Blog 11 : Physical Techniques to make More Milk

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Any form of nipple stimulation, such as gentle tickling, rolling, or pulling, can encourage milk ejection when you’re feeling stressed or anxious. Reverse pressure softening, often used for engorgement, is an easy and effective variation. One particularly effective method is to have someone “spine walk” their knuckles on either side of your spine, from neck to waist. This may cause a shiver or chill sensation that also triggers milk ejection. Another technique is to have someone massage your shoulder close to the neck as you’re nursing or pumping to stimulate an acupressure point that can trigger milk ejection. At the very least, you’ll feel relaxed after this “spa” treatment!

Pumping

Pumping, commonly recommended first to increase milk production, can be an excellent tool though it isn’t always necessary. If your baby is nursing often and effectively and also enjoys comfort nursing, his sucking may be doing such a good job that extra pumping isn’t needed. Supplementing at breast or supplementing first and finishing at the breast may be adequate. You may choose to pump even when baby nurses well to strengthen the “make more message But if your baby isn’t nursing effectively or sucks only the short time that milk is flowing, pumping becomes the primary way to stimulate the breasts. The best strategy depends on your pumping goals. Are you trying to achieve a full milk supply or concentrating more on increasing your current supply? Will you pump for a few weeks to maximize your production capability, or longer if necessary?

Choosing a Breast Pump

There are many types of breast pumps available to nursing mothers, through both rental and purchase. Hospital-grade electric pumps are multi user rental pumps built for both performance and endurance. All models are auto- cycling and have adjustable vacuum suction; some also have adjustable cycling speeds. They are usually rented rather than purchased be- cause they are expensive (US$700 to US$1,500) Rental rates are more affordable (US$40 to US $80 per month). The personal kit to attach to the pump motor is purchased separately and must match the pump brand; they are not interchangeable. The two major pump manufacturers of hospital-grade and higher-end consumer- grade pumps are Ameda (www.ameda.com) and Medela (www.medela.com, which also carries scales).

Consumer-grade electric pumps are usually single-user and range from highly effective pumps that can last one or more years under heavy use to light-duty pumps intended for use a few times a week. The higher-end pumps can handle dual pumping at full suction. Lighter duty pumps have lower suction with the dual pumping setting, All dual pumps may seem capable of the same performance, but they are not.

To be effective, a good pump balances both suction strength and cycling speed to approximate the sucking of a baby. Pumps that reach their pressure too quickly cause tissue damage, as can those that take too much time to build up to the appropriate pressure. Some high end consumer-grade pumps claim to have similar specifications to hospital-grade pumps but differ in their endurance and longevity. Mothers almost universally find that they are able to ex tract milk more easily and quickly with hospital- grade pumps than with even the best consumer grade pumps.

As tempting as it may be to cut corners, it is important to remember that smaller, cheaper pumps wear out quickly and don’t draw milk as efficiently. Check the warranty for the expected life of any pump you’re considering. Your breast pump is an investment in you and your baby and should be the best tool you can afford. If you can’t afford a good electric pump, a good manual pump is often more effective than a poor quality, inexpensive electric or battery-operated pump. Manual double pumping is possible with Medela’s Lactina kit if your arm is long enough to hold both flanges and have a free hand to pull the piston. The kit also can be attached to their foot driven pedal pump .

Breast flanges, or “breast shields,” are the funnel-shaped parts that fit against the breast. Medela and Ameda offer multiple flange sizes to improve the comfort and effectiveness of a pump. Proper fit is critical to effective milk removal. A flange that is too small can cause friction, soreness, or nipple swelling. A flange that is too large may pull in too much tissue, causing swelling and redness. The average flange tunnel is 24 to 26 millimeters, but many women seem to do better with the next size up, which is 27 to 29 millimeters. To know if the flange you’re using fits well, watch the way your nipple draws into the flange tunnel as you pump. It’s normal to touch the sides of the tunnel, but it should move easily. Your areola should move slightly, as well. A small amount of olive oil can lubricate the tunnel and alleviate friction, but a properly sized flange shouldn’t need it. Any marks or redness on the areola or at the nipple base after pumping are signs that the flange doesn’t fit. Try the next larger size. If larger doesn’t feel better, try smaller. Softer, more flexible silicone flanges are available, though they may come in only one Size.

Hand Expression

Expressing by hand is the oldest method of extracting milk and can be an effective way to increase production. Hand expression is an art that comes naturally to some women but is more difficult to learn for others. It should be done for as long and as often as you would use a mechanical pump. Expressing into a soft plastic cup or bowl lets you aim into a large container that can be squeezed for pouring.

Used Pumps

It’s common to see pumps at yard sales and online resale sites like eBay. They may also bee handed down from a friend or sister. If it’s hospital-grade, there’s a good chance that it was stolen at some point. Ask for the serial number and contact the rental company, who will tell you for sure. Used consumer-grade models abound but can be contaminated with bacteria, mold, and viruses or simply be worn down from use so they no longer draw milk out well as they once did. Your supply is vulnerable; why take a chance and waste your hard work by using a pump that no longer performs well?

Pumping Techniques

Simultaneously pumping both breasts is usually the fastest and most effective way to remove milk and may stimulate a higher prolactin surge. Hold each bottle or flange with a separate hand or use one arm to reach around to the opposite breast while tucking the first bottle against the breast with the inside of the same arm, leaving one hand free. There are bras and straps that can hold the pump flanges to allow hands-free pumping, or you can create your own by cutting small slits in a snug sports bra. Single pumping may be more comfortable if you make a lot more on one side than the other. This allows you to alternate breasts while pumping, which sometimes yields more milk. Single pumping definitely makes it easier to do breast compressions on the breast that is being pumped.

As with nursing,it’s important to be comfortable while pumping. Many mothers jam the flanges deep into their breasts, elbows sticking out and their backs curled over so they can watch the milk come out or because they’ve been told they have to lean over to pump. No wonder some say it’s a miserable experience! Instead find a comfortable spot with supportive pil lows so you can lean back. The amount of milk pumped doesn’t increase with leaning forward, so you may as well be comfortable. One caveat: the milk may stay in the flange tunnel because of the angle and can leak back onto the breast if you don’t rock forward periodically to empty it into the bottle. One option if this is a real problem for you are Pumpin’ Pal International’s Super Shields, tilted flanges that fit into vour flanges so that the milk flows forward when you are lean- ing back, eliminating leakage.

Pumping Strategies

Pumping requires patience, persistence, and a consistent, workable plan, but there is no one right way to go about it. The best way to pump is the way that works for you-flexibility is the Key. If you struggle with pumping every feeding then maybe a goal of pumping every other feeding is more realistic and attainable. Occasionally, you might even breastfeed one feeding and pump the next. Figure out what you can do and start with that so that you can feel good about it rather than guilty for what didn’t happen .

Pump After Feeds. The most common approach to increasing Supply by pumping is to nurse as long as baby will actively suck, and then pump This is especially appropriate when baby is leaving a lot of milk in the breast, but also for the baby who sucks well only the short time that milk is flowing strongly. Whatever residual milk the pump removes then becomes baby’s next supplement before any formula. Pump until the milk stops, but at least ten to twenty minutes (the shorter the feed, the longer the pumping time), even if there is no milk flowing during some of this time. Don’t stop just because the milk seems to have stopped. The amount of milk you pump does not matter because baby should be taking the majority of it first. Your goal is extra stimulation to tell your body to make more milk than it is making right now. If baby tends to nurse actively for a short while but then spends a lot of time mostly hanging out, limit his time on the breast to active suckling-even if that’s only five minutes per side-so that you have enough time to supplement him, pump, and keep your sanity.

Pump Between Feeds. If seeing only a little milk s discouraging, pumping between feedings or halfway through a nap rather than right after can provide that visible feedback you want. It also may become more of an extra session rather than the continuation of your feeding session as far as your body is concerned. At the least, having more milk to remove means more for your body to replace. The downside is that there may be less milk in the breast for baby if he wakes up too soon .

Power Pumping. Catherine Watson Genna, B.S., IBCLC, suggests an alternative short-term strategy for mothers of healthy, full-term babies who are having a difficult time fitting pumping into their busy daytime routines. Place the breast pump in a convenient location that you will pass often and where you’ll be comfortable sit- ting or standing, Every time you pass the pump, use it for five to ten minutes or so, as often as every forty-five to sixty minutes. Stop when you begin to feel “antsy,” restless, or annoyed. You can continue pumping into the same bottle and pumping kit for four to six hours without refrigeration, depending on the temperature in the room. After four to six hours, take the accumulated milk to the refrigerator, wash the kit, and start fresh for the next four to six hours. Aim for pumping at least ten times every day. Continue for two to three days and then resume your normal pumping routine.

Taking a Break from the Hanster Wheel. Pumping can be a lot of work! The never-ending cycles of supplementing, breast feeding, and pumping can become exhausting and over whelming and sometimes seem impossible, especially if you have older children who also need attention. You might wonder if you should just give up. What you probably need is a break, and it’s absolutely fine to take one. Jan Ellen Brown, RDH, IBCLC, works with many mothers who feel like they’re on this “hamster wheel.” She recommends simplifying the routine by just pumping for two or three days (be sure to do it at least eight to ten times a day!) and feeding baby that milk by an alternate method. This strategy not only gives you a few days off to catch your breath but also can result in increased milk from thorough, consistent milk removal. When you’re feeling better, add breastfeeding back in. Most babies don’t have difficulty coming back to breast after such a short time when using the alternative feeding techniques described in Blog_4, especially bottle-feeding methods that support breastfeeding.

What If Baby Cries When You’re Pumping?

Your baby’s emotional needs come first, and nothing is as important as comforting him You can always resume pumping later, or even just skip until the next time. Pumping should never cause you or your baby emotional stress.

How Long Do I Keep This Up?

Once you’ve reached your goal, baby can often keep your supply going and you can stop pumping. Congratulations you’re done! But what if you need the pump to keep supply up? Or maybe you’ve hit a ceiling and find you aren’t getting any more milk no matter what you do, if you’ve been pumping very often, try reducing the frequency and see if your body maintains your production level. If so, great! Should production drop just a little, decide if it’s worth the extra effort to maintain the higher level. A small number of women find that they actually get more milk when they back off. Ultimately you’ll want to use the pump as little as you can get away with. Experimentation will help you find the balance where you get the most milk for your work .

Alternative Therapies

Alternative therapies such as chiropractics, acupuncture, acupressure, and yoga are attractive options because they use only external techniques to stimulate milk supply or milk release. They have the most potential for mothers with normal mammary tissue.

Chiropractics

Chiropractics focus on the neurological effects of spinal joint dysfunction. Some what accidentally, it has been discovered that chiropractic adjustments sometimes can help increase milk production in women whose spinal vertebrae move out of position and compress or irritate spinal nerves, which is known as subluxation. Three cases were recently described in a chiropractic journal. While all the mothers had low milk supply, only one was seeking help for that specifically. It was her second baby and she had made plenty of milk for her first. The second mother had back pain, while the third thought her baby’s suck was the problem and so wanted help for her baby. Problems were identified with the first two women for treatment. In the third case, the doctor found nothing wrong with the baby’s suck, so she examined the mother and found several vertebral problems. Each case was very different in history and problems, but within the first few treatments, milk supply increased and eventually reached 100 percent.2 Chiropractic treatment may work by restoring nerve communication in key areas that have been reduced or cut off. This approach may be worth investigating when there is no other explanation but there is a history of physical trauma, nerve pain, numbness, or impingements.

Acupuncture and Acupressure

Acupuncture is a traditional Chinese medicine. (TCM) therapeutic practice during which specific areas on the body are pierced with very fine needles. Acupressure, also called shiatsu, is the application of pressure with thumbs or fingertips to points on the body for therapeutic effects, while reflexology focuses on trigger points in the foot. Although not as common in the Western world acupuncture in particular has been used to treat low milk production for over two thousand years. Research conducted in multiple countries suggests that it can be effective. Acupuncture can stimulate both prolactin and oxytocin, de- pending on the points chosen by the practitioner. Because TCM relies on a thorough screening of the patient to select the proper treatment locations, mothers interested in acupuncture or acupressure treatments for low milk production should seek an experienced and qualified practitioner, who may teach techniques that can be used at home as well. Acupuncture may not be as effective for low production when there is poor breast development.

Yoga

Yoga is a system of exercises to promote control of the body and mind. Awtar Kaur Khalsa, M.A., IBCLC, RYT, a registered yoga teacher and International Board Certified Lactation Consultant, reports that several lactating yoga students experienced increases in milk volume after at- tending her Kundalini yoga classes. She believes that arm movements increase blood circulation, which in turn causes relaxation and easier milk flow. Other mothers have reported increases after various upper arm activities, supporting the idea that such movements can stimulate milk production. From a practical standpoint, yoga is an effective means of exercise and relaxation that is safe for pregnant and breastfeeding mothers. At the very least, the relaxation it affords can help facilitate milk ejection.

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