Power Pumping vs Cluster Pumping - Which is Better for Increasing Milk Supply?

As a retired IBCLC with 30+ years experience in breastfeeding support, I am not sure that power pumping is the best method for increasing milk supply for every mom.  The method has limited scientific research and can cause moms quite a bit of frustration with such ridged and lengthy pumping sessions. Not to mention friction when dry pumping. While nipple stimulation does sustain hormone signals, research supports that regular extraction is the source of increasing milk supply.  Apart from moms who are relactating or inducing lactation, cluster pumping is a better method than power pumping because there is more milk to extract every 2 hours than there is when pumping again in 10 minutes. For clarity, I have outlined the power pumping method and cluster pumping methods below for moms with babies under six months below. While we are listing these times as pumping, nursing sessions can and should be used in place of these when possible.

Power Pumping 

60 minutes session once per day as below; pump an additional 7 x daily for 20 min. 

• Pump 20 minutes

• Rest 10 minutes

• Pump 10 minutes

• Rest 10 minutes

• Pump 10 minutes

Cluster Pumping 

Pump every 2 hours with one 4 hour stretch. The schedule below includes cluster pumping during the midnight to 5am window that prolactin milk producing hormone is the highest.

• Pump @ 12am

• Pump @ 2am

• Pump @ 4am

• Pump @ 8am

• Pump @10am

• Pump @ 12pm

• Pump @ 2pm

• Pump @ 4pm

• Pump @ 6pm

• Pump @ 8pm

• Pump @10pm

Power pumping is normally used for one week daily and a second week every other day.  Cluster pumping is meant to closely imitate an infant's growth spurt and results should be evident after 7 days of the outlined schedule.

No matter how many years go by, research has never found the principle of supply and demand to be refuted.  Better extraction through waiting long enough for milk to build and simulating a natural way baby's cluster nurse is my recommendation.  And remember, better extraction with a breast pump means a double electric breast pump with properly sized flanges and optimally not a wearable breast pump. If you own a wearable, it is for convenience.  Your electric breast pump should always be your main breast pump. But having said that, the best breast pump is the one you will actually use.

Here's to demand for supply!

Tanya

How to Express More Milk with your Spectra Breast Pump

At Lactation Connection, we are frequently asked which setting mom should use on the popular Spectra S1 and S2 breast pump to get the most milk.  While settings are important, flange size is equally important.

Your goal with your Spectra flange size is to engage the milk sinuses which are located an inch behind the nipple.  So it is really important that the flange allows the nipple to move freely without drawing in too much tissue.  You can use the guide below or a silicone nipple measuring tool.

What about the settings?  Cycle pumping is recommended by Spectra when using the S1 or S2. Below is the procedure to start using the Spectra pump effectively.

      Cycle 70 (Massage Mode) for 5 minutes 

      Cycle 54 (Expression Mode) for 5 minutes 

      Cycle 70 (Massage Mode) for 5 minutes 

      Cycle 38 (Expression Mode) for 5 minutes 

Some moms leave their pump on higher setting, but know that the Expression Mode (38 cycles per minute) is very effective at draining the breast and relieving clogged milk ducts.

In addition, relaxed pumping is best. You first need realistic expectations of how much you should be getting when you pump.  After the initial week postpartum, you should only expect what your baby needs.  To determine this amount, take your baby's weight and multiply by 2.5.  Then divide by 8 feedings.  This is the amount you are looking to pump in total from both breasts.  For example, a 10lb baby x 2/5 + 25oz ÷ 8 is 2.5 oz.  So you may get one once on one breast and perhaps an ounce and a half on the other.

Effective tools for relaxation to aid with let-down include the following:

1.  Once you position the breast shields, don't watch the bottles!

2.  Look at your baby or baby's picture.

3.  Wrap a swaddling blanket around your neck so you can smell the baby.  

4.  Relax your shoulders.  Hold the breast flanges in a c-hold at the flanges instead of by the bottles so you can drop your elbows and relax your shoulders.

5.  Make sure you are comfortable.  Use a short stool if needed to bring your lap up and keep you from leaning too far forward and straining your back.  Pumpin' Pal angled flanges are excellent for keeping you from leaning forward and are a real back-saver!

Best wishes for an abundant pumping session!

Tanya

Comprehensive Guide to Increasing Breast Milk Supply

Your body makes milk on a supply and demand basis. Although we don't need ounce markers on the side of our breasts to know the baby is getting enough, we tend to fret over milk supply.   Here is a comprehensive guide to ease your worries and address your concerns.

Is my baby getting enough?
When your baby is first born, his wet diapers should increase daily. On day one, he should have at least one, day two, he should have two, up until day six. After six days of age, they have six to eight pale wet diapers daily and three to four "cottage cheese and mustard" stools. Other ways we can tell the baby is getting enough milk is that he makes quiet swallowing sounds at the breast. The breast feel full before the feeding and softer afterward. The baby seems satisfied after twenty minutes of swallowing. Babies may loose 7-10% of their birth weight, but begin regaining at day 6 and gain 5-7 ounces per week on the average until 6 months of age. The stools can change at 4-6 weeks of age. Only if your baby is not gaining well, invest in a baby scale that you can use to monitor breast milk intake and growth. You will want a scale that shows 1/2 oz increments or greater.

Do I need to drink more water?
Water does not make milk, but make sure you are drinking to thirst. If you are dehydrated your body does not function optimally.  
Can I increase my milk supply with supplements?
If you want a boost increasing milk supply, there are several galactagogues on the market. Fenugreek is safe and effective and can be found in most areas. Make sure you are talking a quality brand like Nature's Herbs or Natures way in an appropriate quantity.  You should take 600-626 mg capsules that only contain Fenugreek.  This normally increases milk supply in about 48 hours.  If you are an average size mom, you should take three capsules, three times daily so 9 per day.  Plus size moms can take up to 5  600-626 mg capsules per dosage for a total of 15 per day.  Make sure you are not getting loose stools and check milk supply after 3 days by nursing the first session in the morning and then double pumping with a good quality double pump like the Hygeia EnJoye LBI, Spectra S2, or the Ameda Finesse Breast Pump for 15 minutes. 

How much is enough?
You should be yielding 2.5 oz per lb of baby's body weight per day.  To calculate if you are making the appropriate amount take your baby's weight for example 8 lb multiply by 2.5 which in this case would equal 20 oz per day.  Then divide by 8 times per day for a baby under 6 months.  This means from both breasts you should be making 2.5 oz for an 8 lb baby.  Here is a link to a page where you will find to an easy to read milk intake feeding supply chart.

Can my baby help increase my milk supply?
Yes!  If your infant will suckle at the breast, this is a highly effective way of increasing milk supply.  Offer the breast every 2 hours with a longer stretch at night for a minimum of 12 feedings per day.  If the infant will suckle for at least 20 minutes each time, your milk supply should increase by day 6.  Remember, breast milk adheres to the supply and demand rule, so the more you demand, the better the supply.

Can I increase my milk supply with a breast pump?
Yes!  If your baby will nurse frequently even if milk supply is low, use the baby; but if your baby will not latch or will not stay latched long enough for you to get adequate stimulation, by all means use a quality pump like the Hygeia EnJoye Cordless, Spectra S2, Ameda Finesse or the Ameda Platinum Breast Pump.  If your baby is under six months old, you should be pumping or nursing at least 8 times per day for 10-15 minutes of double pumping.
If you are already nursing eight times per day, use your breast pump to simulate a growth spurt.  Studies show that you need one hour of additional stimulation per day to increase milk supply.  Pump an additional 10-15 minutes three times per day for five days in a row to simulate a growth spurt and increase milk supply.  If you miss a day, start the process over. You can accomplish this by moving feedings and or pumping to every 2 hours instead of every three or pump.  Frequency is better than duration for increasing milk supply so don't cheat by making pumping times longer.  They need to be more often.

Are there other supplements that help with maintaining milk supply?
Motherlove More Milk Plus comes in a liquid filled capsule with just the right combination of galactagogues to increase milk supply in most mothers.  In addition, products from Motherlove offer specific instructions for dosage in relation to lactation.
There are several other supplements that I would recommend substituting for snacks. Instead of a cookie, grab a Milkmakers Lactation Cookie.  Moms do need an additional 500 calories per day to make milk.  Most of us get them instinctively, but if you are already over your calorie limit, a good mothers milk tea is a good option.  

Are there other tips for maintaining a healthy milk supply?
Busy moms can sometimes miss feeding and or pumping.  Don't just forget them, make up for missed pumping times at work when at home or put later in the day pumping closer together if you have a meeting.  If you are out for a short time and someone else is fed the baby before you could make it back, make sure to pump immediately upon return.  This helps milk supply as well as restocking your freezer.

Is my body capable of making enough milk?  
Insufficient milk supply syndrome is actually very rare.  A mother with a complete mastectomy on one breast can still nourish a baby just as a mother of twins can nourish two. Most milks supply issues are about mismanagement of stimulation of the breast and insufficient extraction of the milk, making your body think it doesn't need to make more.  
What other tips do you have for managing milk supply?

• Nurse within the first 30 min to 1 hour after birth, delaying the bath for skin to skin contact.
• Try to minimize engorgement and don't leave engorgement unresolved.  Nurse often, waking the baby every 2-3 hours.  Use warm compresses and a breast pump if the breasts are too hard for the baby to latch on.  The first day, the baby tends to sleep longer after the initial hour after birth, but continue to try and after that 6-10 hour period increase your efforts.
• Don't miss feeding unless you are pumping.
• Don't forget about growth spurts when you are working.  If you are away from your baby at the 3 week, 6 week, 3 month or 6 month time period, pump every 2 hours instead of every 3 for a total of 11-12 nursing or pumping sessions per day.
• Delay solid foods until the baby had not only double his birth weight but is sitting alone unassisted.  Sitting without help (even from a Boppy) coincides with the loss of a tongue thrust reflex that indicates readiness for solids.
• Feed solids only after breastmilk.  Breastmilk is still the main source of nutrition for at least the first year so do not fill the baby up on inferior food.  Nurse or give breastmilk first.  Besides, who wants green beans on your breast?

Here's to a healthy milk supply!
Tanya

References:
Fenugreek: One Remedy for Milk Production by Kathleen Huggins, RN, MS
Fenugreek: Overlooked but not Forgotten by Rima Jensen, MD

Updated:  2/19/19

Pumping: Increasing Volume of Breastmilk

Our previous post gave information on how to increase your milk supply while pumping,  In addition, there are ways to increase the milk output from the supply mothers already have. 

1.  Massage While Pumping.  Using a hands-free pumping bra or using the pledge of allegiance hold pictured here can give you the freedom to massage your breast while pumping.  This can assist your milk output provided that you are doing it in a relaxed manor and not watching the bottles anxiously.

Mother using pledge of allegiance hold with Ameda Elite Breast Pump.



2. Reposition Breast Flanges.  Instead of just sitting and double pumping for 10-15 minutes, take advantage of the anatomy of your body.  You can engage more milk ducts if you re-position your breast flanges a.k.a. breast shields every 3-5 minutes during your pumping session.

3.  Pump Up the Volume.  Studies on mothers of premature babies show that listening therapy increases their output by 2-3 times. The most effective form of listening therapy includes verbal encouragement plus music.  One way to accomplish this is to have hubby record encouraging words and/or relaxing music.  It doesn't have to be elevator music, just music that is relaxing to you.

Study published in Advances in Neonatal Care, Douglas Keith, April 2012. 



4. Visualize the Prize.  Have a picture of your baby taped to your breast pump bag, on your desk or table by where you are pumping.  This will help milk output much more than staring at the bottles.

5.  Sense of Smell.  Another way to aide with let-down is to have a receiving blanket that has been on the baby or nursing scarf to drape around your neck or even to cover the bottles while you are pumping.

Remember, your expressed milk is liquid love.  You are leaving a part of yourself when you can't be with your baby and you are doing a great job, mama!

Happy Nurturing,
Tanya

Pumping: Increasing Milk Supply

Every Lactation Consultant will tell you breast milk quantity is based on supply and demand, but with today's busy mom taking the baby to bed with you all day to suckle is not an option.  You can increase your milk supply while at work or with your breast pump at home.

First make sure you are already getting the appropriate stimulation for your baby's age.  If your nursling is under 6 months, you should be nursing and/or pumping at least 8 times per day while using a quality double electric pump such as the Hygeia EnJoye or Ameda Purely Yours or Ameda Platinum breast pump for a full 10-15 minutes per session.  If your nursing is 6-12 months, you should be stimulated at least 5 times per day.  For over 12 months at least 2-3 times per day. 

If you are already following the above protocols for sufficient stimulation of the breast, you will need to increase the number of pumping sessions to increase milk supply using a breast pump.  Research indicates that you need an hour of additional stimulation to increase milk supply.  Nature dictates that the average growth spurt where a baby is increasing their nursing sessions lasts about 5 days.  taking these two things into consideration, you should add 3 double pumping sessions of at least 10 minutes for 5 days in a row.  Each breast is stimulated for 30 minutes totaling the 1 hour of stimulation you need. For example, if you are nursing/pumping 8 times a day, you need to increase it to 11-12 times per day.  If you are nursing/pumping 5 times a day, you need to increase it to 8. 

Growth spurts are just that, spurts.  You need to increase your pumping sessions for a full 5 days in a row for this to be effective.  If life interrupts that, you will need to start over and do another 5 days in a row to simulate the growth spurt.

You can also use breastfeeding supplements during this time for additional increase if you prefer.



Happy Pumping!
Tanya

Why Fenugreek Isn't Working for Breastfeeding

     The truth is fenugreek is a great tool to boost milk supply in most moms.  However, in the two decades that I have been helping nursing moms, I get this comment a lot, "Fenugreek didn't work for me."  How can it be that an herb with such great success stories doesn't work for a large number of mothers.  In most cases, the answer is in the quality, dosage or delivery method.

     Many moms buy Fenugreek at a local health food or grocery store in brands that are not stored or bottled in the best way to keep them at full potency.  Also, shelf life factors into this so buying from a store that doesn't cater to the largest market for Fenugreek, nursing mothers, will not have the best turn-around.  It is always a good practice to check the expiration date on any herb before using.  Fenugreek capsules work best when taken in a quality brand like Nature's Herbs or Nature's Way Fenugreek and in the appropriate dosage or combination.   The correct dosage is essential.  If you are under 150 lbs, start with three capsules, three times daily.  Yes, that is nine capsules per day.  Possible side effects of fenugreek for mom are loose stools and you may smell like maple, but who cares if you are taking this short term for a boost and the result is more milk!  If you stools are not loose or you are over 150 lbs, you can take up to 5 capsules three times daily.  This dosage is for Nature's Herbs as it is 620 mg per capsule.  Some brands only contain 500 mg.  You should see more milk in 48-72 hours.  Always finish the bottle which is about a 10 day supply.  Don't save it for later as once you open the bottle, it begins to loose freshness.  If you are still not getting a result, combine Fenugreek with Blessed Thistle.  Take 3 Fenugreek + 2 Blessed Thistle three times daily.  You can also use Alfalfa instead of Blessed Thistle.

Dr. Jack Newman, a lactation specialist at the International Breastfeeding Center in Toronto, writes about the effectiveness of blessed thistle and fenugreek when used together: “These two herbs seem to increase milk supply and increase the rate of milk flow.” He adds that their effects are additive: “Fenugreek and blessed thistle seem to work better if you take both, not just one or the other”. Dr. Newman notes that mothers generally notice an increase in milk production within 24-72 hours after starting the herbs.   The only problem is that the number of capsules taken can be daunting to new mothers.  We recommend St Francis Fenugreek Blessed Thistle which are a high potency blend of fenugreek and blessed thistle in the appropriate dosage with only one capsule taken twice daily!

     What about Fenugreek drinks?  Fenugreek Tea such as Mother's Milk Tea, Earth Mama Angel Baby Milkmaid Tea tea bags should be steeped for about 15 minutes to get the full amount of herb available.  It is more difficult to tell how much you taking so I only recommend using tea bags as a supplement to the capsules or for long-term intermittent use and not for a quick three day boost.
    The best way to get the correct herbal dosage is either a capsule with a single herb such as fenugeek or a single serve kcup lactation tea that serves the same amount of herbs every time.  Anna Naturals Nursing Mama Tea comes in single serve cup for kcup compatible brewers and is the best-tasting of all the herbal lactation teas we have found other than Milkmaker's Tea. Anna's lactation tea cup works in Keurig and other k cup style brewers.  Drink 3 cups daily for best results or use as a supplement in taking with Fenugreek or Blessed Thistle capsules if drinking sporadically.

     Remember, milk supply is usually a supply and demand issue.  Baby is not nursing frequently enough or emptying the breast well enough or you are not pumping for a full 15 minutes or every 3 hours while at work.  Another reason for low supply could be missing out on growth spurts.  If you miss a growth spurt,  add 3 extra nursing or 10-15 minute double pumping sessions with a quality double breast pump in each day for five days in a row to make up for the missed stimulation.  This simulates a growth spurt and studies show this extra hour of stimulation per day.  If you pump frequently, make sure to replace valves and backflow protectors frequently to ensure your pump is functioning optimally to maintain a healthy milks supply.

Some moms should not take Fenugreek.  If you are allergic to chickpeas, peanuts or other legumes do not take.  If you have low blood pressure or low blood sugar, this may be affected with Fenugreek.  If you have low potassium or asthma, Fenugreek may affect these conditions as well.  Also, if you have any bleeding disorders, Fenugreek can work as an anticoagulant so would have an adverse effect. If you could be pregnant, it should not be taken during pregnancy.  The good news is that there are great alternatives that will boost supply in most moms from companies like Legendairy Milk and Motherlove. The most popular in these brands are the Legendairy Milk Lactation Support Bundle, Legendairy Milk Cash Cow and Motherlove More Milk Plus. 

     In addition to everything else you are doing, make sure you are drinking to thirst and make your snacks count.  It never hurts to eat a lactation cookie instead of donuts for breakfast or candy for a snack.

   
While fenugreek alone may not increase milk supply, fenugreek and blessed thistle are a great lactation supplement when taken correctly. And for those with medical contraindications or allergies, other great lactation supplements are readily available.

Best wishes for a healthy milk supply!
Tanya



Induced Lactation: Protocols for Adoptive Breastfeeding Mothers

Motivation as in anything is extremely important in breastfeeding and even more important is tenacity when inducing lactation.  The success rate for the following protocols according to Nemba in the 1994 Journal of Trop Pediatrics was 89%.  In this study 33 of the 37 women nursed their babies for 9 months or longer.
These mothers began with a 100 mg single priming dose of medroxyprogesterone (Depo Provera).  After 7 days, they began 25 mg of chlorpromazine 4 times daily or 10 mg of metoclopramide (Reglan) 4 times daily until adequate lactation was established.  Frequent pumping before infant's arrival and/or frequent suckling afterward is encouraged.  A supplemental feeding device is necessary until adequate lactation is established.  Inducing lactation is a gift of time and love!
Breastfeeding an adoptive baby is more than about breastmilk.  It is about bonding.  Skin to skin contact is essential.  Use a lactation aide to feed donor milk or formula at each feeding.  This is essential for stimulation of the milk production, bonding and success.

Best wishes for nurturing and nourishing your baby,

Tanya Roberts, BSEd, IBCLC

www.lactationconnection.com