I have to start by saying that I am not prescribing a treatment here - every person is different and so what works for one person, won't necessarily work for another. But generally speaking, the more you express the more you make...
Before I had my daughter I had been a midwife for a 2 years and worked in Neonatal Intensive Care (NICU) for 7 years. Obviously midwives have to give loads of breastfeeding advice, and in NICU we have to teach parents how to express and then breastfeed when the babies are ready.
I thought I was an expert in both breastfeeding and expressing....oh how wrong I was!
I had listened to other, more experienced, midwives and nurses say things like 'babies are born to breastfeed', 'if you just put the baby on the breast it will all be fine', 'breastfeeding shouldn't hurt', 'just express for 10-15 minutes, any longer isn't worth it', 'express every 3hrs during the day, 4hrs at night'.
So when my daughter was born and we started having issues, my midwife/nurse brain kicked in. I could only hand express 0.3ml by day 3, and when my milk 'came in' I could only get 10-15mls at a time. I used the hospital grade pump that is used in every hospital here in Perth but could still only get 20-30mls at the most. I tried 4 other pumps with similar results (the most I got was 40mls with a store bought pump).
I started thinking something was wrong with me. But I had had a textbook perfect pregnancy, and given birth at home with no complications, so shouldn't I be able to breastfeed, or at least produce enough milk?
Then I joined a Facebook group for mothers who are exclusively expressing and I realised what I thought I knew was just the tip of the iceberg.
A (probably) well meaning lactation consultant had told me to 'just express when she feeds', which I worked out was 5-6 times a day, because my daughter was having formula. I was told by this group that before 12weeks you should be expressing (or breastfeeding) 8-12 times in 24hrs.
Now this doesn't mean strictly 3hrly. You can express 1 or 2hrs apart and then go 4-5hrs between others, as long as you get a minimum of 8 sessions in 24hrs. So I set up a schedule that looked something like this - 2am, 6am, 8.30am, 11am, 2pm, 5pm, 7.30pm, 9.30pm. Ideally 1 session should be between 1 - 5am when your prolactin levels are higher, but some women benefit more from more sleep
Between 6 and 15 weeks my supply slowly increased from ~200mls/day to an average of 850mls/day. It was probably a combination of things, but I believe increasing how many sessions I was doing was a big part of it
From 12 weeks you can drop sessions, but you need to do it slowly. I chose to drop 1 session/month. Most women can maintain their supply at about 4 or 5 sessions in 24hrs, but each needs to find their 'magic number'.
I often hear of women who have had an oversupply and so only express 4-6 times a day and then find that their milk starts to drop off significantly around 8-12 weeks. Obviously this doesn't happen to every one, or it can happen at different stages. But just be warned that if you do have an oversupply and you do not express that often you may lose a significant amount later on
Another thing I learnt was to express for a few minutes after the milk has stopped flowing. The standard recommendation is to start on 'letdown mode' - the fastest repetition, and then switch over to 'expression' mode when the milk starts flowing. Most women I meet will say they stop expressing after 'xx' time or when the milk stops flowing. Most don't know they should then go back to letdown mode to see if they can get a second let down.
A 'power pump' is another tool you can used to increase supply. Ideally it goes like this - express like you normally would, wait 10mins, express 10mins, wait 10mins, express 10mins, wait 10mins, express 10mins, express at your next normal session (even if it is only 1 or 2 hours later). This is thought to mimic the feeding a baby would do during a growth spurt. You can optimise the effect by repeating it for 3 days at the same time (just once/day)
Remember if you are going to exclusively express then make sure you are using a 'hospital -grade' pump - these are pumps that are capable of initiating and maintaining your supply, and are generally a closed system. Examples are the Spectra® S1 and S2, the Medela® Symphony, and the Ameda® Platinium. Some women are also able to exclusively express with a Medela® Pump-in-Style or Freestyle, or Ameda® Purely Yours.
It is also very important to use the right size flange/breast shield (size does matter!). The majority of pumps come with a 24mm flange (25mm for Ameda), but from an informal poll I did in my exclusive expressing group I found that 40% of women use a 27mm and 31% use a 24mm (the rest use anything between 19mm and 36mm), and recently I have been selling quite a few 21mm flanges*. Generally speaking only about 2mm of your areola should enter the flange with your nipple. But finding the right size for you may involve some trial and error. View a sizing guide here
*I wrote this article over a year ago. Since then I have sold more 17 and 19mm flanges than anything else. I also started selling 15mm flanges after getting a number requests for them (and have sold quite a few). I have become a bit of a flange sizing police officer!! I urge you to double and triple check your flange size!
There are products that can make expressing easier - Freemie Deluxe Kits®* - which make expressing completely handsfree with concealable cups that fit into your bra; Pumpin Pals* - angled flanges which allow you to sit back to express; car chargers* or battery packs for certain pumps, so you can express on the go; and handsfree bras, which hold the flanges in place (*available through Cherished Parenting Services). You can also buy adapters to attach milk storage bags directly to your flanges.
The decision to exclusively express is not usually made lightly. But know that you are not alone - there are others who have done it before you and who doing at the same time as you.
And the best bit of advice I was ever given - 'Never give up on a bad day'. People after ask "how did you know you were ready to stop". My main goal was 6months but I got there and I didn't feel ready to stop - in fact I would almost burst into tears at the thought, even though I was sleep deprived and struggling emotionally. Then I got to 9 months I no longer had the urge to cry when I thought about stopping. This is how I knew I was ready to stop
When I first wrote this information I wasn't a lactation consultant - I now am. To book an appointment click here. To find out about renting or buying a Spectra® breast pump in Perth, please either email me (email@example.com), or call me (0405247998). For more information see www.cherishedparenting.com.au/spectra-breast-pumps-hire-or-buy or www.cherishedparenting.com.au/online-store