Pumping to Empty – Is it Necessary?

THE “PUMP TO EMPTY” MYTH

I was recently listening to a podcast.  One of the people interviewed had mastitis and was talking about how she was always pumping to empty her breasts because she was so scared of getting another mastitis.  This is a common misconception.  You get mastitis after going a little longer between nursing or pump sessions, and therefore you start to pump or nurse more and more in order to prevent another mastitis.  This thinking is based on a theory that plugged ducts or mastitis happen due to stagnant milk that's been sitting in the breasts for too long.  If that’s the case, we need to empty, and empty, and empty, more frequently and more completely to make sure that we don't get another plugged duct or infection.

In reality, “plugged ducts'' and mastitis are caused by inflammation and edema (swelling) that occurs when breasts remain too full for too long.  Milk regulation in the breast is based on finding a happy medium between not having overfull breasts for too long, but also allowing our breasts to remain unemptied if our baby isn’t eating a full breast’s worth of milk during a feeding session, so that our body will slowly downregulate our supply.  It can be a tricky balance. If we pump when we don't need to pump or pump excessive amounts, then we are telling our body to make more and to go into hyperdrive. And when we do that, we create a vicious cycle because then we create a situation of oversupply and then we feel like we need to continue to pump extra to keep emptying.  In fact, it's okay and even necessary to allow some fullness for your body to get the signal that it needs to cut back on production.  A full (or unemptied) breast tells the body to halt production for a bit. 

TRUST THE PROCESS

So you have to understand and also trust the process.  Our bodies naturally go into “oversupply” mode when our milk comes in, and we need to try to stick as much to “physiologic emptying” as possible.  This means emptying about how much your baby eats at each nursing or feeding session, instead of pumping out more than your baby is eating. This will send your body the feedback to regulate to your baby’s needs.  If you pump more, you tell your body it needs to make more.  Instead, we want your baby to send those messages (or if you must pump, you want to try to match your baby’s intake frequency and volume as much as possible) so that you prevent that vicious cycle. 

It is true that leaving breasts too full for too long can lead to enough inflammation to cause a plugged duct or mastitis.  So during this period of regulation, if you start to feel very full and uncomfortable before it’s time for your next nursing or pumping session, it’s important to use some combination of expressing a small amount of milk until you’re comfortable (usually not more than an ounce), icing your breasts, doing lymphatic massage (NOT firm or aggressive massage, even if you are feeling a developing lumpy area), and possibly taking an anti-inflammatory medication like ibuprofen to decrease inflammation.  Slowly, you will find that you can go longer without feeling uncomfortable and will need these inflammation mitigators less and less. 

DO YOU HAVE TOO MUCH MILK? 

Some clues might be that you’re waking up to pump in the middle of the night even though your baby is sleeping through, you need to buy a new deep freezer to store all the milk you’re collecting, or you're always pumping even after your baby nurses and freezing that milk because your baby is gaining weight fine with exclusive nursing.  (Please note: this is assuming your baby is gaining weight fine with the amount of milk they are getting, you have a full-term baby, and nobody has told you that you are at risk of undersupply or you are working with a lactation profession who has recommended that you pump in addition to nursing). 

BREAK THE CYCLE

If you have found yourself in the midst of this vicious cycle of oversupply and you’re doing all the things we’ve talked about to try to downregulate, and you don't feel like you are making any progress, or you continue to get plugged ducts or mastitis, or you’re having anxiety about even trying the above measures, do not hesitate to reach out to a breastfeeding medicine physician for assistance.  A breastfeeding medicine professional can help you with a plan that is safe, and can potentially recommend herbs or medicines that will help with downregulation if needed. 

KEY TAKE-AWAYS

So in summary, you don't have to “pump to empty” (I put “pump to empty” in quotes because our body is in a constant mode of milk production when we are taking milk out of the breast, so your breast will be re-filling even as you take milk out, so you will never truly be “empty.”) The only reason to pump to empty is if you're trying to increase production or if you're an “exact producer,” and your baby is eating everything you are pumping.  In those cases, pumping to empty will ensure that you continue to produce enough for your baby, or it will help you produce more if your baby is not able to get enough milk to grow just by nursing.