Baby 101: Pumping Basics - Frequently Asked Questions

Pumping might be the thing friends ask me about the most - and completely understandably, because pumping can be tricky!  You've just barely got nursing figured out and then suddenly you go back to work / need to leave baby with a sitter / want to do anything for more than 3 hours without being tied to your baby, and pumping enters the mix.  I'm certainly no expert, but I went back to work after 12 weeks of maternity leave with my son and pumped successfully enough for him to be exclusively breastfed until he turned one (woohoo!), so I have some firsthand experience.  

Here are some of my tips and tricks for the questions I get asked the most:

What breast pump should I get?

This is personal preference, of course, but I love my Spectra S2 and prefer it to the Medela Pump In Style Advanced I used with my first - read more about the differences here.  

Don't run out and buy one - most insurance plans cover 100% of the cost of one breast pump per pregnancy.  Check with your health insurance company to see which DME (Direct Medical Equipment) supplier(s) they work with.  I used Aeroflow for both pregnancies (I got a new pump each time, since the motors can wear down) and had a great experience - they handled everything (insurance, contacting OB/GYN, etc.).

When should I start pumping?

I had a LOT of lactation consultant help with my first baby, and their advice was to wait to pump until baby is 2-3 weeks old.  The first couple of weeks (especially with your first!) are stressful enough with figuring out breastfeeding, and it can mess with your breastmilk supply if you start too early (causing oversupply, which can result in foremilk/hindmilk balance issues, engorgement, mastitis, etc.)  

By 2-3 weeks, your milk supply will start to regulate, you'll hopefully be through the painful/confusing/stressful part of breastfeeding and have time to add in pumping.  This timeline allows plenty of time to introduce a bottle to your baby between 3-4 weeks, which is the ideal window to ensure that your baby will accept a bottle without causing nipple confusion.

How often should I pump?

This depends on the reason why you're pumping.  If you're still nursing full-time and just want to build a small freezer stash for the occasional babysitter, I was advised to pump twice a day; once AFTER nursing (to get the extra out for a "rainy day" and tell your body to keep producing that much milk), and once INSTEAD of nursing (to allow you to feed the baby a bottle of pumped breastmilk and ensure they'll continue to accept a bottle).  

If you're going to be away from your baby (going back to work, traveling, etc. - i.e., NOT nursing full-time), you should pump the same number of times, on approximately the same schedule, as your baby will be taking bottles while you're gone - for example, if your baby will take 3 bottles every 3 hours during the time you're gone, you should pump 3 times, approximately every 3 hours.  Pumping less frequently than your baby is eating will tell your body to slow down milk production.

How long should I pump?

This varies depending on the individual and the pump.  I find that my Spectra pump is much more efficient at removing milk than my Medela PISA was, so I generally pump for about 12-15 minutes (as opposed to the 20-25 minutes I pumped with my Medela).  I pump until fully emptied (milk stops flowing), and then I press the "letdown" or "massage" mode button again to encourage a second letdown.  Many women naturally have a second letdown around the 12 minute mark, but you can use the letdown feature on your pump to try to trigger another one once milk stops flowing from the first letdown.  

After the second letdown, I pump until milk stops coming out, and then for an additional 2-5 minutes to encourage my body to maintain production.  If you're pressed for time, you can skip the second letdown and additional 2-5 minutes after milk flow stops, but you'll want to fully empty your breasts to avoid clogged ducts, mastitis, or an unwanted decrease in your milk supply.

What should I bring in my pump bag to work?

Check out my detailed post on this topic here.

How do I know if I'm pumping enough?

This varies so much by person - there is a huge range.  If you're pumping in lieu of nursing, your goal is obviously to pump enough to replace the breastmilk your baby consumes by bottle during the same timeframe (so if your baby consumes 15 ounces of breastmilk while you're gone, you'll want to pump at least 15 ounces to stay "even").  "Normal" production from pumping in lieu of nursing is 2-4 ounces per session for both breasts combined.  

If you're pumping while nursing full time (to build a stash), you can expect your output to be much less - "normal" is considered 0.5-2 ounces per session for both breasts combined.

Keep in mind that milk production is normally higher in the morning than it is in the evenings, so you may see different outputs from pumping sessions depending on the time of day.  Also, remember that a baby is much more efficient at removing milk than a pump - your pumping output is not indicative of your milk supply.

What if I pump too soon to when my baby wants to nurse and there is none left?

Again, a baby is much more efficient at removing milk than a pump; even immediately after you pump, there is still milk remaining in your breasts that a baby can remove that the pump could not.  Also, breastmilk is constantly replenishing, so even as you finish pumping, your body is already producing more.  The milk flow may be slower than baby is used to and they may get frustrated, but don't worry that there isn't any left - there is.  Allow your baby to nurse longer and/or switch sides back and forth.

Why is the suction on my pump weak?

If you're not getting good suction on your pump, first make sure everything is plugged in / assembled correctly - the tubing is well secured, both to the pump and to the flanges, and there is nothing (bra/shirt) in between the flanges and your breast breaking the suction.  If you're only pumping on one side, make sure that you disconnect the tubing for the second side and use the little plug to "block" the tubing connection.

Double check the suction settings on your pump to make sure they haven't been accidentally adjusted.

If you're using battery power (rather than a wall plug-in), make sure the battery is fully charged and/or replace the batteries if using a battery pack.

Inspect the membranes (on a Medela PISA, these are the white rubber circles) or the valves (on a Spectra, these are the white duckbill parts) for any tears; it is good practice to replace these parts every couple of months anyway, because they weaken over time and they have a big impact on the pump's overall suction.  

I'm not pumping enough milk - how do I pump more?

First, make sure your expectations for pumping output are reasonable - see "How do I know if I'm pumping enough?" above. 

Next, make sure there aren't any suction issues with your pump - see "Why is the suction on my pump weak?" above.  You'll also get more milk out if you "prod" your breasts while pumping (some people say "massage", but I don't use motion - I just jab a finger or two into the breast tissue and hold them there while the pump is doing its thing, moving them every couple of minutes to trigger production from different ducts).

If you truly need to increase your milk supply, here is a detailed post on maintaining your milk supply.  In short:

- drink more

- eat more

- add galactogogues (fenugreek, brewer's yeast, oatmeal)

- pump more frequently

- pump longer / pump through 2, even 3 letdowns

Keep in mind that lots of things can impact your milk supply - time of day (milk production decreases in the evening), return of your period (my milk supply took a permanent hit when I got my period back at 7 months), illness, stress, and certain medications, including birth control.

If none of these things work, consider speaking to your physician about prescription medication to help increase your milk supply - Domperidone or Reglan.  I have no firsthand experience with these, but it's an option that's available if nothing else works.

My pumping output is vastly different between each breast, is this normal?

Yes, this is totally normal - many people have "a stud and a dud", where one side consistently produces more than the other side.  You may also switch back and forth between which side produces more based on which side the baby last nursed.  

Pumping is painful, is this normal?

Pumping should not be painful; of course, if you are engorged, there may be some discomfort from the engorgement, but there shouldn't be pain from pumping itself.  

Make sure that you're not setting the suction on your pump too high; contrary to logic, a higher suction setting does not guarantee more milk and/or quicker expression.  Slowly increase the suction to the point of discomfort, and then reduce it from there until you find the setting that is most comfortable for you.

You may also be using the wrong flange size if you're still experiencing pain; flange size is not related to breast size, so small-chested women may still require a large flange size, and vice versa.  Most breast pumps come with a "medium" 24 mm flange size, but there are both smaller and larger flange sizes available.  (Medela: 21mm, 24mm, 27mm, 30mm, 36mm; Spectra: 20mm, 24mm, 28mm, 32mm)  You can use the graphic below to gauge whether or not your flange size is appropriate (although I find this hard to do); a lactation consultant can help fit you to the right size, or you can try a few sizes (they're inexpensive, or you can borrow from a friend) and use trial and error until you find the best fit.

Via

You may also want to lubricate the inside of the flanges to reduce the friction - you can use coconut oil or lanolin cream (I like the Lansinoh brand).

How do I store pumped milk?

First, I always pump into bottles, rather than bags; some brands of breast pumps are compatible with breastmilk storage bags (allowing you to pump directly into a bag); however, these bags generally do not freeze flat, and the ounce measurements on the bags are not accurate since the bag is not a rigid storage container (making it difficult to accurately measure how much you've pumped).  I keep my pumped milk in a refrigerator at work (there is a dedicated mini fridge in the "wellness room"), although you can also use a cooler with ice packs if you don't have access to a refrigerator.

You shouldn't combine warm milk with cool milk; to combine milk from different pumping sessions, only combine warm with warm, or cool with cool.

I pump during the work week; Monday through Thursday, I use each day's pumped milk to supply the next day's bottles.  On Friday, I freeze the pumped milk in breastmilk storage bags, and on Monday, I thaw previously frozen breastmilk to make bottles.  Freezing Friday's pumped milk and using (older) thawed milk on Mondays keeps my freezer stash current.  Right now, I'm using Lansinoh storage bags; you can read a comparison of milk storage bags here.

Pumped milk is good at room temperature for 4-6 hours; refrigerated for 5 days (you'll be able to smell if it's spoiled), in a regular freezer for 6 months, and in a deep freezer for 12 months.  Read a more detailed post about milk storage (freezing and thawing pumped milk; rotating a freezer stash to keep it current, etc.) here.

How do I find the time to pump?

It is hard!  If you're nursing full-time, you probably only need to pump once or twice a day to have a small stash in the freezer.   Try utilizing baby's nap time or consider pumping one side while baby nurses on the other side.

If you're pumping during the workday, you have to guard your pumping time!  I block mine off on my calendar so the time will appear unavailable to my coworkers if they try to schedule a meeting.  I try to stick to my pumping schedule closely; if you start letting it slide (delaying or skipping pumps), your milk production can suffer (and people will learn that your designated pumping times are flexible - it's a downward spiral).  Another time-saver to consider is pumping while driving; I pump each morning during my commute to work, which saves me one pumping session out of the workday.  You can read more about how to pump in the car here.

I think having a hands-free pumping bra is a must-have; it will allow you to nurse, type, wash bottles, read, talk on the phone, etc. while you pump.  My favorite is the Simple Wishes brand.

How do I clean pump parts? 

The pump parts that require thorough cleaning are the flanges, membranes/valves (yellow/white parts), and obviously the milk collection bottles - all of the parts that come into direct contact with your milk.  Tubing does not require cleaning; if you notice milk (or worse, mold) inside the tubing, you should just replace it. It's a good idea to keep an extra set of tubing on hand (you can buy Medela-compatible tubing here and Spectra here).  If you see condensation inside the tubing, keep your pump running after you disconnect the tubing from the flanges to allow the tubing to dry.

You can read the CDC's recommendations for cleaning pump parts here.  In short, they recommend washing with hot water and soap, and then air drying (or washing in the dishwasher) after each pumping session.

I will admit that I do not follow these guidelines during the workday; I pump 3-4 times at work each day, and washing and air drying them each time is not realistic for me.  I store my pump parts in a sealed Tupperware-style container (this is the exact one I use) in the refrigerator between pumping sessions (I do not wash or rinse them first).  Some people use gallon Ziploc bags, but I don't like the idea of throwing out a Ziploc bag every single day.  Refrigerating the pump parts will slow the growth of bacteria on the pump parts in between sessions.  You do NOT want to keep the pump parts at room temperature between sessions, because bacteria will grow too quickly on the residual milk on the parts.  While refrigerating pump parts in between sessions is a widespread practice, it is not something I would recommend for a premature or immune-compromised baby.

I wash my pump parts each evening, either with hot water, Dapple bottle soap (rinses clean faster than normal dish soap), and a bottle brush, or in the dishwasher, and then air dry them on a drying rack (I use the Boon grass).  

How often do I need to sterilize pump parts?

I sterilize infrequently - when the parts are new (or coming out of storage for another baby), after illness (to kill any germs that survive the normal washing process), or when I'm traveling and unable to wash and dry the parts as well as I do at home (e.g., washing in hotel room bathroom sinks).  When new, I sterilize pump parts in boiling water for 5 minutes; for all future sterilizing, I use the Medela microwave steam bags, which are great - each bag (5 come in a box) allows for 20 uses, so one box = 100 sterilizations.  

If you have a premature or immune-compromised baby, your doctor may recommend sterilizing more often; for a healthy baby, daily or even weekly sterilization is not necessary.  Think about it - are your breasts sterilized when your baby nurses?

How do I handle pumping when I'm traveling?

This was intimidating to me at first, but I quickly learned the ropes and took numerous business trips while pumping for my first child.  In short, know that the TSA allows you to fly within the US with an unlimited volume of pumped breastmilk.  Read my detailed post on this topic here.

Do you have more questions about pumping that weren't addressed here?  Leave a comment and I'll add it to this post!

Click here to read all of my breastfeeding/pumping-related posts.