Medical experts agree that breastfeeding your baby for a minimum of six months and up to two years and beyond has a wide range of benefits. Excellent nutrition and increased immunity for baby, enhanced bonding between mother and child and a decrease in the risk of breast cancer for nursing mums are just some of these benefits.
The most recent study on the benefits of breastmilk that was published in The Lancet indicates a positive correlation between breastfeeding and a child’s intelligence quotient (IQ), educational attainment and income later in life.
With all this information on how good breastfeeding is for mom and baby, what’s a mom to do when she can’t breastfeed directly for whatever reason? The first solution that comes to mind is to give the baby formula milk.
Another option that a lot of moms take, however, is exclusive pumping that lets the baby get all the goodness of breastmilk without being directly latched on to the breast.
We spoke to experienced Singaporean lactation nurse Jophia Bok for her expert advice on the subject of exclusive pumping.
Jophia and other lactation experts explain why some moms can't breastfeed directly on the next page.
Why some moms don't breastfeed directly
There are many reasons why moms cannot breastfeed their infants directly. Professional lactation consultants indicate the following:
- Physiological conditions: Some babies may be temporarily unable to breastfeed, perhaps, due to premature birth and other birth conditions. But other little ones may never be able to nurse, such as those with bilateral cleft palates or severe neurological issues.
- Psychological issues: Some women with a history of sexual abuse, for example, may find breastfeeding psychologically challenging.
- Difficulty in getting the baby to latch on: Some moms find it hard to establish proper latch-on techniques, due to engorgement or flat, sore or inverted nipples.
On the other hand, a mother might choose not to breastfeed her baby directly for several reasons. Jophia points out the following:
- Physical distance: It is common in the Philippines for some babies not to live with their moms and have their grandmother take care of them in another house.
- The mom's lifestyle: Some mothers may have to return to work soon after delivering their baby. Some have long work hours.
- Need to monitor milk intake: Sometimes, a mom might be very anxious to know exactly how much milk her baby is drinking, for reasons such as neonatal jaundice or low birth-weight.
- Convenience: Some mothers may simply find bottle-feeding to be easier than breastfeeding. Or it might be that the baby is always being taken care of by someone else other than the mom, even though they live in the same house.
For many women who face one or more of the issues described above, exclusive pumping is a great way for them to still give their baby the benefits of breast milk.
Read about tips for getting started with exclusive pumping on the next page.
Different ways to collect breast milk
There are two ways to go about collecting breast milk: through the use of a breast pump and through hand expression.
When thinking about getting a breast pump, La Leche League International (LLLI) suggests the following considerations:
- Cost
- Portability
- Noise level
- Ease of use
- Efficiency
There are two main kinds of breast pumps: electric and manual.
Electric pumps
There is a wide range of electric pumps -- some quite small and portable, others quite large like the hospital grade ones.
According to lactation experts at LLLI, when there is limited pumping time and larger quantities of milk are needed, some moms may rely on full-size automatic electric pumps. The suck-release cycle of these is closer to how a baby might suck, unlike the continuous suction of smaller pumps. These may have to be rented.
There are also the very popular automatic electric pumps that are quiet and efficient. These are usually listed as single-user pumps by the manufacturer and are used to pump a breast at a time, or both breasts at the same time. Such pumps often work well for working moms and come with a wide-range of accessories.
Jophia emphasizes the need to periodically maintain your electronic pump and to regularly change some of the parts such as tubing and funnels for efficiency and hygiene purposes.
Manual pumps
LLLI recommends manual (hand operated) pumps for those who need to pump on an occasional basis. Most are easy to operate, small, and easy to transport. These are inexpensive, too, compared to electric pumps.
However, according to Jophia, what's more important than the type of breast pump is how comfortable you are with using it. She suggests to keep practicing until you are proficient with using your pump, whether it is manual or electric.
Hand expression
Jophia personally recommends hand expression to collect breast milk and touts this as being very convenient and fuss-free.
She points out that with hand expression, all you need are clean hands, sterilized milk bags or bottles and a cooler bag. A large shawl for covering yourself when you cannot find a nursing room is also handy.
If you would like to learn more about efficient hand expression, please visit the Medela website.
Getting started: Frequency of pumping
It is important to establish your pumping schedule soon after delivery. In fact, as a start, Jophia suggests that you should already start expressing your colostrum every 30 minutes to an hour on each breast, for five to 10 minutes.
Jophia explains that you can can then proceed to pump every two or three hours, or according to baby's demand once the mature milk comes in, which is around five days to one week after birth. Each expression should not be longer than 20 to 30 minutes.
However, she emphasizes that you should also monitor your baby's hunger cues and express milk accordingly. You will know that your baby is getting enough of your milk through the number of wet diapers a day, which is around six. Birth.com.au provides a rough estimate of how much milk you should be pumping according to your baby's age.
Do you know for how long you can keep breast milk at room temperature? Find out on the next page.
Storing your expressed breast milk
Here are some breast milk storage guidelines provided by Jophia:
- All milk should be dated before storing.
- Storing milk in two to four ounce (60 to 120 ml) amounts may reduce waste.
- Preferably, breast milk should be refrigerated or chilled right after it is expressed unless you are going to feed it to your baby immediately.
- If you are not able to transfer freshly expressed milk to the fridge immediately, ensure it is kept as cool as possible. Freshly expressed milk can be kept at room temperature for around four to six hours.
- If you are storing your milk in an insulated cooler bag, ensure you keep ice packs in constant contact with the milk containers and avoid opening the cooler bag too often. Breast milk can be kept in this manner for up to 24 hours.
- When storing milk in the fridge, place it right at the back where it is the coolest. Breast milk can be stored like this for up to 72 hours.
- If you are freezing breast milk, store it towards the back of the freezer. You can keep it like this for up to two weeks if the freezer is a compartment of the fridge. If the freezer compartment has a separate door, you can keep it for up to three to six months, and up to a year in a deep freezer. Do note that when frozen, milk fats may break down over time.
Jophia points out that refrigerated milk has more anti-infection properties than frozen milk. She also advises mums to smell or taste their own milk before offering it to their babies.
Other lacation experts suggest briefly scalding the milk before storing it to prevent it from getting an unpalatable metallic flavour that is caused by the enzyme lipase found in breast milk.
You can do this by letting the milk get hot enough for the edges near the pan to bubble a little, then by quickly turning off the heat and cooling it down before storing as normal.
For more guidelines on breast milk storage, please click this link.
What can you do to increase your breast milk supply? Find out on the final page of this article.
Tips for moms to increase their breast milk supply
Jophia is a self-proclaimed "naturalist" when it comes to advice on boosting breast milk supply. She believes that a mom's first point of call when it comes to producing adequate milk should be through a healthy, balanced diet.
However, if a mom really needs to increase her milk supply, it is recommended to eat certain kinds of "milk boosting" foods such as:
- Green papaya and fish soup
- A meal containing seafood
- Abalone
- Fish maw
- Black bean chicken soup
- Red bean soup
If these do not work, milk production supplements or "milk teas" that are readily available in pharmacies and health food shops are also an option. Jophia, however, does not recommend supplements with fenugreek as it may cause gastrointestinal disturbances like bloating, constipation, very watery stools or reflux in young babies.
Power pumping is another way of boosting breastmilk supply by repeatedly pumping the breasts.
Moms following this method need to pump continuously for 20 minutes, rest for the next ten, pump again for ten minutes, rest for another ten minutes and pump for ten minutes before stopping. This can be done two to three times a day if you are exclusively pumping.
Moms, if you are thinking about exclusive pumping and are worried that it may have a negative effect on bonding with your baby, fret not. As Jophia explains, cultivating a loving relationship with your baby does not depend on the method of feeding your baby.
Loving your baby, providing him with the best within your means, and most importantly, giving him a secure and loving family will result in all the positive bonding you and your little one need.
*Jophia advises that it is best for a mom thinking of using exclusive pumping to ask a lactation expert about the proper method of using a breast pump or hand expression techniques.
We would love to hear from any mums who are currently exclusively pumping, or who have in the past. Do share your experience and tips with us by leaving a comment below.