Greetings all,

Regarding Barbara's recommendation for increasing milk supply via power-pumping in 5 minute intervals rather than 10 minute intervals, Barb said:

"Instead, I have my moms try to do 1-3 times a day, 5 on, 5 off, 5 on, 5 off, 5 on. A total of 25 minutes. They seem to be able to get to this at least once a day. Also, if they are struggling with low supply by the time they get to the 5 minute mark, they are dripping milk at best. I even have my moms stop pumping for 1-2 minutes in the middle of a 15 minute pump."  

Barb's advice reflects the five to 7 minute average duration of one milk release, with a range of 2 to 9 minutes duration per milk release according to the research out of Australia on the MER.  Stopping milk expression for one to 2 minutes when the flow begins to slow down from spraying to dripping is ideal for one to 2 minutes of light breast massage, or to switch the cycling of the pump back to the "stimulation phase" of lighter and faster cycling, which is intended to mimic what babies do to stimulate the initial MER and subsequent MERs.  (Various pump manufacturers' patient literature could be more helpful by including these specific tips.) When mothers are working toward building a full supply, and also when mothers need to increase a reduced volume, it's critical to teach that there is more than one milk release to be obtained, since 3 to 5 MERs occur in an average feed - - it's not unusual to hear some mothers report that they stop pumping entirely for a pumping session when the first flow of milk slows down and stops.  For decades, many of us have used the teaching of the initial MER = the first course in a meal of typically 3 to 5 courses, served much like a meal in a nice restaurant where there's that short lull before the next course is served.  And of course we teach about the soup to dessert changing menu from low fat to higher fat content as the meal progresses at the breast.  

I love using a particular pumping log that was first shared with a group of colleagues by Vergie Hughes sometime around 2005 in northern Virginia.  Pumping logs have been around for a long time, but this particular pumping log quickly became beloved by our group.  This log has the volume goal listed for each day in the first two weeks in the far right column, starting with drops (with an expected range of 0 drops to multiple drops for Day 1) and going up to 25 to 35 ounces daily by Day 14 for a singleton, and I've since created other logs for mothers of multiples and logs with varying starting points of a low supply.  So much teaching can be done with these logs, showing mothers who have seen a drop (typically due to skipped pumpings due to sleep deprivation) how to increase their volume by increasing the number of pumpings, not going longer than 4 to 6 hours at night without pumping until volume is very well established, and so on.  I relocated to north central Florida in 2013, and this pumping log has been latched onto down here by various lactation colleagues as well.  I don't know if Vergie designed this particular pumping log or if she came across it at a conference or from another source, but will say "Thanks, Vergie!" for the log and for so much other professional lactation education over the years.  Those of us who have had the opportunity to train under her have been fortunate.   That's my Vergie Hughes tribute for today! 

Will have to say that when I first started using this pumping log around 12 years ago, I wondered how much of my patient teaching about tracking pumping volumes on the log was being taken to heart by exhausted and stressed new NICU mothers.  At that time, I was working in a large urban facility with 12,000 births annually and a 108-bed Level III NICU; our time was limited then due to very short staffing, and it had occurred to me on more than one occasion that maybe no mothers were filling out their pumping logs.  One day I had a typical request to meet with a primip NICU mother who was concerned about her volume, and it so happened that I had been her LC on the postpartum floor.  We exchanged warm greetings, and lo and behold, she pulled out her folded-up pumping log from the back pocket of her jeans and said, "I think I've solved my problem, but I want you to tell me what you think."  

Her pumping log had been diligently filled in each pumping slot for at least 8 pumpings daily, until Day 8 when she skipped two pumpings that night out of sheer exhaustion.  On Day 9, she skipped 3 pumpings at night also due to exhaustion, and by early on Day 10, she saw the dip in her volume show up in the collection bottles and on the pumping log she continued to diligently fill out.  In a panic at that point over a drop in volume, she added back the skipped pumpings, and by the time we met on Day 12, she had seen her volume come back up to within one ounce of her former daily total volume before the drop.  I counseled her appropriately, and was amazed by her diligence.  It had become my teaching habit to give anticipatory guidance in how to handle a drop in volume in such an instance, and I thought she must have heard my teaching on this during her postpartum stay.  It was so professionally gratifying to have that interaction with her, but I've also worked with mothers who are absolutely adamant that they will not pump at night until their very early preemie is getting close to going home, or will not pump more than three times a day in the first one to 2 weeks postpartum, and volume drops very, very low or never reaches full volume, and we teach and teach about the critical aspect of frequency including nighttime pumpings for building volume, going no longer than 4 to 6 hours at night without milk expression during the building and early maintenance phase of a full supply, and so on and so on.  These teaching challenges are sometimes a stressful part of our day, but we otherwise have so many joyful and gratifying experiences in this work.   

Certainly formal study beckons in regard to how and to what extent power-pumping helps mothers to build volume, and NICU seems to be the ideal population.  A longitudinal study would provide helpful formal insights, but without the ethical concerns of a randomized study, etc.    

With kind regards,

Debra Swank, RN BSN IBCLC
Ocala, Florida USA
More Than Reflexes Education
http://www.MoreThanReflexes.org

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