Is pumping breast milk necessary for everyone?  And if you do need to pump, how much do you do it, and how do you store the milk?  Read on to learn more!

When to Pump

The first question to address is when you should start pumping. If you are doing exclusive breastfeeding and spending most of your time with your baby throughout your breastfeeding journey, frequent pumping might not be necessary. Enjoy these moments of nursing if it's going well - there's no reason to keep yourself tied down to a breast pump.  For some, a manual pump or hand expression will suffice to express milk for occasional storage.

Women going back to work at some point often worry about having enough milk stored for their baby for when the time comes. If you intend to continue to provide your breast milk after going back to work, you will need to plan to use a breast pump to express milk when you are at work and away from your child. 

But contrary to what many people think, you do not need to pump excessively during your leave to create a "freezer stash."  All you will need to have stored will be enough milk for the first day back at work (and possibly a bit for random times you may be separated from your baby before then).  Once you return to the office, you will pump each day at work for the following day's meals for your baby. It's important to know that storing excessive amounts of milk in the freezer isn't necessary and can sometimes lead to problems, like having excessively high milk production.

Some women or babies encounter problems with directly nursing at the breast.  In this case, exclusive pumping might be necessary to build and maintain a milk supply.  In this case, a double electric breast pump will be an essential tool for your breastfeeding journey, and you will want to pump approximately the amount your baby eats each day.

For mothers who are having a smooth breastfeeding experience, infrequent pumping is adequate. Pumping once a day or every other day, after nursing, can provide a small reserve for unexpected situations.

What Kind of Pump is Best?

There are many options on the market for personal electric pumps these days, and there is no "perfect" breast pump. 

Hand pumps:  If you are not going to be heading back to work and you intend to directly nurse most of the time, a hand pump may be all you need for the now and then. 

Personal Double-Electric Pumps:  Generally, a double-electric breast pump is the best option for women who need to exclusively pump or are working on bringing in a milk supply.  I love the pumps that have controls for both suction strength AND cycle time.  These give you multiple ways to adjust and find the settings that are most comfortable and efficient for you because everyone responds a bit differently to the pump. 

Wearable Pumps:  Wearable pumps can be a great option for people heading back to work who won't have the ability to take regular sit-down break pumps easily, but they tend to have less ability to personalize settings (including flange size) and are not ideal in the early months for exclusive pumping.  

Hospital-Grade Pumps:  Do you need a "hospital-grade pump?"  Years ago, there were very few personal pump options out there, and the "hospital-grade pumps" that were multi-user types offered during a hospital stay were often the best pumps available.  "Hospital-grade" also referred to pumps that were closed systems (meaning they could be shared by different users safely) and had strong, longer-lasting motors, providing better suction strengths and the ability to use the same machine for many users over many years. 

These days, most personal pumps provide just as much (if not more) suction strength and often provide more settings and controls than the traditional pumps labeled as "hospital-grade," so it is less important to rent a "hospital-grade" pump and more important to find the one that will work best for you.  Unfortunately, it's difficult to know this until you've tried the pumps, so working with a lactation consultant who has a variety of pumps on hand to trial can be very useful to help you make your decision.  

Pump Parts and Flanges

Each pump has unique accessories and flanges.  Some of these are cross-compatible, or one can buy converter pieces to make them compatible with other pumps.  Flanges come in many sizes and materials.  They can be hard or soft and flexible, and some have cool mechanisms to make them behave more like "real" nipples.  Similar to pumps overall, personal preference plays a big part in what will make the most sense for you. 

In terms of flange sizing, you want to balance not pulling too much areola into the flange canal, and not having too much nipple rubbing.  This isn't always easy to accomplish, and for most people, it's best to err on the side of more nipple rubbing and less areola being pulled in, so often sizing down is best.  Most women need flange sizes less than 24 mm.  Nipple measuring tools can give you a starter point in determining what size flange you will need, but what's most important is what is happening while you are in the act of pumping.  Again, a breastfeeding professional can be very helpful by watching you pump and helping to determine sizing.  

Storage Tips

When it comes to storing breastmilk, there are various options like breast milk storage bags or glass containers. Whatever you choose, ensure it's a food-grade container. Leave some space at the top of the container because breastmilk expands when frozen, and you want to avoid any spills.

As for the quantity, it's prudent to store milk in smaller amounts. Most babies consume about four to six ounces per feeding. By storing milk in two or three-ounce containers, you minimize waste as you can thaw only what you need.

Remember to label your milk with the date and time, and optionally, your or your baby's name. This practice helps in tracking and using the milk efficiently and will be required for any baby in the hospital.

Shelf Life of Stored Milk

The shelf life of breast milk is a topic of ongoing research. Breastmilk has anti-infective properties, which help it last longer than formula. However, the exact duration milk remains usable under different conditions is still somewhat unclear.

General guidelines, which align with CDC recommendations, are as follows:

• Room Temperature: Freshly expressed milk can be kept at room temperature for about four hours.

• Refrigerator: In the fridge, it's good for up to four days.

• Freezer: In the freezer, it can last for six months in a typical freezer attached to a fridge, and up to 12 months in a deep freezer.

It's important to note that the longer breastmilk is stored, the more it loses some of its beneficial properties. Therefore, it's advisable to always use fresh milk first to feed your baby. Fresh milk contains antibodies responding to the environment you and your baby are currently exposed to and simply has more of the "good stuff" still active within it.  Only store extra extra milk beyond the amount your baby is eating each day.  

Handling Guidelines

Storage guidelines are not absolute. For instance, milk may last longer than four hours at room temperature in cooler conditions or if expressed in very clean conditions.   Similarly, in the fridge, if stored and expressed well, it might last more than four days.  The CDC recommendations are conservative guidelines. The Academy of Breastfeeding Medicine suggests that these durations could be extended, but more research is needed for definitive guidelines, so until we have that research, generally following the CDC guidelines is prudent.  

Regarding sterilization, it is sufficient to clean bottles and pump supplies with soap and water. Regular cleaning and occasional dishwashing should suffice; sterilization is not necessary for every use.

Conclusion

Whether you're directly nursing, doing exclusive pumping, or a combination of both, a lactation consultation can help to optimize your pumping experience and get you off to a great start!  And remember always, you've got this!