What I Didn't Know

There are many things that took me too long to learn about breastfeeding. Some things I'm still learning and I'm sure I will continue to learn. I have spent 16 months and one day nourishing my son with my body. I'm a first time mom and while my own mother breastfed my brother, I have no memory of this. Before I breastfeed my son I have only witnessed 2 people breastfeeding that I can recall (with the exception of photos, TV and movies - more on that later). This little exposure I had to breastfeeding didn't deter me from trying it myself, but it did mean I didn't know anything about how to do it. I also didn't know what I didn't know.

About halfway through my pregnancy I received one of the worst pieces of breastfeeding advice I've ever heard. I was at my midwife's office, waiting on a regular check-up and I mentioned to whomever was with me that my breasts and nipples were itchy and sensitive. And that they were driving me crazy.

One woman suggested a body oil that really did work wonders and make everything feel a lot better. Another woman had a different approach. She was older, probably had been past her child bearing years for a while.

"You're going to want to toughen your nipples up if you want to breastfeed," she said.

She recommended a brillo pad or scrubbing vigorously with a coarser luffa. "They're going to hurt when you feed your baby so you want then numb to that pain."

I took her advice for a couple days. Then stopped. If breastfeeding truly did hurt, then I didn't want to also hurt my breasts this badly during pregnancy.

This is where I found out that common and normal are not the same. Nipple and breast pain during breastfeeding are common. But it almost never normal. Pain, especially after those first couple of days, is often linked to a bad latch. Baby may need a different position or baby may need a chiropractic adjustment. There could be a tongue and/or lip tie involved. When pumping you may need a different size flange or lubricated pump parts.

Breastfeeding doesn't have to be, and what's more, shouldn't be painful. If it is, reach out for help! Lactation specialists are vital if you're in pain. They can help find ways to reduce or eliminate pain, prevent thrush, mastitis and a host of other issues. Please, please, please don't roughen up your nipples by using a brillo pad.

Another thing I didn't know, or didn't know well, is that breastfeeding is a supply and demand game. Think of it like the ice maker in your freezer. If you don't empty the ice bin, it won't make more ice. If you empty it halfway, it will fill half. If you empty it into a separate container, the ice maker will fill the container. If you don't clean it out frequently enough it could get clogged. When I read this analogy from somebody's husband, it made sense. I'm not saying that supplements and certain foods and hydration don't help, because many moms swear by them and I think anecdotal evidence has its place, but milk removal = milk production. There are always exceptions to the rule. There are moms who have insufficient tissue or glands. There are moms who over produce and end up with clogs. There are moms who have other stressors that impact supply. And always remember that pump output does not equal supply. Baby is almost always going to remove milk more effectively than the pump. 

Another thing I didn't know: you do not have to have 1,000 ounces in the freezer. I had at most 40 oz, usually though, about 20. I do still wish I would have had more because I thought about ounces and bags ALL THE TIME. Once I realized I would never be able to donate to other mamas and babies, my goal was 100 oz in my freezer for myself. That way if something happened there would be a few days of milk for my little guy.

Try not to stress your stash mamas. That's hard advice to give and even harder to follow. But my baby from 3 weeks on never once needed formula. And those 3 weeks were to help with more fluids for jaundice.

What else was news to me? Did you know babies often eat more often than 8-12 times per day. That "every two hours" may be every 90 minutes. Or every 45. Or 4 hours of cluster feeding.

I'm not saying this to scare you or turn you off from breastfeeding, but to let you know that this is not only common, but normal. And it does NOT mean you have an inadequate supply. Babies have tiny bellies and breastmilk is easy to digest. It's why they pee and poop so often.

One more thing I didn't truly know. How absolutely beautiful and rewarding and amazing and exhausting and awesome if was, and still is.

World Breastfeeding Week: What's the Deal with Pumping?

"Pump up the volume, pump up the Jam!"

"Pump, pump, pump it up, P-U-M-P."

"I'm going to pump, you up."

These are all things I would say or signs I would hang in those early months of pumping at work. It's a little bit awkward to say "hey I'm going to go hook these things up to my breasts that attach to a motorized pump that will suck milk out into bottles." So instead I would deflect with humor. 

I went back to work 8 weeks to the day after my son was born. It was a Friday, which I chose on purpose so that I would have one day back at work, then two days off, before starting my first full week back. I will tell you this, I was not ready to go back at 8 weeks. No, I'm not talking physically. Many women aren't physically ready to go back after their maternity leave, regardless of the length. I felt relatively normal, physically speaking, within a handful of days of the birth of my son.

I wasn't ready not to be near him. I wasn't ready to spend 10 hours away from him 5 days a week. Nearly 16 months later, this is still something I struggle with. But that's not what this post is about. This post is about the expression of milk via pump.

I pumped part time and latched/nursed the rest of the time. Our schedule in those early days of returning to work typically was 5 a.m. feed, get ready for work, 7 a.m. feed, 7:30 drop baby off 8:30 arrive at work, 9:30-9:50/10 a.m. pump. 11:30 pump, 1:30 pump, 3:30 pump, 5:35 nurse, 7:30 nurse, 10 p.m. 1 a.m. 3 a.m. You get the picture.

Rinse and repeat. Monday through Friday. Sometimes I would pump at 11 p.m or 5:30 a.m.

On the weekends those pumping sessions were replaced by latch feeds. Occasionally I would pump once or twice on the weekend as my little boobie monster allowed.

As I said in my last blog post, I had it in my head that in six months time I would pump enough excess milk to have another six month supply and I would be able to stop latch feeding my son at 6 months old. For more on how and why that didn't happen, check out that post.

Long story short I had to pump all the way to his first birthday. Plus a few weeks to slowly wean down pump sessions. What started as 4 sessions during work turned to 3 during work plus 1 on the drive home to 2 at work and one while driving, to one at work and one while driving. To one at work. To none at work. To none. I haven't pumped in 3.5 months. He's been weaned from the bottle for 3.5 months as well.

I selected my first pump by literally going with the only brand I had ever heard of. My first, insurance-provided, pump was the Medela Pump In Style Advanced. Commonly known as the Medela PISA. I not-so-lovingly referred to it as the PISA shit.

It's a fine pump. It's not awful...I guess.  It was loud, bulky, not a closed system, moisture got into the tubes. But it did its job...for a while.

I struggled with pump output. I say pump output and not supply because my supply was adequate. I made enough to feed my baby but responded to the pump less well than if my baby had latched for those sessions.  If I needed enough for four feeds I had to pump 5-6 times.

I was sick of not being able to take work calls while pumping (I typically preferred to work during my pump sessions for a variety of reasons). The sound of the PISA was not pleasant and I found that the tubing would come off the pump or I would lose suction.

Overall I was underwhelmed by my pump.

On all the breastfeeding support and mom groups on Facebook women raved about their haaka pumps and how they built a snazzy little stash in their freezer using just this silicone pump. They are worth the investment since they are very low cost…but they didn't do anything for me. Haaka style pumps are silicone "pumps" that use passive suction to catch the let down on your opposite breast while you nurse your baby. For moms who leak or have stronger let downs they catch milk that would have soaked your bra or nursing pads.

But I never leaked. I used a nursing pads exactly once because I just thought you needed to. That all women leaked. That I would have ounces going to waste. 

Even when I forgot my pump parts and went 8 hours without relief, I never leaked. So the haaka would get .5 oz to an ounce sometimes for me, and I would use that to rub on ouchies (both baby's and mine) but I never collected enough for feeds. Still, it cost me maybe $20 for both silicone pumps and accessories so it was not a wasted investment.

Then I bought the Medela Harmony hand pump to have at work for days I forgot the parts I needed or if power was out, etc. I actually responded quite well to it, but you can only do one side at a time, you can't work while doing it and boy did my hands get tired. I broke this hand pump so I also bought a Lansinoh manual pump and I definitely plan to have a hand pump for the next baby because I found it mimicked my son's suckling quite accurately.

I also purchased the Baby Buddah pump. It's nice because it's small, chargeable, quiet(er) and powerful. I didn't notice an increase in pump output but my pumping time went down by a third and I could pump while driving or walking around the house, so it was worth the investment for me.

The point of this information is this: women who pump at work are badass (I'm not saying you aren't a badass if you don't pump at work). They are giving up time, and often pay, to provide nutrition at its best to their child. They are dealing with flanges that don't fit right, swelling, chaffing and discomfort (heads up, while common, this isn't normal and you should get sized by a professional). They smell like milk. All. The. Effing. Time. They have milk stains on their clothes. They have dried milk on their car seats and their steering wheel. Their desks. Their phones. They lug pump bags and purses and coolers and lunch boxes and diaper bags and bottle bags in and out of the car every freaking day.

This is a pro tip to all you employers out there: you want a pumping mama on your team because she does something that's challenging, and difficult, often without seeing the positive outcome daily, for the long haul. She doesn't give up on those long projects. She works hard. She's dedicated.

It might seem like an inconvenience that her door is closed a few times a day, or that her meetings are scheduled around what her breasts are telling her.

But women who pump have kids who are sick less frequently. Women who pump are also meeting their breastfeeding goals, so postpartum depression risks are decreased. A woman who pumps is also at a reduced risk for breast cancer.

Babies who are breastfed (this includes babies drinking expressed milk) enjoy health benefits for years, even decades, after breastfeeding ends, even if they weren't breastfed for a long period of time. The longer the baby breastfeeds, the more long term those benefits are. Meaning the future workforce will be one with lower healthcare costs and fewer sick days.

Pumping at work means not getting to eat lunch with friends or run errands on your break. At least it did for me. I wanted to give up probably once or twice a month for the entirety of that year-ish that I pumped at work. And if I'm being honest, I do not miss pumping.

But it was worth it in every single way. Andrew has never thrown up. He's spit up maybe six times in his life. Maybe we are lucky but I like to think his tummy was, and is, a happy one. He's had a few, short-lived colds. One ear infection and a couple low grade fevers. But on days he didn't want to eat and getting him to drink was a challenge, I knew he was getting fluids, calories and nutrients from his "mik" as he so loving calls it.

Pumping at work is HARD, but with the right support, knowledge and education you can do it. I promise.

Our Journey

When I was pregnant with my son, my breastfeeding goal was 6 months because that's the minimum recommendation by the American Academy of Pediatrics. My plan was to latch feed and pump for 6 months and that I would have enough pumped milk in my freezer to last him until 12 months. I would then use up whatever we had left over in the freezer and switch to whole milk.

And God chuckled at my plans.

Our first 2-3 weeks was rough with AB/O incompatibility, jaundice and slow weight gain. We supplemented after each feed for 2 days when we were readmitted to the hospital and then one feed a day for most of the next  couple weeks. At 10 days postpartum I pumped for the first time, getting 1.5 oz which is a pretty great volume considering I was also latching him full time.

He reached birth weight at 3 weeks old. We never had to use formula again and I thought we were back on track for my freezer full of milk plan.

And God chuckled.

Andrew had a lip tie and it made feedings loooooooong and often difficult. His latch sucked, my nipples were sore and he was eating 15 times or more a day. We corrected the lip tie and his latch improved (but still never really became that deep latch that we craved). My nipples no longer felt like I had a sunburn, but feedings were still long. He fought for let downs at almost every feed after that initial burst of flowing milk.

Every few nights I would express some milk for my husband to feed the baby while I got out of the house for 20 minutes to go to the store or to just lay in bed watching TV without a baby attached to me. I often didn't have time to pump and couldn't figure out how to pump and nurse the other side (can we just give mothers four hands already?). But I thought, "when I go back to work and I'm pumping during the day, surely I'll pump what he needs and I'll be able to put a night pump in the freezer."

And God chuckled.

I went back to work with about 20 ounces of really hard work and late nights in the freezer. I had been told 1-1.5 oz per hour that you're gone from baby. So if I was gone 9.5 hours I would need 9.5 to 14.25 oz of milk for him.

He ate 14. 

I pumped 10.

And I cried.

The week continued with numbers like that. 10. 9. 10. 8. 12.

I pumped more than 12 oz during the work day exactly twice in that year. I pumped more than 5 oz in a single pumping session less than 5 times and most of those were because I forgot parts at home or missed a pumping session and went too many hours between pumps.

To keep my son fed with enough ounces I had to pump 4x per day at work for the first several months. One of those pumps per day was a power pump for the first few months. I often spent 2.5 hours of my day at work pumping. Sometimes while eating. Sometimes while working. Often while crying.

I also power pumped each night at 10 p.m. and often got up at 5:30 to pump before feeding the baby and getting ready for work. This went on for several months.

Eventually when we introduced solids at six months, the pressure to have 15 oz for the 10 hours a day I was gone lessened as he ate 10-12 oz instead of 14-16. I never once had more than 40 total ounces of frozen milk and until he turned 6 months old, I had formula sitting on my counter, waiting for the day that I didn't have enough milk pumped and he was inconsolable.

That day never came, but because I produced literally exactly the amount my baby needed, spread out across 8 feeds and 3-5 pumps per day, Andrew ate every 3 hours. All the time. Always. My breasts capacity was always at that 2-4 oz unless I forgot to pump and then my breasts ached. We never got down to that 4-6 feeds a day that other 12 month olds reach. 

I would often see freezer stashes and feel inadequate. Like my body wasn't doing what it was supposed to do.

In reality my body was doing exactly what it was meant to. Latching baby almost always is better for supply than the pump. To get 4 feeds most pumping mom's need 5 pumping sessions. In most cases a latched baby is better at milk removal than a pump by a considerable amount. There are exceptions to this rule, but it is the norm.

Babies are meant to wake through the night, as frequent feeds prevent SIDS and helps maintain your overall supply.

As a mom who works 40 hours outside the home plus the drive to and from, I didn't want to hear that not only was all of this common, but normal, and in some cases, good. I wanted my kid to sleep through the night and to stop tweaking my nipple and to have a perfect latch and to spend 10-15 minutes at the breast instead of 30-45.

But we made it through that year. Somewhere in those first few months I decided my new goal was 1 year. I was never going to have a stash to keep him in milk without latching him. And I, mostly, loved nursing him.

So it got easier and the pumping demands eased up and I dropped my two extra pumps a day, except on the weekends). I occasionally put a couple bags of milk in the freezer. Sometimes it would be weeks in between donations to the Andrew Milk Bank. 

And I finally realized God wasn't laughing at my plans. I successfully provided my son with breastmilk. We developed a healthy, comfortable, beautiful breastfeeding relationship with God's help. If my plan had worked, I don't know if I ever would have gotten to the place of "loving" breastfeeding because my goal was only about milk and ounces. Not about moments looking at my son and putting hard work into a goal that was so important to me.

My struggles mean that even though I met and exceeded my goal (I said goodbye to the pump after my son turned one but we still latch), I know the struggle women go through with supply, lack of sleep, being touched out and more. 

For everyone that has breastfeed to their goal and beyond, congratulations. To everyone who has breastfed for any length of time, congratulations. To anyone who had the desire but lacked support, ability or whatever else it takes to make it work, congratulations on being a great mama. I see you. I'm here for you. And I believe that together we can make more mamas' goals a reality in the future.