Milk

For many moms, one of the most stressful aspects of working and pumping is the constant worry about pumping output.  While some women are blessed to be high producers, many women are not. The reason for this is:
  • Breastfeeding is a supply and demand relationship.  The more milk that is 'demanded' - removed from the breast by baby or pump - the more milk will be produced in the future.  This is due to two main physiological factors, 1)empty breasts make milk faster than full ones, and 2) empty breasts send reinforcing hormonal signals to the brain that increase their rate of production.
  • In the majority of cases, baby is better at removing milk from the breast than a pump.  It makes sense - our breasts evolved to be responsive to the action and feel of a suckling baby, not a vacuum pump. 
  • If a woman is not careful to ensure that she 'demands' as much milk by pumping as baby would by nursing directly, her supply will eventually decrease.
So, how can we meet that last criteria - 'demanding' as much milk with your pump as baby would if he were nursing directly?  I've put together a list below that covers using your pump effectively, managing your nursing sessions, and dietary, herbal and pharmacological supplements.

Effective Pumping Techniques: (assumes use of an electric pump but may be adapted for a manual)
  • Allow the stimulatory phase (shallow, quick cycles of suction) to run completely.  This increases release of oxytocin (the nursing hormone) and stimulates maximum milk ejection reflex (MER - also known as 'let down')
  • Use the strongest suction that you can comfortably tolerate.  Don't cause yourself injury, but generally the stronger the suction, the more milk will be removed per cycle.
  • Ensure you have the proper sized horns.  Nearly all brands of pumps have horns available with larger diameter outlet for women with larger nipples.  You want all of the nipple and some of the areola to fit into the shaft of the horn.
  • Replace your membranes (if appropriate to your pump) frequently - about every 2-3 months.  If they are bent or torn at all, your suction will be noticeably reduced.
Managing Your Pumping Sessions:
  • Pumping more frequently through the day is more effective than pumping for a longer time per session.  For example - if you have 60 minutes to pump during a day, 3-20 minute sessions will be better for your supply than 2-30min sessions.  If you can swing it, 4-15 minute sessions would be even better.
  • When your first let down slows, switch your pump back to the stimulatory phase.  It is often possible to achieve 2 or 3 let downs in a single 15 minute pumping session.  Each let down results in a release of milk and stimulates the breast to further increase production.
  • Pump for approximately 5 minutes after your milk stops flowing.  This signals the breast that more milk needs to be made and will eventually help to increase your rate of production.
  • Use breast compression.  There are specific methods (Manualex is one), but essentially you are manually squeezing and massaging the breast to force more out while pumping at the same time.
  • If you are really falling short on your total output, consider pumping in the evenings before bed, or even once in the middle of the night (this is most reasonable if your baby is sleeping mostly through the night).
Supplements - dietary, herbal and pharmacological
  • Oatmeal - many women find eating a bowl of oatmeal helps to increase their supply.  These lactation cookies also get rave reviews from many moms.
  • Water - while you don't want to overdo it and make yourself sick, do make sure you are getting plenty of fluids throughout the day.
  • Fenugreek - A common and very safe herb (used in a number of foods), available at most health food stores.  See the link for excellent information. 
  • Blessed Thistle - Commonly mentioned in breastfeeding forums, this herb has less hard evidence supporting its use in lactation and some concerns about safety.  I do not recommend its use.
  • Domperidone - a pharmaceutical widely prescribed around the world (except in the US) and known to significantly increase milk production.  It is not currently approved by the Food and Drug Administration (FDA), but based on all available evidence, it appears safe and effective.  I would use it if needed - the difficulty comes in that it generally must be ordered from Canada or another international pharmacy.  It is recommended highly by Dr. Hale, the world's foremost expert on medications and breastfeeding.
  • Reglan - another pharmaceutical proven to stimulate milk production, and it is FDA approved.  However, Reglan is associated with potentially serious side effects (serious depression, tardive dyskinesia) and is generally considered less desirable than Domperidone for lactating mothers.
There are other herbs that some women use, as well as tricks and tips - leave a comment and share what worked for you!

A final note: Many working and pumping moms feel that they aren't pumping enough for their babies, when it's actually the case that well-meaning daycare providers are overfeeding their babies.  Look for a post coming soon that will address how to bottle feed an exclusively breastfed baby!


    1. Another great lactation aid is Fennel Oil, if you can find a good, ingestible version it is great for both milk production and helping baby with colic. Check out young living for good oils.


    2. Would you say pumping every 3 hours for 10 mins is good while at work?

    3. Every 3 hours is excellent, but 10 minutes may be a bit short - 15 minutes is what is recommended by most lactation consutants. However, my experience is that it's really a trial and error issue - if you can get enough milk and your supply stays up, than you're fine. For me, personally, I pump 15-20min in the car on the way to and from work, but only 10min in the middle of the day when I don't have as much time to devote to a long session. The longer sessions seem to help make up for the shorter lunch time one.


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