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Sole expressing - how to ensure sufficient supply?

(36 Posts)
BoyMeetsWorld Wed 13-Nov-13 17:24:50

Hi everyone,

Due to v personal reasons, I cannot bf when baby comes in a couple of weeks. As I fully appreciate the nutritional benefits of breast milk, I'm going to try expressing as much as possible.

Please could anyone with experience of this share any tips / advice they have about relying primarily on expressed breast milk for baby - how to get supply going from the moment of birth & keep it going. Ideally without resorting to skin contact with breasts or I'd be able to just bf in the first place!!!

Particularly interested in those first few feeds in hospital & how to stop supply drying up.

Thanks in advance!

Bejeena Wed 13-Nov-13 21:41:37

Well my story is as follows, my baby came 4 weeks early and was too small to be able to latch properly, we tried everything but he couldn't latch and we had an awful start to breast feeding.

I started to express straight away but from the start (my milk late coming in, possibly due to things being messed up as he was early) I was never able to express enough to exclusively feed my little boy. I was expressing every 3 hours for 20 minutes each side and it was soul destroying. I think to get supply going you have to do this and more. Sadly my supply never seemed to catch up and even though in the end my baby did start to latch properly and i can breast feed now I was never able to produce enough milk to satisfy him and we have been topping up with formula.

In my opinion expressing is extremely hard work and as I said for me it was soul destroying.

Do you intend to solely express for a long period of time or is this just for first few weeks before switching to formula? In my experience solely expressing is so hard, you have to be on that pump every three hours and if your baby is crying and needs comforting and you are alone then that is very difficult. Personally I wouldn't recommend it.

LadyMedea Wed 13-Nov-13 21:47:39

I'm afraid I'm about to have my first so no direct advice. If I were you I'd get in touch with the Breastfeeding Network, La Leche League etc and ask if they have a breastfeeding counsellor who is particularly knowledgeable on expressing.

You can also take inspiration from this post www.thebadassbreastfeeder.com/my-exclusive-pumping-journey-9-months-and-going-strong-by-guest-blogger-chasity/

And don't talk yourself down, you are breastfeeding! Pumping is just a different delivery system.

scissy Wed 13-Nov-13 22:10:55

I had to express after DD refused to latch and I received no practical help from midwives/HVs (other than give formula/express hmm). I had a routine similar to Bejeena in the beginning. The problem I found was that expressing is time consuming (30mins every 3 hours) and once my DH went back to work after 2 weeks I found it extremely hard to keep to the every 3 hours (or more) schedule as I had to look after DD on my own. My supply dwindled very quickly after that as I found that was what slipped when I was trying to do everything for her (and rest myself). It is certainly possible to do (I know someone who did it for her DD who had cleft palate), if you have family/friends who can help you in the early weeks with other aspects of babycare so you can build your supply then that can really help.

shivs1974 Wed 13-Nov-13 22:11:25

I exclusively expressed for dd1 for a year so it is possible. Lots of people told me that I couldn't do it so please ignore them-it is possible but hard work.
There was some threads on expressing a few years ago (2006-ish) called Expressing Clique...can't link to the thread on my phone. Lots of useful ideas there.
I also have a book called Exclusively Expressing Breastmilk that I no longer need. If you'd like it, please PM your address and I'll send it on.
Happy to answer any questions you might...it's been a few yrs as dd1 is now 8!
To prepare yourself get a double pump!

shivs1974 Wed 13-Nov-13 22:14:08

Oh and the key thing is that you will need to pump during the night for quite some time. I had a v bountiful supply (managed to also donate to a milk bank) but did pump 7-8 times a day for 6 mths. I was quite organised and am also v stubborn so refused to be defeated...I did something like 7am, 10am, 1pm, 4pm, 7pm, 10pm and during the night.

PenguinsDontEatPancakes Wed 13-Nov-13 22:22:24

I haven't done this, but know people who have.

The thing I would say is that it is far harder work than direct breastfeeding. The most important thing is to try to have people around you who respect how hard it is, how much work it involves and who are willing to pitch in with other parts of the baby care. It will take up a lot of your time, so the more help you have, the more achievable it will be.

Sadly, expressing is often seen as an easy option. You even see threads where people talk about not 'fancying' breastfeeding and so planning to express, wanting to be able to sleep a full night so planning to exclusively express, etc. I think that can mean that the help is even harder to come by than it should be. You need to ensure that none of your close loved ones have fallen into the trap of thinking it is easier, rather than harder, than other options.

The other things I think are central are a really good double pump, preferably hospital grade, and a commitment to night pumping.

Jims Wed 13-Nov-13 22:22:28

Hire a hospital grade pump - medela do them direct. I could get 200 ml in 10 mins with one which took me at least 30-40 with a medela swing. I got one as my second son was hospitalised twice v early and it was my back-up incase he refused the breast after being fed ebm in hospital. Fortunately for me, he fed fine but i kept the pump for longer than really necessary as it was just so much more effective!

MrsFuzzyBuzzy Wed 13-Nov-13 22:22:41

I exclusively pumped for my first dd for 2 weeks as she arrived 6 weeks prem and was tube fed. I continued to express a couple of times a day for the whole time I breastfed so my dh could do one of the night feeds. I started pumping in the hospital using a Medela hospital grade double pump. When we all went home I tried using a small pump I had bought and it really didn't compare - took an age and was single sided so had to so each side separately. I ended up hiring a hospital grade pump from Medela (the nct do them too) which was quite pricey but well worth it. You need to pump at least every 3 hours, which is a bind, but I managed to rig up a 'hands free' system using hair bands to hold the pump cups to my underwear (very attractive) which means you can do some (limited) other stuff at the same time. Good luck!

Bejeena Thu 14-Nov-13 10:49:21

With regards to the pump I had the hospital grade medela symphony one to start which I hired, but then I moved to the medela freestyle which is a lot more portable and you will need that if you do want to go out anywhere for an extended period of time. I found it just as good as the hospital pump and so did my friend, who also solely expresses.

Regarding hands free, medela also do a bra that can hold the bottles, it does look very silly but my friend used it and is very pleased with it as she can check emails etc whilst pumping. However this also depends on your supply, if you are unable to produce a lot it might not be a good idea to do other things whilst pumping, this what my midwife told me.

MightilyOats Thu 14-Nov-13 16:14:11

I would second the hospital grade double pump - DS had tongue tie so ended up pumping for a few days to give things chance to heal a bit, domestic pumps are noisy and take forever and only do one side so you end up with milk dripping from one whilst you pump from the other. Had to pump a couple of times in hospital for one reason or another and the pumps were amazingly quiet and efficient smile good luck op, also second the advice ^ to make sure people know you are going down the difficult route, not the easy route.

Inglori0us Thu 14-Nov-13 16:56:33

My advice is to keep trying different things if it's not working. I rented a hospital grade pump but it didn't really work out for me. The best results I got were with an Avent manual pump in the end.
It is hard work as you have to be strict with yourself to get supply going and keep up with demand. Also the sterilising is a pita.
Get breast milk freezer bags.
Be prepared to top up with formula if you have to, even if it's a temporary measure.
Benefits are that you can know exactly how much your baby is taking in and that other people can do some feeds to help you out.
Eat loads. Drink lots of fluids.
As a very wise paediatrician said to me "feeding your baby is more important than breastfeeding your baby".
Good luck! And remember that it all counts, even if you need to top up. xx

UnderCoverChristmasElf Thu 14-Nov-13 17:22:42

Sorry mini hijack - will/do the hospital rent out the hospital grade pumps?
If not where do you get them from??

Have b/f before but not done much expressing but expecting twins and interested in this as it may be necessary.

Best of luck OP and sorry for hijacking your thread.

tia

Inglori0us Thu 14-Nov-13 17:36:08

Elf I rented my pump from an NCT lactation consultant.

lotsofcheese Thu 14-Nov-13 17:40:30

I'm another who has expressed due to 2 premature deliveries & wouldn't recommend as a feeding method. It doubles the workload! A new baby is hard work for everyone, but you will spend ALL your time expressing, cleaning equipment & feeding baby. If you think that baby will feed 2/3 hourly & you have to express that often too, it leaves no time for anything else. I found getting up for a baby was fine, but setting an alarm for a pump was soul-destroying. I also found I literally didn't have time to ENJOY my baby, which is very sad, in hindsight.

If you still feel this is the way for you, I 'd agree with others re: a hospital grade pump with double-pumping facility. I used an Ameda Lactaline. My unit/hospital did not hire them out. & it cost over. £100 to buy the pump, but it did last the course.

It.'a possible to start collecting colostrum pre-delivery, maybe discuss with your midwife? You can start expressing into a 1-2ml syringe after delivery. Both times it took me nearly 1 hour to get 1ml. It 'a painstakingly slow to start with. Once my milk came in, within 2-3 days, I switched to a pump & gradually built up.

Many of the NICU mums used domperidone on prescription to improve supply.

Good luck! X

PenguinsDontEatPancakes Thu 14-Nov-13 17:49:12

Don't know about other sources, but as a pp said, the NCT hire them out - NCT pump hire

PenguinsDontEatPancakes Thu 14-Nov-13 17:50:03

Sorry, that last post should have been addressed to ChristmasElf

MrsSpencerReid Thu 14-Nov-13 17:51:35

I used medela swing and ameda lacteline, the ameda was the best as you can double pump, they were about £50 in eBay when I had DS April 12 and if I need to pump again I will be getting one!! Pumping is not an easy option ime good luck and enjoy your baby

Andcake Thu 14-Nov-13 17:56:00

I exclusively pumped for 4 mo then mix fed til 6 with bf from pumping. I actually preferred a avent hand pump as it meant I wasn't tied to the mains and I produced more as it wasn't as depressing as the noise of the pump.
I only did it as ds refused the breast and was hospitalised due to losing weight hmm
Hated pumping - but didn't because of the benefits of bm
You need a lot of support eg dp feeding baby in night whilst you pump. I lost the plot a bit around 4 mo when ds slept through and I had to still get up every 3 hours in the night!
It also means you are a bit housebound unless you take pump out with you. So think pump leave house then only 2.5 chunks before having to return to pump and scheduling everything around pumping. I also found spending more time pumping than cuddling baby hmm
Also when ds would cry if he wasn't held I would have to balance it all - in the end he won over pumping- I stopped doing even a little at 6 mo as weaning as well would have been tricky.
But I am proud I did it - take each milestone eg 6 weeks as a target and make sure everyone knows how hard it's going to be - you will need their support. I wish ds had been able to bf hmmhmmhmmhmm and I hate being judged for having to ff as I couldn't hack pumping longer hmm
Good luck

BoyMeetsWorld Thu 14-Nov-13 18:04:25

Thanks everyone. For those who have said not to feel bad about topping up with ff - wouldn't that make my supply stop totally though? If for example I pumped during the day & ff at night, would I still keep producing enough milk? So confusing!

48th Thu 14-Nov-13 18:21:52

Hi boy... Yeah bm in day and fm at night wouldn't work. That said I don't think every expresser finds it harder than direct bf just different. It is tying but then so is bf.

A reasonable plan would be-

Hand express colostrum 12 or more in 24 hrs until milk comes in .
On day 3/4 to switch to hospital grade double pump and express at least 8x24hours leaving one larger gap of no more than 5 hours
Continue this for 2 weeks aiming to express 1 litre of bm per 24hrs by day 14. (750ml is fine but keep going Hangul you hit 1litre putting in more sessions if needed)
Continue expressing 8xdaily with no gaps larger than 5hours and getting around 1litre a day for the next month.
You will now be able to reduce expressing sessions and or have bigger gaps. This varies woman to woman with some still needing to do daily every 3/4 hours but less at night to just 2 sessions being needed.

Good luck

48th Thu 14-Nov-13 18:26:14

Oh and no need for domperidone for supply if a normal term delivery, the best thing you can do is pump more to boost supply.

badguider Thu 14-Nov-13 18:35:37

Am I right in thinking your personal reasons also mean you won't be able to accept mw help with hand expressing in the first days?
This might be your biggest problem. I'd read up on how to do it but it wasn't till a mw tried that I found my milk ducts are a lot closer to my nipple than in the diagrams. Nevertheless I suggest you read everything you can find on this if you can't accept physical help (you will need to hand express colostrum the first days before your milk comes in).

Also think about how you can manage some "skin to skin" as it REALLY helps the hormones. Can you do it with a bra on? Think about what you can manage and not manage beforehand but the more bare your chest can be with the baby lying on it the better.

Good luck.

NomDeClavier Thu 14-Nov-13 18:36:55

I would seriously look into buying an Ameda Lactaline. I didn't exclusively express but I went back to FT work at 4 months and it would have been impossible without a good double pump. If you plan to keep it up then buying is cheaper.

You need to pump very often and definitely at least once between 1 and 3am, starting just after birth. You may find hand expressing is more productive in the first few days but I appreciate that may be difficult for you. You can hand express colostrum and freeze it beforehand. I am currently expressing and freezing ahead just in case I need a CS under general and can't BF straight away (epidural unlikely to work on me and no donor milk available).

Read up on when typical growth spurts are and replicate that feeding pattern by cluster pumping or extending sessions even if you aren't producing milk. Your body will need the pattern to be mimicked as closely as possible.

Skin to skin is important although it needn't be on the breast. Would you be comfortable wearing a bra and having baby inside your top/in a sling?

You'll need to be careful about positioning the pump to ensure the whole breast is drained and no ducts are getting blocked by the funnels etc. Blocked ducts and milk blisters can still happen when pumping.

I assume it's some kind of abuse or assault that makes you feel this way (forgive me if I'm wrong). I just wanted to say I supported a lady with a similar history who found that the mother-child relationship was totally different and she was able to BF directly. I only saw her later when she was having problems with recurrent blocked ducts but she told me a little about her BF journey. I don't want to minimise your feelings but birth does funny things. She hadn't intended to BF at all.

Good luck!

Mandy21 Thu 14-Nov-13 18:38:49

I had to express for my prem twins and my two pearls of wisdom are 1) the night time expressing is REALLY important and 2) you need to be eating lots too (rather than just drinking lots which is what most people think is the answer).

It was written all over the hospital / SCBU / recited by every midwife / nurse I came across that the optimum time to express and stimulate your supply is 2-3am. I have no idea why, but they were adamant about it. I agree that it is hard work getting up in the middle of the night when on the face of it, there is no crying baby and no need to, but it really makes a difference.

There are lots of ways you can help the milk flow to make sure you get good amounts - completely agree to hiring a hospital grade pump (I also used medala), saved so much time, breast milk freezer bags, a cold water steriliser (found this much easier - could just get items out in the night), lots of photos / things that smell of your baby when you're trying to express, shower (although appreciate you're not going to get in the shower every 2 hours) but certainly in the morning. I also used to express whilst I was feeding - it is a juggling act but if you can manage to arrange the pump hands free, this often works.

I agree its hard work - so good luck. Don't be put off if you only get small amounts at first, I used to sob when I got 2 or 3ml about trying to express for 20 mins and thought there was no way I would ever produce enough milk for twins (without top ups) but I did eventually.

lottiegarbanzo Thu 14-Nov-13 18:54:16

It's possible, I did it for seven months.

Get a good double pump or it will take forever. I used the Medlea Freestyle, as buying it cost the same as renting a symphony for six months-ish and we can sell it on.

You just start off sticking to an 'every three hours' schedule to get your supply going, then, after two or three weeks, you can relax it a little bit, so go for a longer period at night.

If your baby needs more to eat at the beginning, a little bit of formula is ok, as you're still expressing as much as you can and increasing supply, it's not like bf where ff usually means not extracting so much from you. It's very reassuring to know you do have enough food for the abby, whatever happens to your timing and supply that day.

I expressed seven times a day for a few weeks, then, once well established, 6 or 7 and was producing about 1.4 litres a day - more than enough, I froze some.

If your timing gets pushed back once, it quickly becomes impossible to catch up, so having that bit of leeway, accepting 6x a day, so that a four hour gap was ok and five or six hours at night, made it much more relaxed.

It is tricky practically because your hands are occupied and you're probably fixed to the spot, so you can't do much with your baby, which is one reason why you need the most efficient equipment possible.

Bouncy chairs and singing helped a lot. Also routine and the normal process of learning to read her signals and work around her. At least when they're tiny they can't move and ten mins of crying isn't the end of the world.

lottiegarbanzo Thu 14-Nov-13 19:14:32

Interesting about the 2-3am thing. I was up then to feed dd for months anyway, so expressed too, even if I then slept for five or six hours.

BoyMeetsWorld Thu 14-Nov-13 19:46:51

Some more really good advice, thank you smile

I'm particularly interested in the idea of starting expressing before birth - how easy is this to do, how do you do it / store it and when could I start ( I'm due in 2 weeks). Nom is totally right - I wouldn't be able to accept help from the mws, can't even stand my DH or son to be anywhere near my boobs so would probably go to pieces if a mw tried!!! If I could get enough ready beforehand to last while in hospital that would help massively.

Nom - unfortunately, I'm not expecting to suddenly feel differently at birth - already got one DS who I did actually force myself to bf for 3 months but the experience nearly destroyed me and took months to get over. Totally ridiculous situation. So have been advised not to put myself or baby through it this time, ESP if I can manage to express enough.

The 1-5am pump doesn't worry me too much - I'm a naturally restless sleeper and tend to get up a few times per night (around 3 or 4am generally so hopefully this would do for my pumping session). If baby wakes then too DH will just have to do that feed whilst I'm pumping. I'm more concerned about the logistics during the day - ideally I'd like to bottle feed baby EBM at same time as pumping but can't see how to juggle both!! I've got an avent manual pump & a medela swing electric?

I can do skin to skin with a bra on & baby in a sling I think - so long as baby doesn't try to grab or touch my chest when he gets a bit bigger hmm I'll just have to try it & see if I can cope. Fortunately I'm fine dealing with them myself so manual expressing may be ok - hard to tell until I try.

Thanks lots for all your advice - there's so much info out there on bf or ff but so little on expressing except as a top up

NomDeClavier Thu 14-Nov-13 20:01:55

You could start now. I express into a sterilised small bottle and then suck it up with a syringe before freezing it in my chest freezer. You will still need to pump or hand express in hospital. Getting the technique sorted now will get you off to a good start though.

With a double electric and an adapted bra you could probably feed and pump at the same time, although it might not be the most comfortable!

Inglori0us Thu 14-Nov-13 20:13:41

I gave formula top up after each bf & ebm feed. I wasnt producing enough or she wasn't feeding properly so we had to top up. As long as you're regularly expressing, it doesn't matter when you give ebm or formula.

BoyMeetsWorld Thu 14-Nov-13 20:15:39

Thanks Nom that's brilliant - I just has an experimental squeeze after shower & there is some there so will start. Daft questions but: will just any syringe do the job? Presumably it's going to be teeny amounts so if I do multiple times in a day can I just mix it all together & won't the air that gets into it via syringing be bad? Also if I store it in my freezer until birth how do I take it to hospital?

Thanks loads!

UnderCoverChristmasElf Thu 14-Nov-13 20:17:00

Thanks all for help and links = appreciated
Lots of good advice here - again, good luck with it all OP
smile

LadyMedea Thu 14-Nov-13 21:00:40

If you haven't unwrapped the medela swing you could send it back.... Probably not best for exclusive pumping. Ameda Lactaline is a similar price and a double pump (and a closed system so more hygienic).

lottiegarbanzo Thu 14-Nov-13 21:12:26

Sleepwise I found getting up for an hour at 2-3 (dd would wake, so feed her, nappy, back to sleep, express) was fine and got used to it. In fact sleeping 7 / 7.5 hours a night with an hour gap in the middle was much better for me than six hours straight through, which for me is not enough.

Must be to do with natural sleep cycles - I think they are 3 to 4 hours and if you wake in between it's much better than waking in the middle of one.

Those night time logistics were easy and often dd went back to sleep in the sitting room, I expressed, then we both went back up. Day time was trickier, which is why not stressing out if you get a bit delayed is important. Being as calm and relaxed as possible does help the milk come out.

NomDeClavier Thu 14-Nov-13 21:14:35

I have 2ml and 5ml oral syringes. You should be able to buy them from a chemist.

If you're storing then follow guidines for BM - up to 24 hours in the back of the fridge - but you could use a tiny bottle to get as much as you can over 24hours and put a screw lid on each time then syringe it up. It depends how much you get at a time really.

lottiegarbanzo Thu 14-Nov-13 21:18:31

Oh yes, in my very limited experience, hand pumps were worse than useless (hand expressing worked better). You really need a double pump if you're going to see this through. The more expensive ones are more powerful too, so quicker.

Really, I can see the idea of pumping with one hand, holding and feeding the baby with the other seems nice but, you'll be there for 25-30 mins and your timing won't always coincide with feeds. Getting it all done in 10-15 mins is so much easier.

When dd was tiny she could lie on a cushion on my lap while I expressed. The sound of the pump is quite calming I think. Then, bouncy chair, playmat etc. I stopped around the time she started crawling, or things would have got more interesting!

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