The Anatomy of A "Perfect Pump"
Pumping can feel like such a daunting task and a complete mystery. What’s the right setting? What’s the ideal flange fit? How can I get more milk? Why doesn’t my body respond to my pump like it does to my baby? Let’s reduce the overwhelming pressure with pumping by keeping it simple. To make things easier let’s look at how we can make your pump similar to when your baby eats at the breast.
The anatomy of latch & breastfeeding
When babies are brought to the breast to feed they use their hands to identify their food with the grasping or palmar reflex. You may notice this when they grasp or seem to try to even pinch your nipple…ouch! This touch and stimulation is great for baby to identify the nipple and perk up the nipple to prep it for latch. Next, baby will begin to root and search for the nipple with their mouth. This sometimes looks like head bobbing, bouncing or even a nose dive to bump into the breast. All this movement and stimulation to your breast is the perfect way to wake up your tissue.
We know that the warmth of a baby combined with massage is great to widen and shorten milk ducts which makes milk flow easier. When baby latches to the breast they create a perfectly lubricated vacuum and seal. The tongue then moves in like a wave motion lifting from front to back to actually create milk sprays from the tip of the nipple. Once the milk sprays toward the back of a baby’s mouth they will swallow the milk that is collected. Overall, the idea is that the tongue curls and cups the nipple upward to the soft palate, while the lips create a seal around the breast. Baby coordinates all of these things with your help to get latched and start feeding.
After establishing a latch, the baby will start sucking very fast at about 40-120+ sucks per minute to trigger milk flow or “the let down reflex” . Once milk is flowing, baby will settle into a slower pattern to control the extra milk flow from the letdown. This process of milk letting down is triggered by fast suckling and can happen multiple times throughout the feeding. This is often why you will see baby change their rhythm at the breast a few times throughout a feed. The change from this faster lighter suction to slower deeper suction happens as needed to match the flow of milk. Simultaneously you are getting a rush of feel good hormones from the milk flowing, eye contact and naturally find a comfortable feeding position. It can be complex but once you and baby learn the rhythms it gets easier. Let’s now take this detailed framework and apply it to a pumping session.
The anatomy of pumping
Prior to putting the pump on your breast there are a few major things to do: get comfortable, prep your breast and nipple and check your flange fit. Often when I chat with pumping moms they are rushing to their session and feel stressed about taking too long or inconveniencing others. It’s so important to roll your shoulders down, take a deep breath and find a comfortable position for you.
In working with many pumping moms I find many lean forward with their shoulders hunched and lower back poorly supported. This type of positioning naturally decreases your air intake and can decrease the breast seal on the pump flange. This is why lower back support with attention to rolling your shoulders down and away from your ears is so important when you are sitting down to pump.
The next thing to prep is your correct size breast flange. You can do this by measuring your nipple. This is the firm portion that everts with stimulation, or if you have flatter nipples use your finger to shape and then measure the nipple. In clinical practice I find you take that exact measurement and add a 1-2mm for ideal fit. The best way to know if it’s your perfect fit is if it’s comfortable and does it get milk flowing in 1-2 mins when you start pumping. If you can accomplish both of those things it’s your ideal fit.
Next, let’s chat about prepping your breast and nipple for pumping. To prep your breast, milk ducts, and help milk flow, movement and touch is ideal. Using your bare hands to your breast like you are applying lotion. One text even recommends a hot, wet washcloth as the most effective stimulus for initiating letdown. Just remember to be gentle. Many moms are told to massage prior to pumping and think they should squeeze, and this actually creates pressure points that can cause soreness and tenderness. The goal is the exact opposite light sweeping touch with the palm of your hands to “wake up” the breast. Nipples should be prepped for the flange by rolling them between your pointer finger and thumb; this will help the nipple to point outward. This “perky” nipple is easier to sandwich into the flange once it is shaped.
While you are getting the nipple prepped this is a great time to apply food grade coconut or olive oil along the length of your nipple. Remember babies have natural lubrication from their saliva and oral tissue. Pumps are lacking in this regard so we can help the nipple move easily in the flange by adding moisture and lubrication. This may all seem like a lot of steps but this can all be done in about 2-4 mins before applying the flanges to your breast. Once you’re positioned and you are all prepped you are ready to apply the pump flanges to your breast.
I think this step is really assumed or implied, like plop the flanges on and you are good to go. However, it’s so important to line up your nipple and apply the flange with some attention to the seal of the breast. Meaning, you should sandwich your breast and direct your nipple into the flange with a gentle amount of pressure. To know if you did this correctly look at your nipple and it should extend slightly into the flange before you turn the pump on. The remainder of your breast tissue should create a nice seal on the flange with no spacing or gapping. Another amazing option to encourage a seal is to use a flange that will offer some flexibility and mold to the breast tissue. Some of my favorites are angled flanges, silicone flanges, or in the case of Pumpin’ Pals, both an angle and the flexibility!
Once your nipple is inside the flange, turn on the pump at a high speed or cycle (60-70+) with light or gentle suction until milk starts flowing. After milk is flowing, slow down the speed or cycle to (30-60) with a tad higher suction. Many times I’m asked what is the perfect suction? And there is no one setting because everyone is individual and unique. It’s important that you feel the suction and pull on your nipple but for any pinching, pulling or pain that means the suction is too high. Continue with this slower speed and return to the high fast pace every 5-10 minutes to try to encourage your body to have another letdown.
When you are pumping or breastfeeding it’s ideal to have multiple letdowns per session for effective draining. You can also help the draining process by adding in gentle massage and compression with your hands while pumping. This massage and compression has also been studied to increase fat draining into pumped milk and improve overall output.
Ending a pumping session can be tricky but overall my opinion is that 20-25 minutes is the maximum amount of time anyone should be pumping. Ideally if you are making your pumping session as similar to breastfeeding as possible it should be efficient. Meaning you should see the milk flow stop, or slow significantly, and that would be when you want to shut off the pump. Additionally look at how you feel just like any other activity you tend to feel when you are “done”. The best comparison is like going to the bathroom and once everything stops flowing and you feel relieved. . You can even remove the pump and do 1-2 minutes of using your hand to squeeze out any remaining milk. This will give you visual reassurance of draining and can help get those last fatty portions of the milk.
Lastly, I want to be realistic and say as an IBCLC and fellow mom I know not all of this may be feasible for every single pumping session that is ok. What I want you to keep in mind, is how can I make pumping similar to what a baby would do at my breast. Remember to slow down and give yourself credit for all the things you are doing for your baby. Nips out and snack in hand you are rockin’ it!
Sources
Rasmussen KM, Geraghty SR. The quiet revolution: breastfeeding transformed with the use of breast pumps. Am J Public Health. 2011 Aug;101(8):1356-9. doi: 10.2105/AJPH.2011.300136. Epub 2011 Jun 16. PMID: 21680919; PMCID: PMC3134520.
Riordan, J., & Wambach, K. (2010). Breastfeeding and human lactation. Jones and Bartlett Publishers.
Wiessinger, D., West, D., & Pitman, T. (2010). The womanly art of breastfeeding. Ballantine Books.
