Sunday, December 02, 2007

Pump-a-palooza

At last, here's my big post of links and info on pumping, breastfeeding, low supply, and breastfeeding with PCOS. I've been working on this for...well, Blogger tells me I started this post on 6/2/07, so for six months now. I'm finally motivated to get it up after the latest rash of beloved bloggers writing about their breastfeeding woes.

Even though I had read blogs (like Julie's) of other women who exclusive pumped (or EP'ed, as it is jauntily referred to online), I didn't really comprehend that EPing, or even half pumping half nursing, was possible until I did it myself, and then I had a hard time finding information on it. Skip to the end of this post if you just want links to other pumping moms, but I've collected here as much as I can think of on pumping and supply. I added the bulk of these links when I was fresh from pumping hell, months ago, so it should be pretty thorough despite my now being a happy formula-feeding mom (yes, you do eventually make peace with the evil formula!).

General info
Start with Julie's excellent pumping tips post--read the whole post and all the comments for tons of great info. Most useful tips for me:
• Get multiple collection kits (horns, valves, bottles, the whole rig) to save yourself from having to wash in between pumping sessions. Throw it all in the dishwasher once a day (if you have four or more sets, plus the bottles and nipples you're using to feed with, you should have no problem filling up the dishwasher every day) and don't mess around with sterilizers--the dishwasher gets plenty hot and steamy and you don't need another piece of equipment to worry about.
• Use the same rig for more than one pumping session. I'd go up to six hours (2-4 pumps) pumping into one set of bottles, leaving the whole thing out at room temperature between sessions (both my local LC and a lactation MD told me this was OK). Of course this only works if you don't fill up the bottles each pump--but this was never a danger for me.
• Olive oil on the horns or on your areolae/breasts (my PIS horns covered nearly all of my tiny breasts, so I lubed up the whole breast) improves suction and minimizes irritation. This is important--after three months of pumping 8-12 times a day, I started getting a boob rash from the constant friction.

Other great general resources:
Pumpmoms yahoo group (there is also an exclusive pumpers group but I never got around to joining that one)
• Jo's post on PCOS and breastfeeding problems
Breastfeeding with PCOS
Kellymom, of course
Eva has tons of pumping and low supply links on her sidebar, so rather than rip those off her I'll just link to her here.
The Lactivist has a bunch of good links and advice too.

How I pumped
It took me a couple of months to find the right groove with this--I was pumping on too high suction at first, and after I gave up on breastfeeding and went to exclusive pumping it took me a few days to figure out I should pump a lot longer to completely empty the breast. (My lactation MD advised me to pump just 5 minutes at a time, which worked great because I had such speedy letdown that most of the milk came out in 2-3 minutes. It also helped me stick with pumping when I was ready to give up--there's a big difference between 5 and 15 minutes 8x a day! But when I stopped feeding direct from the tap and wasn't getting the additional stimulation of my daughter nursing, I needed to pump longer to make sure I was getting all the milk out.)

Here's how I was doing it at the end: I started the pump (Pump in Style Advanced) on minimum speed/suction, then slowly turned it up (you want the lowest suction that will give good milk yield--you have to experiment. NOT the highest suction you can tolerate--you don't want to be in constant discomfort). I'd hit the button to switch to expression mode as soon as milk was dripping from both breasts--for me, with my ridiculously fast letdown, that was after about 30 seconds. After about 5 minutes, the milk would start slowing down. When it slowed to a slow drip, I'd start massaging toward the nipple to get more out. At about the 10 minute mark, I could usually get a second letdown with a combination of massage and "pumping" the cones (pressing them into my breasts, then releasing, a few times). Other women I know put the cones on asymmetrically (not exactly centered on the nipple) and get good yield by moving the cones around the nipple so as to stimulate different milk ducts. I stopped at the 15 minute mark or a minute or two past when the milk stopped dripping. (Pumping for longer than 15-20 minutes at a time is generally not recommended, though I have a friend who had extremely slow letdown and so swore by 40-minute pumping sessions.)

How often to pump?
Standard advice is to pump every few hours, or as often as a baby would nurse. If you are trying to increase or establish supply, some great advice I read is that instead of thinking "I have to pump every 2-3 hours," you should think, "I have to pump 8-10 times a day." Then just try to squeeze those 8-10 pumps in however you can--if it means you go 6 hours between pumps (because you're sleeping! hallelujah!) and then pump three times in the next 6 hours, that's fine. The important thing is to get in at least 8 pumping sessions a day, and you're much more likely to do that if you just get them in however instead of worrying about spacing them evenly. That said, it's also important to maintain your sanity, and if that means you pump fewer than 6 times a day, but you're able to enjoy your baby more, then that's what you should do.

Power pumping
"Power pumping" is frequent pumping aimed at stimulating your supply, much like a baby cluster feeding during a growth spurt will cause your production to increase to meet the increased demand. There are a number of ways of doing this--one method is to pump for 10 minutes, break for 10 minutes, pump for 10 minutes, and continue for I think an hour or two (not sure--I never did it this way). Another method is to pump for five minutes every hour for 24 hours. An easier method is to spend one day just pumping whenever you have a spare moment--leave the pump set up and throw the horns on every chance you get, for however long you can, whether it's been 10 minutes or 2 hours since your last pump. Got 15 minutes when the baby's napping? Pump. Got 2 minutes before your visitors arrive? Pump! You'll squeeze in tons of little sessions, just like a fussy cluster-feeding baby would do.

The way I power pumped was simply to insert an extra pumping session between my normal daytime sessions. This worked out to pumping every 90 minutes or so during waking hours (I was not insane enough to try to power pump at night), for a total of roughly 12 sessions in 24 hours. At 3 weeks postpartum, I started power pumping for two days, then taking one day off (regular 6-8x/day), then two days on, one day off. I did this for I think one or two weeks to jumpstart my supply, along with herbs (see below). Then I cut back to power pumping twice a week, then after another month or so I just did it once a week. When I went back to work I stopped power pumping altogether, because who has that kind of time? (I also knew at that point I was getting ready to quit.)

Galactagogues
I had super low supply--I pumped maybe 0.25 oz. in 15 minutes the first day my milk came in, and after a week of nursing and pumping was up to maybe 3.5 oz/day. With a lot of effort, I was able to get my supply up to 10-11 oz/day. I used all of the following galactagogues (supply boosters), with varying success:

Foods (not sure how much they helped but I figured they couldn't hurt):
• Oatmeal (or oats in any form. I ate oatmeal every. damn. day. for sixteen weeks. Also granola, oatmeal cookies, etc. etc.)
• Almonds
• Sesame (PSA: Bear Naked Fruit & Nut Granola contains oats, almonds, and sesame seeds)
• Barley/barley malt (regular Ovaltine has barley malt, or drink beer!)
• Protein in general
• NO soy, which is suspected to decrease supply

Herbs
I took fenugreek and blessed thistle--taking them together is supposed to have better effects than either alone. 3 capsules of each 3x/day to start with, with immediate results, then 4 capsules 3x/day (on doctor's orders), with less obvious results. I tried taking the liquid tinctures for a while, as they're supposedly more effective, but they tasted horrible (suspended in grain alcohol!) and I actually smelled less mapley (which is a bad thing--you know you have an effective dose of fenugreek when you smell like maple syrup), so I switched back to capsules.

Domperidone
Domperidone is what kept me going--just when I was ready to give up (5 weeks in and only pumping 5-6 oz/day), domperidone doubled my supply, giving me the motivation to make it to the 4-month mark. I took 2 10mg tablets 4x/day, as directed by my lactation MD, who instructed me to take it for no more than 8 weeks, then slowly wean off (to prevent sudden dip in supply): 7 pills/day for 3 days, then 6 pills/day for 3 days, and so on. I ordered it from Inhouse Drugstore in New Zealand and felt like a badass outlaw (and also fretted that the meds would be seized by customs).

Metformin
Since I have PCOS, it was thought by the various experts I consulted that met might help increase supply--and that it might have helped me develop better milk ducts etc. had I remained on it during pregnancy. I was skeptical, because it never seemed to help me much in the ovulation department, but I was willing to try. I worked up to 1500mg/day (my TTC dose), overcoming the nausea etc., but I don't know how much of an effect it had, since I started it around the same time I started the herbs.

Other pumping babes
Finally, in the worst, darkest days, it helped me so much to know that so many women in blogland had been through pumping hell too. (Hmm, kind of like discovering infertility blogs for the first time?) So here, in no particular order, are just a few of the Internet ladies who have pumped, either exclusively or in combination with nursing:
Julie pumped for Charlie
Menita pumped for Polly
Pru pumped for P.
Blue pumped for Azure
Pumpmom pumped for two of her kids
Miss W. pumped for the lowercase
Cecily pumped for Tori
Alice pumped for Henry, and is hilarious about it
Momo pumped for B. (exclusive pumping for 6 months!)
Chris pumped for her twins (old blog with more pumping stuff may be taken down)
Aliza pumped for NG
Meg pumps for Jasper
Eva pumped for Baby (EP for 8 months!)
Rockmama pumped for the Prawn
Jennifer pumped for Elnora (EP for 14 months!)
Thalia is pumping for Pob
Kath is pumping for Banana

I'm sure there are tons more, so if you or someone you know has blogged about pumping, post it in the comments. Ditto if you know of any other great resources or some awesome advice I've forgotten.

Oh, and one more thing: If you are struggling with low supply or a baby who won't latch, you will feel like it is all your fault, that if you just worked a little harder, you should be able to fix it. (Probably because this is conventional wisdom among many lactivist types.) Please don't beat yourself up. I know that's easier said than done (anyone who reads my breastfeeding posts--Feb through June 07--will see I did plenty of self-flagellation), but really, all any of us can do is our best. Don't feel bad because someone else worked harder or pumped longer or did more or nursed until their baby went to college. As Moxie would say, you are the perfect mother for your baby, whether you breastfeed or not. There are no mothering awards given based on volume of breastmilk fed, and if giving your baby formula or pumping less or saying fuck it to the whole breastfeeding concept allows you to be the mother you need to be, then do it. Enjoy your baby. Don't let your boobs get in the way.

Labels:

12 Comments:

Blogger MsPrufrock said...

Oh, I do love you, and not just because you linked to me. I do worry that my posts would put someone off pumping, but hey ho.

What a great comprehensive post. 6 months of work was not all for naught!

10:27 AM  
Blogger Eva said...

Great post! Of course I still have enough PTBD (post-traumatic breastfeeding disorder, haha, as we have discussed) that I didn't read all of it because I didn't want to get all anxious about the topic. But anyway good work. :) I had one like this drafted for a while and gave up and now since you've done such a great job I don't have to worry about finishing it!

11:07 AM  
Anonymous Anonymous said...

you're last paragraph was especially meaningful for me today. After 9 months of all out exclusive breastfeeding, my son has decided to self wean. In 3 days. i can't pump enough to keep up with him (and I am not willing to chain myself to a pump at this point) so i've decided to supplement with formula. it's a crazy thing to think of, but i have to do what's best for him now and right now that doesn't involve trying to get him to breastfeed when all he really wants is to feed himself. sigh your words of encouragement really hit home today. thank you.

2:18 PM  
Blogger Thalia said...

Thank you for doing this, I've been meaning to do the same but you are way ahead of me here.

The one link you don't major on is to MOBI _ mothers overcoming breastfeeding issues. I've found that site and the yahoo list of the same name really helpful, because unlike sites which major on bfeeding, they understand that sometimes it doesn't work, and make it ok for you to give up if that's best for you and your baby.

2:39 PM  
Blogger May said...

Wow, this is fabulous. Just what I needed as I face figuring out how to feed #2 while D runs around being a toddler.

I think this time will be easier, mostly because I'm not going to beat myself up about using formula as badly as I did last time. And at least ONE of us will know what we're doing this time. And I'm all over that New Zealand link.

3:27 PM  
Blogger MoMo said...

You are a rock star for putting this together! This is such a useful source...Thanks for sharing it with everyone!

4:06 PM  
Blogger Becky said...

Hi Electriclady, I'm finally delurking. You and I were pregnant at the same time, so I followed you from then. My Alex is a couple of months younger, but sounds similar in temperment to your daughter.

Just wanted to say "hi" and thanks for this post. I pumped with my first (not for as long, and this was before the Internet could've assisted me) and this post would've helped a lot back then.

I hope that you don't mind, but I am going to add you to my blog roll.

5:12 PM  
Blogger Meg said...

Hey Electriclady - thank you for this post and in appreciation of the late night googling / blood, sweat and tears that it came from.

The point that you can only do your best- that trying just a bit harder will NOT solve the problem is so important, becasue people keep on giving you assvice about it all day long. I am really tired of breastfeeding counsellors, LCs and general BF advocates refusing to accept that there is such thing as chronic low supply.

(Sorry, there goes my post-traumatic breastfeeding disorder again)

8:11 PM  
Blogger Kath said...

Dear Electriclady, this post is wonderful! So much useful information, and such an important note at the end, too. Thank you for all that -- I will be checking out those ladies I don't already read.

You're so right about everything -- also about the power of discovering a community of pumpers/BF sufferers. It's very much like the rush of discovering IF blogs so many moons ago.

11:02 AM  
Blogger Anita said...

Great post! I'd like to link to is if that's OK.

I only have one boob affected by low supply and posted about it's troubles and hopefully a soulution.

I have noticed that several of us in the IF community have had trouble with supply issues and mentioned to to my lactation consultant. She said she noticed that a lot of her clients with supply touble have had some help conceiving in one form or another. Make you wonder.

10:23 AM  
Blogger TylerandBrianne said...

I did not blog about pumping but would like to say that I pumped exclusively (dd could not nurse) for 16 months. I bf my oldest ds for 1 year. I had supply issues and had to take dom. I wish lactation consultants would not tell mothers that all women make enough milk to feed their babies. Many woman with PCOS do not make enough milk. They think that with PCOS hormone levels attribute to milk ducts not forming properly in puberty. Oh and until my milk comes in I have nothing in my breast. I starved both of my kids to death at first till I was crying and my husband gave them a bottle. It was a mess.

9:33 PM  
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3:48 AM  

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