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Friday, 18 January 2013

To pump or not to pump? When is expressing really necessary?

This article was published in the Australian Breastfeeding Association's Essence Magazine, January 2012.

When you're expecting a new baby, it is easy to be overwhelmed by the abundance of baby products and information on the market. Almost every item is marketed as essential. It can be confusing to work out exactly what you are really going to need for your new baby.

I am often asked by expectant or new mothers about expressing milk for their baby ‘How do I express? What sort of pump do I need?’ Breast pumps and associated equipment are marketed alongside sippy cups and baby blankets — firmly entrenched it seems, within the ‘essentials’ category. The aim of all marketing is to create a sense of need in the consumer — even if the product is not really necessary(1).

So when is expressing breastmilk really necessary?

In some cases that answer is relatively simple; for example, if the mother will be away from her baby for any length of time and the baby will need to be fed her breastmilk by a caregiver during her absence — in instances such as returning to work or study. In other fairly common scenarios, a mother of a prematurely born infant may need to regularly express her breastmilk in order to establish her milk supply and supply her breastmilk for her baby to be fed in hospital. Some mothers find that a breast pump can help keep milk flowing to clear a blocked duct and pumps can be useful to help increase milk supply — but more often than not, the baby is perfectly equipped to manage those tasks.

So why are breast pumps so commonly available on the market? Does every breastfeeding mother need to purchase a pump and learn the art of expressing as part of her breastfeeding relationship? The answer is no! It is perfectly possible to breastfeed your baby throughout his childhood, right through to weaning, without ever even touching a breast pump.

It seems that a school of thought exists in our culture that expressing, or pumping, may be necessary to maintain a mother’s milk supply. This is usually advocated as part of a regimented breastfeeding schedule or routine. But if we look at how breastmilk is made and a mother’s milk supply is maintained, we can see that, provided the baby is given unrestricted access to the mother’s breast, expressing is not actually necessary.

Breasts contain three types of tissue. Firstly, there is fatty tissue, which determines the size and shape of the breast. Secondly, there is glandular tissue. This is where breastmilk is produced and, unlike fatty tissue which varies enormously from one woman to the next, most women have roughly the same amount of glandular tissue. And lastly there is connective tissue, holding it all together.

During pregnancy, glandular tissue grows and develops, preparing to provide nourishment for the baby. Once the baby is born and the placenta is out, the body is given the message — make milk!

As the baby suckles at the breast, nerves within the mother’s nipple are stimulated, causing hormones to be released into the bloodstream. One of these hormones, prolactin, stimulates glandular tissue into milk production. Another hormone, oxytocin, causes rhythmic contractions of the milk ducts within the breasts which causes milk to be pushed or released out of the nipple. This is known as the let-down or milk ejection reflex. The more often the let-down reflex is stimulated by a baby’s suckling and the more milk that is removed, the more milk will be produced. This is known as supply and demand — milk ‘supply’ regulates to equal the ‘demand’ for milk.

Just like breastfeeding your baby, expressing breastmilk is a learned skill, and something that takes time and patience to master. Additionally, it can take quite some time and a lot of practice for a mother’s body to become conditioned to ‘let down’ milk for a breast pump, as a pump is not nearly as effective at milking the breast as a human baby!

As a result, it is quite common when learning to express, or only expressing very occasionally, that mums are unable to express a lot of milk — or even any milk at all. This can often cause a mother to feel unnecessarily anxious or worried about her milk supply. A mother may also often assume that the fault must lie with her, or her breasts, rather than what is more likely faulty or potentially even harmful (if used incorrectly) equipment(2). Given how differently a breast pump works at the breast when compared to a human baby and how the let-down reflex works within the mother’s body, the amount of milk that can be expressed is not at all an accurate indication of the amount of milk that a mother can actually produce for her baby.

Even in instances such as the mother returning to regular work or study, expressing may not always be necessary. Perhaps the baby is old enough to have solids and water while she is away and can ‘catch up’ on her breastfeeds at home or when they are together. Alternatively, a mum may find that hand expressing yields a sufficient amount of milk to provide for her baby during her absence so a pump may not be needed.

In instances where expressing with a breast pump may be necessary, there is a wide range of pumps available. For short term, occasional expressing, many mums find that a manual, hand-powered pump works well. For longer-term, regular or frequent expressing, such as instances of returning to work while the baby is young, an electric pump would be recommended.

Whatever the case, chatting to an ABA breastfeeding counsellor will help you work out firstly if there is a need for expressing during your breastfeeding relationship. Secondly, she can also help you decide what may be right for you and for your baby.

(1), (2). Thorley V 2011, The dilemma of breastmilk feeding. Breastfeeding Review 19(1): 5–7

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