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Establishing and maintaining milk supply when baby is not nursing
By Kelly Bonyata, BS, IBCLC
It is important to express your milk to establish and maintain
milk supply if your baby is not nursing at all or not nursing well.
By expressing, you will also have your milk available to feed baby
- every bit of moms' milk that baby gets (even the tiniest amount)
is like liquid gold.
When should mom start pumping?
- If baby does not nurse immediately postpartum, mom should begin
pumping within 6 hours of baby's birth -- starting early makes
a difference for future milk production.
What pump is best?
- If baby is not nursing, seriously consider renting a hospital-grade
pump (such as those made by Ameda or Medela) that will allow you
to pump both breasts at the same time. A hospital-grade pump is
the best choice for maintaining or increasing milk supply.
- If you are not able to rent a hospital-grade pump, consider
buying
a pump (preferably a quality double pump) and/or hand
expression.
How much milk should mom be pumping if baby is not nursing?
- Aim for pumping 750-800 mL (25-27 oz) per day by 7-10 days postpartum.
If you have twins or higher order multiples, aim for pumping 800-950
mL (27-32 oz) by 14 days postpartum.
- It's useful to evaluate mom's 24 hour pumping output at 10 days.
If supply is borderline (350-500 ml / 11-17 oz) or low (less than
350 ml / 11 oz), then galactagogues (prescription meds or herbs
to increase supply) or other interventions should be considered.
- The research tells us that milk production at 2 weeks is an
indicator of breastfeeding outcome, so it is important to get
a good start. Even if milk production doesn't start out well,
however, don't get discouraged--many moms will see an increase
(even as late as 9-15 weeks after birth) if they continue with
regular pumping.
How often should mom pump?
- 8-10 times per day: Until supply
is well established, it is important to get at least eight
good nursing and/or pumping sessions per 24 hours. Ten sessions
per day is better, particularly if you have twins or higher order
multiples.
- These sessions don't need to be evenly spaced, but you should
be nursing/pumping at least once during the night in the first
few months or anytime you notice a decrease in supply. Avoid going
longer than 5-6 hours without pumping during the first few months.
- When pumping during the night, milk yield tends to be better
if you pump when you naturally wake (to go to the bathroom or
because your breasts are uncomfortably full) than if you set an
alarm to wake for pumping.
- If you are having a hard time getting in enough pumping sessions,
adding even a short pumping session (increasing frequency even
if milk is not removed thoroughly) is helpful.
How long should mom pump at each pumping
session?
- If baby does not nurse at all:
- The first few days, before mom's milk comes in, hand
expression is often the most effective way to express
colostrum. Double pump for 10-15 minutes per session for additional
stimulation.
- Once mom's milk is in, pump for 30 minutes per session,
or for 2-5 minutes after the last drops of milk.
- If baby nurses but does not soften the breast well
- Double pump for 10-15 minutes after nursing.
- Empty the breast as thoroughly as possible at each session.
To ensure that the pump removes an optimum amount of milk from
the breast, keep pumping for 2-5 minutes after the last
drops of milk. Use breast massage prior to pumping, and massage
and compressions during pumping to better empty the breasts and
increase pumping output.
Additional tips
- Rest & relax as much as possible.
- Skin-to-skin (Kangaroo care) can make a significant difference
in pumping output.
- If double pumping is difficult to coordinate in the beginning,
then single pump, alternating sides. Move to double pumping as
soon as you can.
- Avoid any medications that might interfere with milk supply
(hormonal birth control, pseudoephedrine, ethanol/alcoholic beverages,
bromocriptine, ergotamine, cabergoline)
- If supply is not increasing as expected by 7-10 days after birth,
consider the use of galactagogues. Fenugreek,
metoclopramide
(Reglan) or domperidone
(Motilium) can be helpful for increasing milk supply.
See Got Milk? for more
information on milk supply.
Page last modified:
10/10/2005
Written: 02/19/1999
References and additional information
Note: Premature infants are certainly not
the only breastfed babies who have problems nursing at the breast,
but much of the writing and research in this area involves premature
babies and their mothers. Talk to your lactation consultant about
adapting these guidelines for older babies.
@ 
@ other websites
References
Mohrbacher N. Cutting Edge Breastfeeding Trends, Orlando, FL, June
9, 2004.
Wight NE. La Leche League International Conference Session--The
Premature Infant and Breastfeeding: Myth, Reality and Evidence-Based
Practices, San Francisco, CA, July 5, 2003.
Furman L, Minich N, Hack M. Correlates
of lactation in mothers of very low birth weight infants. Pediatrics.
2002 Apr;109(4):e57.
Jones E, Dimmock PW, Spencer SA. A
randomised controlled trial to compare methods of milk expression
after preterm delivery. Arch Dis Child Fetal Neonatal Ed. 2001
Sep;85(2):F91-5.
Meier PP. Breastfeeding
in the special care nursery. Prematures and infants with medical
problems. Pediatr Clin North Am. 2001 Apr;48(2):425-42.
Hill PD, Aldag JC, Chatterton RT. Initiation
and frequency of pumping and milk production in mothers of non-nursing
preterm infants. J Hum Lact. 2001 Feb;17(1):9-13.
da Silva OP, Knoppert DC, Angelini MM, Forret PA. Effect
of domperidone on milk production in mothers of premature newborns:
a randomized, double-blind, placebo-controlled trial. CMAJ.
2001 Jan 9;164(1):17-21.
Hill PD, Aldag JC, Chatterton RT. Effects
of pumping style on milk production in mothers of non-nursing preterm
infants. J Hum Lact. 1999 Sep;15(3):209-16.
Bier JA, Ferguson AE, Morales Y, Liebling JA, Archer D, Oh W, Vohr
BR. Comparison
of skin-to-skin contact with standard contact in low-birth-weight
infants who are breast-fed. Arch Pediatr Adolesc Med. 1996 Dec;150(12):1265-9.
Anderson GC. Current
knowledge about skin-to-skin (kangaroo) care for preterm infants.
J Perinatol. 1991 Sep;11(3):216-26.
