On a snowy day in the Chicago-area (our 1st snowfall of the year), the kids
are having fun playing in the snow, and I'm having fun pursuing this dialogue
on pumping issues. Luckily for me today, my only follow-up happens to be a
neighbor, so I'll walk across the street amidst the 5 inches or so of snow to
see her later on.
Now, the question posed as to where I got the guideline of 200 minutes of
pumping in 24 hours....I asked a colleague of mine as to where I got that one
from in my dusty brain files. I don't often make things up, but I do
occasionally experience brain infarcts when I'm talking numbers. It is from the
literature of Paula Meier on exclusive pumping, and I believe it was published in
1999. I'm still searching my files to locate the exact reference.
I have located much of the literature by Peter Hartmann et al. and am
enjoying re-reading the articles regarding pumping and its relevance to milk ejection
reflex and to storage capacity of the breast. The articles denote the timing
of a woman's milk ejection reflex in correspondence to milk yields. The
expression phase is defined as the first 5 minutes of a feeding/pumping session.
Despite the fact that milk yields differ drastically between women, the mean
percentage of available milk expressed by a breast pump during a 5 minute
session is 99.4%. Furthermore, at 5 minutes, the rate of milk expression
decreases. These findings support the suggestion to mothers who are pumping and only
get 5 minutes worth of pumping into their tight schedules of baby care,
self-care, and supplements to take the short 5-min. pumpings as having great
significance on potential higher milk yields.
Jan mentioned that she recommends moms not pump immediately after a feeding.
Her advise is supported by the research findings that "volume of milk
expressed is related to the degree of fullness of the breast". I can't locate it
right now, but somewhere in the literature as I was reading today, the suggested
timeframe given for pumping was 2-1/2 hrs. after breastfeeding in relevance to
the storage capacity of the breast. These guidelines are in relevance to a
baby effectively suckling at the breast and to the assumption that the breast
is being adequately emptied at the time of the feeding.
When there's a baby going to the breast in addition to pumping, and I'm
managing a low milk supply problem and ineffective suckling issue, as in today's
consult, I usually recommend moms pump at least 6 times in 24 hours, and if she
has milk ejection, I encourage her to pump until the flow ceases and an
additional 2 minutes. I always encourage moms to go ahead and get a 5 minute
pumping in if that's the best she can do in terms of her baby and her other
children's needs, rather than to miss a pumping altogether. I believe these
guidelines make a difference in milk yields related to the milk ejection reflex and the
expression phase as demonstrated in the literature. So though I quoted the
200 min. pumping guideline, I do believe it was pumping time spent without
breastfeedings. Therefore, most of the time I am indeed using the above
guidelines because I'm seeing moms who are not solely pumping.
According to the literature, how much milk is stored within the breast is
highly variable between women, and thus the milk yield from a pumping session
doesn't seem to be determined by parameters of timing between pumpings. It is
the storage capacity of the breast and the effectiveness of emptying of the
breast that determines milk yields. As the literature states: "Therefore, it must
be recognized that different mothers, particularly those expressing
exclusively, require different instructions on pumping duration if they are to maximize
milk output while optimizing time spent at the pump."
Mitoulas, L. et. al. "Efficacy of Breast Milk Expression Using an Electric
Breast Pump", JHL 18(4); 344-352.
Several of the references state that increasing the vacuum (pressure) does
not correlate with increased volume or percentage of available milk expressed.
However, the rate of milk expression and the mean vacuum applied by the breast
pump differed greatly between mothers. And vacuum applied was not related to
either volume of milk removed during the expression phase or the percentage of
available milk expressed.
Kent, J et al. "Response of Breasts to Different Stimulation Patterns of an
Electric Breast Pump", JHL 19(2); 179-186.
Thus, my answer to my question as to what's the best time to pump to optimize
milk yield? According to the latest research, there is no absolute answer to
the question posed. I didn't think there'd been any further recommendations
to give to this father, but I thought I'd ask the group here. Linda, thanks
for reminding us that you'd asked Peter the question as to when after a feeding
it was best to pump. I knew I was somewhere when I heard the question posed
to the Peter team, and that at the time there was no data to support an answer
to the question, but I wondered whether there was an update.
Now, it does raise a level of awareness to the common recommendations to a
mom to pump her breasts for 15-20 minutes. Almost all moms with whom I see have
been told formerly to pump within this timeframe. However, the literature
seems to support the duration of 5 minutes of pumping greater than the typical
15-20 minutes. And, then the literature supports the technique of pumping for
2 minutes beyond the cessation of milk flowing as having an impact on greater
milk yields, rather than an absolute 15 or 20 minute timeframe. And, the
research has focused on storage capacity and on milk ejection reflexes as having
variable influences on milk yields. So, it seems to me that presently we
cannot counsel a mom as to an absolute "best time to pump" in relevance to
breastfeedings based on the evidence presently available to us.
Here are my references:
Hill P et al. "Effects of Pumping Style on Milk Production in Mothers of
Non-Nursing Preterm Infants", JHL 1999; 15(3):209-216.
Kent, J et al. "Response of Breasts to Different Stimulation Patterns of an
Electric Breast Pump", JHL 19(2); 179-186.
Mitoulas, L. et. al. "Efficacy of Breast Milk Expression Using an Electric
Breast Pump", JHL 18(4); 344-352.
Mitoulas, L. et al. "Effect of Vacuum Profile on Breast Milk Expression
Using an Electric Breast Pump", JHL 18(4); 353-360.
Zinaman M et al. "Acute Prolactin and Oxytocin Responses and Milk Yield to
Infant Suckling and Artificial Methods of Expressing in Lactating Women",
Pediatrics 1992; 89(3): 437-440.
Carol Chamblin, RN, MS, IBCLC
Breast 'N Baby Lactation Services, Inc.
St. Charles, IL
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