UnityPoint Clinic Urgent Care - West

2255 John F Kennedy Road
Dubuque, IA 52002

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Breastfeeding Education

Exclusive Pumping and Feeding

Some mothers make the decision to pump and feed exclusively, others are separated from their babies and this becomes a necessity. Whatever the reason, please use this guide to help you.

What type of pump?

You should use a good quality, double electric pump. One that has specifically designed pumping patterns to initiate the Let-Down reflex and maintenance phase. (Any of the electric Medela or Spectra pumps). Make sure the flanges fit correctly.

When should I start pumping?

A study in 2012 found that women who begin hand-expression or pumping within the first hour after birth (as compared to 6 hours) had significantly earlier onset of milk production as well as more milk at 3 weeks post delivery.  So, begin as soon as you are able.

How often should I pump?

If you are exclusively pumping from the time of birth you should pump 8-10 times per day during the first week-10 days after birth. If you are beginning exclusive pumping after full milk production, you can vary this depending on the amount of milk you are already producing. Newborns feed 8-12 times in a 24 hour period for the first few weeks and average 8-10 feedings in the first 3 months so your pumping pattern should mimic this. Do not go more than 5 hours between sessions even at night. The more frequently the breast are emptied, the more milk you will produce.

How long should I pump my breasts?

Start with 15-20 minutes. Even if you are not getting milk yet, it is important to pump long enough to get nipple stimulation which is important for milk production. If milk is flowing easily you may pump until the breasts feel "soft". Pumping an additional 5 minutes after the milk stops flowing will help increase your milk supply. Never pump longer than 30 minutes per session. Be sure the pump suction setting is set high enough for you to feel the pump working, if it is set too low you will not get enough stimulation to elicit a milk let down.

How much milk should I get?

Every woman will get different amounts of milk during pumping sessions. As a guide, by Day 10-14 your expressed milk supply should ideally be 750ml (25 ounces) in a 24 hour period of time. If you are getting less than 350ml (12 ounces) in a 24 hour period, you are exclusively pumping and feeding  and your baby is 2 weeks old please call to speak with a Lactation Consultant at 563-557-2837.

How do I bottlefeed Expressed Breast milk?

It is very easy to overfeed a baby with a bottle. A baby cannot control the flow of milk from a nipple like he/she can from the breast, therefore using a slow flow or "newborn" nipple can help. Breastmilk should never be warmed in a microwave as it can alter the composition of the milk and destroy nutritional qualities. Instead warm under running tap water or let it sit in a bowl of warm tap water to thaw and/or warm.  Ideally bottle feeding should mimic breastfeeding, allowing baby to take as much as he/she wants whenever he/she wants. Breastmilk digests in about 90 minutes so one would expect feedings every 1.5-3 hours apart. Since it is so easily digested, the baby that takes exclusive breastmilk needs to eat more often, but they don't need as much per bottle. 

For more information, please call or ask our Lactation Team for help at: (563) 583-BABY(2229)

Helpful websites:

Nipple Shields

What is a nipple shield?

A nipple shield is a flexible silicone nipple that is worn over mom's nipple during a feeding.

Why did I receive a nipple shield?

Often shields are recommended during the first few days after birth to help baby achieve a proper latch by creating a nipple shape in the baby's mouth which helps transfer more milk from the breast into the baby. This may be the case if nipples are flat or inverted, nipples are sore, baby is pre-mature and/or has a disorganized suck, mom is engorged or baby is having difficulty latching.

What are the advantages of using a nipple shield?

Although nipple shields should be used after all other options have been tried and you have been evaluated by someone from our Lactation Team, it is better to have a baby at the breast with a shield than not at the breast at all. 

What are the disadvantages of using a nipple shield?

Baby may transfer less milk while using a shield therefore decreasing your milk supply. Mother may be at more risk for clogged ducts and mastitis if less milk is being transferred. There may be inadequate weight gain if your milk supply is decreased. It can be difficult to wean from a shield. They can cause nipple damage if not applied or sized correctly.

What should I watch for if I am using a nipple shield?

By following thru with the recommendations outlined you should be able to avoid problems.

  1. Be sure it is on correctly. Turn the shield inside out and place on top of nipple, turn it back out and your nipple should pull into the shield slightly. Moisten the edges to help it adhere. Hand express a little milk into the nipple shield if able. Make sure the babies mouth does not close on the shaft of the nipple shield. You should feel the nipple pull into the shield when baby is sucking. Wash after each use with hot soapy water and rinse well.
  2. Make sure baby is actually transferring milk properly while the shield is on. You should check to be sure the baby is not just sucking on the tip of the shield but is drawing the nipple into his/her mouth inside of the shield. Look for milk on the inside of the shield when baby comes off. Watch and listen for swallowing. Be sure the breasts feel soft after feedings.
  3. Count wet diapers every day. He/She should have at least 6 really wet diapers every day after you are discharged from the hospital. He/She should have at least 3-4 stools every day if he less than 5-6 weeks old. If older than 5-6 weeks there may not be as many but they should be large and loose.
  4. Have your baby weighed at the Breastfeeding Support Group or thru your provider's office at least once per week until it is clear you have a good milk supply and baby is gaining weight well.
  5. It may help to hand express or pump your breasts after feedings to establish milk supply. Once you are home with your baby continue to watch for signs of adequate feedings (content after nursing, 5-6 wet and 3-4 stool diapers, adequate weight gain) If you are concerned about any of these please call our Lactation Dept. You may need to pump several times per day to keep milk supply well established the entire time you use a shield.
  6. Talk to your Lactation Consultant with any questions or concerns - (563) 583-BABY (2229)

When should I wean baby from the shield?

This will be different for every baby and situation. Some babies need a shield for a few days others have nursed successfully with a shield for a year and beyond. Every situation is different. Please consult with our lactation team or attend Breastfeeding Support Group for help and tips on weaning from a shield.