Exclusively expressing - queries on logistics

[BarrelOfMonkeys]

I'm poised to commit to buying a double breast pump as feeding from the breast hasn't worked for us despite a lot of heartache, and I'd like to try and get my supply up so we can feed our LO on expressed breast milk however it's a lot of money and I have a few queries. I know it can be done as a friend-of-a-friend has successfully fed her baby for 12 months purely by expressing for similar reasons. Before I press the 'buy' button, does anyone have any answers to the following:

• How often do I need to be expressing - is 6 x a day enough? LO is nearly 5 weeks old.
• Does it matter how far apart the expressing sessions are, e.g. every 4 hours vs bigger gap in day and then clustering in evenings?
• How long before my supply is established in this way?
• How critical is it if one session is missed? (Can I drop one of the night sessions after 3 months/supply is established?)
• How long should I pump for - is 30-40 mins enough (15/20 mins each side)? Can this reduce over time? Is it better to alternate between breasts every 10 mins or two chunks of 15/20 mins?
• I'm currently taking 3 x 2 fenugreek caplets daily. Do I need to keep taking fenugreek once supply has increased, or until it is established?
• Should I be aiming for same volume of milk in oz as per equivalent of formula?

Thanks in advance if anyone has any answers or experience to share...

Hey Barrel me again

How are you and lo?

*I would start with expressing 8 times a day if you can to bring your supply up to the max.

*Actual spacing not that critical, but make sure there is a late evening, a middle of the night and an early morning one.

*No idea sorry

*As a one off a missed session will make you full and uncomfortable, if you miss out a session everyday your supply will reduce. But you may still make enough depending on lo's needs.

*30-40mins is very long. If you want to express exclusively you really need a double pump. Express until the gush slows to a trickle, pause for 60secs, pump again until it slows to a trickle then stop.

*no idea about fenugreek

*babies tend to take a bit less in terms of ounces of bm versus formula.

a friend who expressed almost exclusively found this site helpful

My LO is 14 weeks, and is fed almost exclusively with ebm as bf isn't very successful, and is mostly for comfort now. My info mainly comes from the John Radcliffe bf clinic in Oxford, though some is personal experience and may differ from you.

JR advice is that you need to pump 6 times a day, but there's no need for one to be at night. If you have spare milk, and anyone to help, get someone else to do the night feeds and only to wake you when the last bottle is gone - sleep is essential to successful expressing. Expressing too often can make your boobs sore, so try not to do it more than 3 hours together. Lansinoh is still important, as expressing can be hard on your boobs, too.

You don't need a routine as long as you pump 6 times daily - babies are best demand fed, after all. But DO pump off both breasts, and pump until you aren't getting any more milk. You can pump one till the flow stops, then the other, then the first and then the other again. Your boobs still work on supply and demand, and your freezer will be there for any excess, so empty the boobs and thereby place the next order.

Don't use formula as a guide to bm, as it takes twice as long to digest formula because lots of it go straight through! So they theoretically need a lot more formula than bm, as so much more gets excreted. Having said that, my son is a greedy chap and snarfs far, far more than the bf norm. Basically let your baby eat what s/he wants and on demand, and you'll soon work out their appetite (though even then he can vary hugely in what he wants, feed to feed).

I posted what I've found helps me supply-wise near the end of this thread and so did another express-feeding mother, whose points I totally endorse as well.

Fenugreek can be taken as long as you feel it helps, I still am, but I have to admit I couldn't face blessed thistle tea (still in the bag...). I know other people use Domperidone, too.

I'm starting to think there should be a MN support thread for us lot - seem to be a fair few, quietly expressing away.

Forgot to say that breast compressions/massage help a LOT. I'd start with double pumping, then convert to single and use the free hand to compress/massage. And pumping works heaps better when feeling calm/happy, too. DVDs can help - they distract nicely!

Oh - d'you need guidance on storage etc.? There's a thread on that, too (MN is a goldmine).

I expressed (exclusively) for my first for 6 months. DS was a lazy suckler and lost a lot of weight.

I had an advent manual pump. I initially expressed the same number of feeds and ended up with a fair bit in the freezer as I was feeding less than each express and splitting it down. Over time found I could get away with 4 sessions of expressing a day if I swopped the bottle half way through.

It would typically take about 15-20mins to express.

I know that I was very distressed by DS not suckling in the early days but it did turn out to have a couple of advantages....I could go out over a feed period, I could have a drink on special occassions and use stored milk for the next couple of feeds whilst throwing away mine (encase any alcohol), occassional middle of the night feeding off.

DS2 was another story all together latched on when born and I barely got him off for 6 months.

I exclusively expressed for 18 months. It is not easy but it can be done. There is a book called Exclusive Expressing that you can get from expressyourselfmums.co.uk, along with all the other things you might need.

TBH I am surprised at the JR advice to do 6 times a day and don't worry about the night. Everything I have ever read - which is a lo - suggests that 8 times is more like it and that the nights are very important in the early days. I certainly noticed a big dip in supply when I dropped the night express at 6m.

I think a lot of it comes down to individuals. I find it very easy to express and as long as I kept the night express going I got more than I needed with 4 -5 expresses. Other people find it more of a struggle and would need to do it a lot more often. Of the people I know who did it I would say that every 3 hours during the day and once at night was about average.

It is a good idea to have an initial 48 hour expressathon, every 2 hours round the clock, in the way that a newborn would feed. That should kickstart your supply. Then evet 3 hours invcluding one at night, and then dropping an express and monitoring output to make sure you always produce a bit more than you need - to allow fir wastage and to put some in the freezer for emergencies. I found that a godsend when I was admitted to hospital for 4 days.

Will post more later, DS calling!

Qally who advised you at the JR? Because I was advised there to pump at night and it both gave lots of milk at the time and almost doubled the amount I pumped at the next session.

Sally Inch did? I get 440 ml now at the 8 am expressing, so it definitely worked for me. (Before that I was trying to express at 4 am as well and the exhaustion was making it more like 200ml, with 80 or so at 4am). Though I'd been expressing a while by then, and stress was probably reducing supply all by itself. The emphasis was on 6 times a day, and setting times that suited you.

Hi madmouse, and thanks! We're getting on okay, LO's weight is on the up and she's nearly back on track with the combined EBM and formula feeds. I'd like to get my supply up to feed her exclusively on EBM but still only getting between 50-70ml per pumping session so only about half of what I need at present. Roughly been doing 9pm, 1am and 5am for the evening/morning routine, getting used to fitting that round DD's feeding demands, on a good night we almost synchronise! The website you suggested is where I am looking to buy a double pump from, think I am just going to have to bite the bullet and cough up tomorrow.

Thanks Qally - that's interesting stuff. It's been quite hard to find any info or people that have just fed on EBM, a support thread on MN sounds like a great idea! The other thread raises some useful pointers, some of which I know but some are new. I'll have a look for the storage info, got a leaflet on that from our local BF clinic but they weren't too familiar with the idea of solely feeding on EBM.

Thanks both!

Oh gosh, I must have been really slow typing my last post - lots more posts to read through now...

Thanks all. I think it sounds like I need to cut back the length of time I spend expressing and up the number of sessions, at least for a bit. I don't find expressing a problem as such, about half of the amount I get in a session gushes out in the first 2 mins on each boob, and then it starts trickling out, so I'll try switching breasts more often with my current pump (I tried the Avent Manual and it made me much more sore than the electric Mini Medela, although interestingly I get the same amount of milk in the same time whichever of those pumps I use). Shouldn't be a problem with the double pump I guess, if I just have pauses as Madmouse suggests. I dream of making 200ml in one sitting!

Good to know there are others out there who have made it work, thank you!

Qally Sally Inch is gospel in my book! she is fab.

I was told by ds's nicu nurse and by the scbu bf counsellor, and it worked for me

guess it can be different for different women.

I think maybe it was because I was already established, and that by then sleep/stress mattered more than that night session? Though I do think it varies a lot from woman to woman - double pumping, which everyone says is the gold standard as it increases hormones, never worked as well for me as single pumping, using compressions. And I tried 2 hourly pumping at the start, and it slowed my supply because I was so tired and anxious - thoroughly pumping every 4 hours worked much better. So it probably is very individual.

Was your SCBU bfc the JR one, too? I love her to bits too - I was put through to her when trying to find someone who could help me (we aren't local), and the JR bf clinic was shut over Xmas, and she was also wonderful beyond belief. I wish Addenbrookes/the Rosie had even one staff member as good on bf as those three women - I'd seen a slew of people locally, none of whom had done much of use.

Sally is so, so wonderful - once she stood all hunched over for 20 mins, with her finger protecting my nipple, so he could feed without macerating it when screamingly hungry. Another time she stood, wiping the tears away, so I didn't have to unlatch him while I cried! She was amazing. Not just in terms of expertise, but understanding and kindness.

The bfc is called Sue. We left scbu a year ago and I have forgotten her surname. Will see her tomorrow as ds goes for review with his consultant. She does the weighing in clinic.

Sally kind of cancelled clinic and came to my room in the JR when i was looking at this pump longing to hurl it at the wall. My ds was in nicu, no one was prepared to tell me he would live, I was trying to express but he was not allowed to have my milk as they did not know what was wrong.

Sally was very down to earth, told me to express when i could, not to exhaust myself, prioritise visits to my ds and ignore things I had been told about adjusting the speed of the pump to mimic a bay. 'It is not a baby it is a pump. But it will get the milk out'.

I bf until 11 months!

Qally, I think you must be local to me if you're familiar with the Rosie! Are the JR people happy to talk to non-Oxford people? If so, I may give them a call.

It is cheaper to buy your own pump than to rent it.

The Ameda Lactaline is v. sensibly priced and very good. It works as good as a hospital grade pump which I have used.

You need to pump at least 8 times a day at roughly 3 hr intervals around the clock.

Fenugreek and domperidone will only have limited effect. What makes you make more milk in the long run is the removal of milk. so setting up a routine is crucial.

No matter how great you are at expressing, your supply will slowly diminish and you will have days when you will have to 'cluster pump' or 'power pump' in order to rebuild your supply. So you will have to have a plan to accomplish that.

You do not need to wash the pump after every expression. I used to wash mine once in the night with hot soapy water. That is it. Between pumps I stored it in a Ziplock bag in the fridge.

If you use breast compressions near the end of the flow, you can get a bit more milk out of each breast. Also, if you go back and pump 10 mins later, you'll get another letdown.

It can be mentally difficult to sustain this routine and having someone to talk it over with in the dark times is helpful.

There is a little book called 'Exclusively Pumping' I think, available from Expressyourselfmums.co.uk. It is a great read. It was written by a mum who expressed for a year and it covers the physical and psychological aspects of exclusive expressing.

power pumping: pump every 2 hrs round the clock for 2 days will boost your supply as it is mimicing a natural growth spurt. Enlist friends/family to help look after your baby.

cluster pumping: pump for 5 - 10 mins every 45 mins for a few hrs every few days. (you only need to wash your pump every 4 - 6 hrs)

you may already figured this out but also, when your flow is slowing down, feel your breast for the pea-like structures which are actually milk sinuses. If you hold your breast in a C between your thumb and fore fingers where you can feel the milk, it helps to drain it better when the milk flow is slowing down. .

Barrelofmonkeys, they are happy to talk, & happy for you to just go, too. They're wonderful. Sally or Chloe can both help - they're there on Mondays and Thursdays. They're light years ahead of any of the support I had locally, in terms of bf. And if you live anywhere near the Black Cat on Mill Road, and want to meet for a coffee, we could do that too?

I also have an Ameda Lactaline, which is a good pump. You can double or single pump with it, which is very handy. The clinic has a variety, so if you did go and wanted to try different makes out to see which suited you, I expect they'd be fine with that.

Challenge pumping didn't work for me, but I know it does for a lot of women. The main thing that's helped my personal supply is relaxing, and being consistent about pumping. You'll get to know your own body and what suits you if you experiment. Trust your instincts.

haven't read all the answers - but I expressed for my twins til 9 months - never quite got enough and topped up - but still they were mainly fed this way.

Fenugreek - play it by ear - if you have no problems with supply then try reducing it.

Double pumping is more effective - and stick ot max of 30 mins per session - 20 might well be enough.

Stick to regular times - 3-4 hourly and try and keep the night session up for a while - that stimulates supply a lot.

Volume - yes aim for up to 9oz per feed - although mine rarely took that much.

by the way - keep trying with breastfeeding when you are both feeling relaxed - my first didn't start getting the hang of it until at least 4 weeks.

If you can crack it then it is really so much easier than expressing.

Thanks, I've taken the plunge and gone for the Medela Pump In Style so hopefully that'll do the job. I'm pumping every 2 hours today but it seems to be just getting half as much per go as I usually get when pumping every 4, yet taking a good 20 mins to get there. Hoping the boobs will catch up if I continue.

Qally - I know Mill Rd well! A coffee would be good, when suits you?

don't stick with every 2 hours for long - just a day or so - to stimulate supply - and then cut back a bit.

One tip - don't worry how much you get - stressing about it always reduced supply with me !

Thanks Qally, have emailed you.

Throckenholt, thanks for the tip!