By Jessica Bower, IBCLC
If all is going well in the early days of breastfeeding, there's no need to pump. You will be busy enough just feeding your baby at the breast! Of course there are some times when pumping is necessary. The most common reason that pumping may be necessary in the early days is if you need to supplement your baby (with your expressed milk, donor milk, or formula). If you are supplementing your baby, you will want to pump in order to stimulate your breasts to tell your body to make more milk. However, if all is going well, do not pump in the early days because we want your body to make just enough milk for your baby - you don't want to make extra milk in the early days in most circumstances.
When to start pumping if you don't need to pump in the early days depends on your unique situation. Will you be going back to work at 6 weeks postpartum? 8 weeks? 12 weeks? Will you go back to work at all? And what are your long term breastfeeding goals? For this post, I'll assume that you might get 12 weeks of maternity leave before returning to work. And then I'll also assume that you hope to feed your baby breastmilk when you are back at work for as long as possible (or as close to one year as possible).
If the above is your situation, this would be my recommendation:
Start pumping once per day when your baby is 3-4 weeks old. You will likely get the most milk from a pumping session if you pump immediately after the first feed of the morning (once you and baby are waking up for the day). Pump both breasts with your double electric pump (check out what pumps I love in the My Favorite Breastfeeding Things blog post) for about 10-15 minutes.
The first few times you pump, you might get only .5-1 oz. Or maybe you'll get more. If you pump at the same time each day, your body will likely start making more each day. Try not to pump more than 4-6 ounces each morning so that you're not uncomfortably full in the early hours of the morning before you feed your baby and pump.
If you need to go back to work or school or need to be away from your baby or miss feedings before the 12 week mark, you can absolutely start pumping sooner. It's very nice to do an in-person or virtual lactation consultation to figure out a pumping routine that will prioritize getting the milk you need, rest, and convince for your unique situation.
A great time to introduce a bottle is at the 3-4 week mark. If your baby has not had a bottle at this point, then breastfeeding is well established and likely very smooth. Babies are very accepting of bottles at this age and it's a good time to try it. Whenever you start bottles, I like to start with a preemie nipple. Not a size 1... a preemie nipple. My favorite nipple/bottle combo is a Dr. Brown's bottle with a preemie nipple. I like this combination because babies have to work very hard at getting milk out of this bottle. Just like breastfeeds take awhile, bottle feeds should take awhile. By making the feed take awhile and making the baby work hard at sucking, the baby should be able to be patient and not get frustrated when they go back to the breast. Sometimes, if the milk comes out of the bottle quickly, the baby can get frustrated when they go back to the breast and the milk comes out slower. This is usually not a problem when breastfeeding is well established, but it's still beneficial to do paced bottle feeding.
Here are some additional bottle feeding tips:
If the baby gets a bottle, the mom needs to pump to replace this feed. Ideally, it's best for the mom to pump close to the time of day when the baby got the bottle so that mom and baby stay as in-sync as possible.
A general way to know how much to offer a baby in a bottle is to give about 1-1.5 ounces of milk per hour. For example, if it's been 2 hours since the baby last ate, they will probably want 2-3.5 ounces of milk in their bottle.
It's nice if someone other than the breastfeeding mom can give the baby the bottle. This also frees up the mom to pump while the baby is getting a bottle.
To make sure that the baby continues to accept a bottle, it's great to practice a bottle 2-3 x per week. Sometimes breastfeeding is going so well that moms don't want to practice bottles because it's a pain to use a bottle and pump when breastfeeding is going well! However, if mom has plans to go back to work or she wants to use a bottle occasionally sometime over the first year, it's important to keep practicing 2-3 x per week.
Milk Storage Guidelines:
Freshly Pumped Milk can be stored...
At room temperature for up to 4 hours
In the refrigerator for up to 4 days
In the freezer for 6-12 months
Milk that has been in the refrigerator should be used within 2 hours of being reheated. Discard leftovers.
Milk that has been frozen can be thawed and stored in the refrigerator for up to 24 hours. Milk that has been frozen can be thawed, heated, and offered to the baby for up to 2 hours after heating. Discard leftovers.
I hope this helps! This is a lot to process, so that's why taking it one step at a time is helpful. Also, feel free to text me or set up a lactation consultation to come up with a bottle feeding and pumping plan! Most insurance companies cover in-home lactation visits. Feel free to see if your insurance covers visits by completing this form.