Where’s the Beef (on Pumping)?

Hi Amy,

I’m working up to being a first time mom in September and have thrown some questions at you in the past. I live abroad and have noticed some cultural differences in how Germans (where I am now) approach things like breastfeeding and I’m trying to overcome an info gap here. I want to breastfeed and hope to manage six months (maybe longer). I do want to be able to work some freedom into the feeding schedule and also give my husband a chance to take part. You’ve discussed breastfeeding, supply issues, and bottle supplement feeding before, and quite well.

There are just some things I don’t get: when can you start pumping and giving the baby breastmilk from a bottle? Does this really work in tandem with breastfeeding (can my husband take a few night feedings)? And what’s the deal with preventing nipple confusion or using restricted flow nipples?
I have a feeling this isn’t laid out well in the books I’m reading because I’m apparently the only one who doesn’t know. But I don’t! Help?

(Also feel free to recommend any books in this, I haven’t found them on my own so far.)

Thanks,
M

This is actually a deceptively tricky topic, so don’t beat yourself up too badly over being kinda confused about it. Because it sadly, DEPENDS. Depends on your boobs, your supply, your baby…and even what “expert” you’re talking to or reading at the time.

If everything is going according to “plan” for you in regards to breastfeeding, it’s best to put off pumping until your supply is fully established. Extra pumping (on top of your baby’s on-demand feedings) can lead to oversupply. This happened to me with Ezra, and it’s distinctly not fun — think rock-hard boobs and a FURIOUS let-down of milk that chokes and gags your baby, which leads to stuff like gas and vomiting and other digestive distress. On the flip side, REPLACING actual feedings with pumping — or skipping feedings entirely while your husband gives the baby a bottle of pumped milk — can cause undersupply.

Basically, for the first month (or even up to six weeks), you ideally want to let your baby handle most-to-all of the milk removal business. IN A PERFECT WORLD, ANYWAY. If you have supply issues or your baby comes early or spends time in the NICU or won’t latch right at first or any one of a million other hypotheticals, you very well might end up pumping during that first month. Or not! DEPENDS, ARGH.

I pumped AFTER every feeding with both Noah and Ezra to boost my supply. I did not pump INSTEAD of nursing, and only with Ezra did I actually pump enough milk to store and use in bottles. If I was home and available, I nursed, even at night. “Your baby is best at emptying your breast,” was the stupid rhyme my LC singsonged at me. The bottles were for the babysitter or for Jason if I had to leave the house for a few hours.

This time, with Ike, I didn’t bother with the post-feeding pumping, as my supply established itself just fine without it. We have gone out (sans baby) about once a week so far  — usually for all of three hours or so — and the first time I left a bottle and formula behind. (He’d had both at the hospital, and I refuse to be all neurotic about it.) Then I came back and prepared to pump…but Ike woke up and demanded to eat anyway. The second time, he stayed asleep upon our return and I was able to pump a few ounces to stockpile, and I’ve OCCASIONALLY pumped in the evening when Ike surprises us with a longer-than-usual stretch of sleep.

Now, at five weeks postpartum, I pump because 1) Ike is sleeping and my boobs start feeling uncomfortable, and 2) I want to start really building up a stash of frozen milk for nights out (and my upcoming two-night trip to Blogher) and just sort of…do it in between feedings when I have free time. (HAAAAA.)  I still don’t hand off nighttime feedings, though — I don’t want to be reckless with my supply just because it *seems* perfectly established, and honestly, I’d have to wake up and pump anyway, because OW. And pumping at 3 am is really not an equal trade off. Nursing at 3 am is seriously the better option for getting more sleep.

So. Three babies, three COMPLETELY different experiences with pumping. Noah was never really exclusively breastfed and the pump didn’t really help my supply issues — if anything, replacing feedings with the pump once I went back to work is ultimately what killed nursing for us completely. With Ezra, pumping was a regimented-from-day-one attack on the supply issues, until I hit oversupply levels and had to dial it way back because the pump was SO effective. With Ike, I’ve pumped all of…three times, I think. I have a couple bags of milk in the fridge and will be trying to find more time to pump this month before I have to fly to San Diego, but again — if he gets a bottle of formula or two, I’m not going to go berserk over it. He’s getting buckets of breastmilk and we’re doing just fine without agonizing over the pump.

My husband is used to not really being “part” of the feeding process by this point, at least early on. He handles other things — like the late-night diaper change, or bath time, or wearing Ike in a sling during the pre-bedtime fussy hour. He doesn’t feel “excluded” or anything because we don’t give Ike bottles regularly, honest. He’s super pro-breastfeeding and supportive and finds other ways to be hands on with a newborn. And before we know it, Ike will be on solids and probably getting bottles more often (I will have to go get mah hair did, at some point, and he’ll be on solo-dad duty next month during Blogher), so…yeah. Don’t feel like you’re leaving your husband out in the cold by not pumping from the get-go in order to pass off the 2 am feeding. Trust me, you’ll be awake through the whole thing anyway. Thanks, biology!

As for your last question about nipple confusion — I suppose it happens. I have no personal experience with it. All three of my babies were introduced to the bottle in the first days of life and all three of them went back and forth between bottle and pacifier and boob no problem. (Noah and I definitely had a ton of difficulties, but “nipple confusion” really wasn’t one of them.) I’m…actually kind of in favor of introducing the bottle earlier, since it SEEMS like most of the babies who reject bottles altogether are the ones who follow the “no bottles until six weeks old and breastfeeding is established!” rule. I really think you can do both, though that’s where the low-flow (“preemie flow”) nipples come in. You want the baby to learn to suck from something besides your boob, but you also want to make sure they do have to really SUCK and work at it a little bit. The nipples they gave Ike in the hospital were not preemie-flow and seriously, you tipped the bottle just slightly and the formula just gushed the hell out into his mouth. Ever since, I’ve had a preemie nipple in the bottle so he really needs to suck and not get all lazy and develop a bottle preference. One bottle a week and a mass of rejected pacifiers later, he definitely has not lost interest in nursing.

As for books and resources, I love kellymom.com. Books…eh. Granted, I read a couple while struggling early on with Noah and got so angry at every one of them because they were totally not realistic or honest about how difficult things can get. “If it isn’t going well, it’s just that you’re just doing something WRONG” was the message my overly sensitive postpartum self received, even if that wasn’t at all their intention. But a lot of them don’t really address pumping or how to balance wanting a break or some freedom while still being committed to breastfeeding — in fact, it’s often the opposite. Nurse no matter what, all the time, it’s glorious and bonding and you love it anyway and if you think otherwise UR DOIN IT WRONG.

(I just recently read a breastfeeding article that was SUPPOSED to be about introducing the pump but went on and on about letting your baby use YOU as a pacifier as much as they want early on — with no mention of how much that can freaking HURT, like KNIVES, when your nipples aren’t toughened up yet and scabbed and raw. Mine were, even with Ike, for two full weeks. Everything changed at three weeks, but I sure as HELL offered him pacifiers or my fingers for the comfort sucking instead of my boobs. And if you told me not to do that and to only let him suck on me in spite of all that pain…well, if he was my first baby I probably would have quit. Anyway. Not sure why I’m bringing that up except to say that it’s okay to not do things according to the books. Nobody knows everything about breastfeeding, because nobody else will know what it’s like to breastfeed your particular baby. And that’s the real wild card here, because I’ve done this three times and am still making it up as I go along.)

Anyway. You’ll figure it out! You will do great. And if you have other specific questions once you get started, well, you know where to find me and my run-on sentences.