Common Pitfalls of Exclusive Pumping, and What to do About Them

I wasn't completely new to pumping with baby number 3. I'd had to return to school or work after the births of each of my other children, and I'd pumped whenever I had to be away from them. I figured I knew what I was doing, at least to some degree. However, as I've discovered these last few months, exclusive pumping is a whole different ball game than occasional pumping, and frequent nursing. Here is the first common pitfall of EP-ing-

Clogged Milk Ducts. Yes, you can get them while nursing, and many women do, but you are far more prone to get them when exclusively pumping, and they are a lot harder to get rid of with a pump than with a little latched mouth. It's always better to prevent them in the first place, and here are somethings you can do-

• Avoid Prolonged Pressure on Your Breasts. Wear a soft, supportive bra that is not too tight, and does not have any under-wire or push-up pads. Do not sleep in positions that put pressure on your breasts from your arms, or anything else. 
• Breast Compression While Pumping. Breast compression basically just invovles squeezing the breasts between suctionings of the pump. I usually wait until after the first let-down, and use both hand on one breast, and then the other. You will want to change the position of your hands a few times, and squeeze at multiple angles to ensure that the breast are able to get as empty as possible. Feel for any firm spots, and massage through them towards the nipple while you pump. The prevents excess milk from pooling, and the fat from sticking to the duct, and blocking it. It can also increase your milk supply. Here is a link to a youtube video showing the basics of breast compression while pumping. It does show a woman's full breast as she is pumping, but if you're like many nursing and pumping moms, boobs don't phase you in the least, especially when they're being used to express milk.
• Sunflower Lecithin. This stuff is amazing! This is the one I take, but any brand should be fine.You'll want  sunflower lecithin rather that soy lecithin as soy can mimic estrogen, which can affect your milk supply, your weight, and your fertility. I take 1200 mg daily for a maintenance dose, and 1200 mg twice daily when I have a clog. Lecithin basically acts as a lubricant, and makes the milk fat less sticky so it doesn't stick together and block the ducts. 

Exclusive Pumping: How it's Like Breastfeeding, and How it's Different.

When I realized that I was going to be feeding my baby from a bottle, I wanted it to be as similar to breastfeeding as it could be. However, I also realized that I didn't know much about bottle feeding. I'd never done it before, and never tried to learn anything about it because I didn't think I would need to. There are some key differences that are important to be aware of, as well as some important similarities. (Quick disclaimer; my links are underlined once. Unaffiliated advertisements not intended by me are underlined twice.)

Here are some differences-

• It's important to have your baby slightly upright, with their head at least a little higher than their tummy when you bottle feed them. When lying flat while being fed from a bottle, the child is more likely to have milk go into their trachea rather than their esophagus ("going down the wrong tube"), causing coughing or respiratory infections. It can also pool in their middle ear causing ear infections if they are lying flat while being bottle fed. The baby is less able to unlatch and turn away from a bottle nipple than from a human nipple, so you never want to prop a bottle up to feed them, as this can also cause coughing and breast milk going down the trachea into their lungs.You also want to watch the bottle to make sure the breast milk fully fills the nipple so that they aren't sucking in any air and giving themselves painful gas bubbles. This link has some good suggestions for positions to feed your baby in.
• You can actually know how much breast milk your baby is getting; a common worry among breastfeeders is the question "Is my baby getting enough milk?" However, don't get too caught up in this, and realize that many babies will eat less breast milk than they would formula, because they don't need as much volume to get the nutrients they need. Click here for a good general guide for how much breast milk a baby needs, but remember that some babies need more than others, and you should never restrict or schedule your baby's feedings. The best way to tell if your baby is getting enough is to feed them on cue, and watch to be sure they are gaining weight, have healthy looking eyes and plump skin, and are having at least 5 or 6 wet diapers per 24 hour period.
• Pumping and feeding requires more planning ahead, especially when leaving the house. Once you get a routine down though, it's not as difficult as it is at first. I have a car adapter for my electric pump, and a nursing cover I take with me when we go anywhere. Then I'm not stressed about being back home in enough time to pump, as I know I can just plug into the car in a parking lot somewhere and pump. Some women also carry a cooler with ice to store anything they pump in, as well as a thermos of hot water to use to reheat any stored milk.
• You have to know how to handle the milk. When it comes directly from your breast, you don't even have to think about it. If you are heating previously pumped milk for your baby, never microwave it. Even with vigorous shaking (also not recommended,) sometimes little globules of fat from uneven heating will hold onto the heat and will not be able to be fully mixed in enough to disperse the heat. These globules can burn your baby. Plus microwaving destroys some of the nutrients. The best way to heat it is to put the sealed baggie in a bowl of hot water, and gently squish and swish the bag around until it feels warm enough. It's better to err on the side of too cold than too warm, as milk that is too cold doesn't hurt the baby, while milk that is too hot can. Some babies are pickier about the temperature of their milk than others, though it seems that most babies will take most anything from room temperature to body temperature. While cold milk won't hurt them, many infants refuse it. Lastly, don't shake the milk when you are mixing back in the fat that has separated. Shaking breaks down some of the more delicate proteins in the milk. You do want to mix that fat back in, but do so by gently swirling the bottle, or squishing the bag instead.
• Sleep is different. I haven't decided if it's worse or better, and much of this will depend on your individual baby, and your individual parenting choices. I have co-slept with all my babies, so when I would nurse the older two at night, I would basically just roll over, get them latched, and drift back to sleep. Now that I have a baby eating from a bottle, I have to get up and pump a couple times in the middle of the night. If I wake because the baby wakes, I feed her, then lay her back down to sleep, and then go pump. If I wake because I need to pump, I go pump, and then gently pick my baby up and offer her the bottle. I do this in an effort to sync up our sleep patterns up. At first, if I woke needing to pump, and she hadn't woken to eat, I would pump and go back to sleep. Then she would wake an hour or 2 after that, and I would feed her. Then an hour or 2 after that, I would wake needing to pump again. I was waking twice as often, and getting to a scary level of sleep deprivation. Now our sleep and wake patterns are matching up much better. It is still hard to wake up fully and go pump in the middle of the night rather than just to roll over, latch, and go back to sleep. However, with bottle feeding, my baby doesn't want to slowly snack all night long, like my nursers did. She snuggles in for a bottle, and then goes right back to sleep. I lay her back down, and am able to sleep in whatever position I want to, instead of having to make sure I'm in just the perfect position on my side to keep the baby latched. It's a lot more comfortable, especially for a back sleeper like me, and I have less back pain throughout the day than I did with my nursers.

Here are the similarities I have found-

• The amazing nutritional benefits that you read about in every article and book that talks about infant feeding are all still true. Your baby still gets the perfect food, the antibodies, the micro-nutrients, and the probiotics that only breast milk has.
• You can (and should) still feed your baby on cue. The signs that your baby is hungry are still the same- rooting, sucking on their hand, minor fussiness, etc. It's best not to wait until they are actually crying to feed them, as by that point they are generally so hungry that it's painful for them. Breast milk stays good at room temperature for 6-8 hours, which is helpful because you are able to always keep a bottle of breast milk on hand. This way you don't have to turn your attention away from your baby to prepare a bottle when she's giving cues that she's hungry; the bottle is already ready to go. This will work better for some babies than others, depending on how particular they are about the temperature of the milk, and if they will take it at room temperature or not.
• I still feel that special sense of accomplishment watching my baby grow and get that adorable baby pudge, knowing that it's my milk nourishing her. Comedian Jim Gaffigan said in his comedy sketch "4 kids," "But truly, women are amazing. Think about it this way: a woman can grow a baby inside her body. Then a woman can deliver the baby through her body. Then, by some miracle of life, a woman can feed a baby with her body. When you compare that to the male's contribution to life, it's kind of embarrassing, really." Not to dog on men, but it really is pretty miraculous that we women are able to feed babies with our bodies. Whether we are are able to partially provide for our child's nutrition, and supplement with donor milk or formula, or we are able to fully provide for our baby's nutritional needs, or if we create more milk than necessary for out own child, and are able to donate the excess to other babies; it is an amazing miracle. (For more information about milk-sharing, whether you have excess to share, or are in need of donor milk, search "Human Milk 4 Human Babies" along with the name of your state, province or country in the search bar on Facebook. Every state, and many places outside the US, have Facebook pages which facilitate getting people with breast milk to donate in contact with those in need. There is no exchange of money allowed, but it is common practice for the mom receiving the milk to give the donor mom storage baggies to replace the ones she's taking that are filled with breast milk.)

• My baby still wants me all the time, and wants to be held frequently. At first, I had worried that without nursing directly from the breast, I would somehow be more replaceable to my baby. I mean, anyone could snuggle her and feed her my milk from a bottle; what would be different about the care she received from me to set me apart from anyone else who cared for her? However, I have found that even without nursing, she knows I am Mom. When she caught her first cold, she didn't want anyone else, even Dad or Grandma, both of whom she normally adores. When I have been away at work for the day, she needs me to just hold her and be with her for awhile when I first get home. No one can calm her as well as I can, and she seems to save her best giggles for me. Your baby may not do these exact same things, but I'm sure will have enough of his or her own ways of showing you that even without nursing, they know you are Mom, and that Mom is different than any other caregiver. Regardless of how they receive their nourishment, there is no other attachment like the bond between an infant and a mother.

What have you found are some similarities and differences in bottle feeding versus breast feeding? And are there any handy tricks you've found to make it any easier or better? Let me know in the comments below.

My Story

I have always been a big proponent of breastfeeding, a "lactivist," as it is sometimes called. My first 2 children were breastfed until they were each a little over 2 years old.  There were a few hiccups early on from latch issues with one to fore-milk/ hind-milk imbalance with the other, but we worked through it, and I was able to share a beautiful nursing relationship full of cuddles and bonding with each of them.

When my husband and I found out we were expecting baby number 3, I admit I was dreading the impending nausea and other symptoms of pregnancy.  And I can't say that I was excited for the countless sleepless nights and exhaustion ahead of us that first little while after a baby is born.  But one thing I was looking forward to was the sweet bonding experience created by nursing and comforting my baby in the way that only a nursing mother can.

After a very fast labor, I found myself gazing at my perfect little newborn, my heart overflowing with love for this miracle. She latched on well, but let go after just a few sucks. I wasn't worried, though. She was less than an hour old, and probably exhausted from her journey to get here. Besides, I knew she could latch, and that was the main thing, right? She continued to latch well, initially, but wouldn't stay latched beyond 3 or 4 sucks. I was continuously getting her re-latched, up to 30 or more times per nursing session, and the more I had to do this, the more she began resisting.

By day 4, she was no longer latching well. When I would put her in the position I normally nursed her in, she would fuss, and arch her back away from me. She would turn her head away from my breast. I tried nursing her in different position like the cross-cradle hold and the football hold.

I scheduled an appointment with a chiropractor, thinking that maybe she was having pain or discomfort from being born with her hand up by her face; had that torqued her neck? Maybe she just wasn't comfortable enough to snuggle in for a good nursing session. The doctor said that she did seem to have a little issue at C-7 and he gave her a gentle adjustment. She did fuss less after that when not nursing, and we continued to take her in to ensure the problem stayed fixed. Unfortunately, it did not change anything with nursing.

When she was 6 days old, she was losing weight. I know it's normal for babies to lose weight and regain it, but my baby did not look to be healthy and thriving. I went to the store and bought a bottle. I had already been pumping some to make sure that engorgement wasn't inhibiting her latch, and I had milk stored up. I gave her some of my milk in a bottle. She took it easily, and gulped and gulped. She looked so relieved, and ate until she passed out, milk-drunk, like my other babies had when they nursed. I continued to try to get her to nurse first, but when she would fuss and arch away from me, I would stop and just give her a bottle of breast milk. She started filling out, and gaining weight. Her skin and eyes took on a healthy glow.

She was a happier baby after that, except when I would try to nurse her. I reached out to lactation consultants, as well as to knowledgeable friends. I followed up on each of their suggestions. I ended up taking my daughter in to be evaluated for lip and tongue tie. She did indeed have a fairly severe lip tie, and a posterior tongue tie. I scheduled the appointment to have them both revised. I was a little nervous about putting her through the procedure, but was assured by many that it was very quick, and that their babies had hardly cried. Well, my baby was different. She screamed like she never had before. And I don't blame her, the procedure looked painful. And we had to "stretch" the tissue with little exercises daily for 2 weeks following to prevent the tissue from healing back down and having to have the revision re-done. She cried hard every time I did the tissue stretching. She whimpered in her sleep for the next several days. And it still didn't help with breastfeeding.

But we continued trying. I would try to get her to latch when she was sleepy. We did lots of skin to skin time. We took warm, relaxing baths together and tried to nurse while in the bath. A few times, we had success. She would stay latched for longer once every couple days, but still never enough to get even one full meal. I continued to pump, and follow up feedings with a bottle, which was where she was getting the vast majority of her food.

One day when she was about 2 months old, I had a bottle of pumped milk at the bedside, and was going to try to nurse her first. As I got her into position to nurse, the little smile fell away from her face. Her body tightened up, and she looked up at me. Her eyes were filled with fear and pain. She made a heartbreaking whimpering sound. I started to cry. What was I doing? I had a little conversation with myself. Why was it so important to me to nurse her? I wanted to have the same sweet nursing relationship I'd had with my older 2. I wanted the benefits of bonding that nursing brings. And I hated pumping. Who was I doing this for, her or me?

The answers came flowing to my mind, almost as if they weren't coming from myself. She was not one of my older 2 kids; she was her. I needed to treat her as herself. Bonding happens when you respond to your baby's cues and communications to build trust. Her cues and communications were all telling me to stop trying to make her nurse. I gave her the bottle which she happily took. I didn't even try to get her to latch first that time. In fact, I never tried to get her to latch again. I think she must have known that something big had just happened because as I held her close and fed her from the bottle, she paused and smiled at me before cuddling in to finish eating.