Hi Lisa:
Lactnet is just a trickle of messages now, but its archives are often
useful. While it will create a very long post, I'm copying my 2021
reply on this very question -- you've already offered many of these
ideas! Your client previously got an easier, larger pump output,
possibly during the more engorged early weeks? Now she's more in
balance with her thriving baby and trying to wedge in pumping sessions
in between frequently feeding a young baby. When she's back at work,
she'll likely be more full because she's harvesting accumulated milk
that the baby would have taken.
The pump doesn't suck out the milk -- it's trying to trigger the
hormonal click of a squirting let-down. Sweet babies excel at getting a
hormonal whoosh. After disappointing pumping sessions, just the sight
of the pump, which is going to let her baby *starve,* creates stress
hormones that impede the release of oxytocin. So your relaxation and
distraction suggestions are helpful. Once she has some successful
sessions, she'll have more momentum in the other direction.
Just a side note -- all pumps have lots of fussy parts that can
invisibly get flabby or wear out. The Spectra pump has a good track
record, but the duck-bill valve and the soft diaphragms have to seal
completely. Did you get a chance to check her pump with a suction
gauge? Also, the Spectra's instructions used to be confusing (someone
told me they were improved), in not making it clear that one pushed the
button first to start out fast and light, and then switching to the
slower, stronger pull. And you already encouraged playing around with
those guidelines. And desperate pumpers sometimes really crank up the
suction and pain also gets in the way of happy hormones.
USLCA's journal "Clinical Lactation" recently had a "Breast Pump Primer"
issue. For its article "Exploratory Research on Comparing Breast
Pumps," the author Allison Tollman,LPN, IBCLC had engineered a "boobie
barometer" mechanism to track suction and cycling patterns of several
machines (one brand even changed it product midway!) While the author
was able to gather useful objective data on a few brands (amid an
explosion of new pumps) she astutely pointed out "it is still unclear
which variety of cycle patterns and suction levels is most effective for
milk removal in lactating mothers." And wow does that seem like
fundamental information! Like it says in every journal article on every
topic, "more research is needed."
I've just been wrestling with a class on some of the same themes, and
found that JHL's issue of 2024, just arrived, opens with a thoughtful
editorial about the changing world of lactation and the balancing act we
face in helping families both with the timeless, normal interplay of
nursing, while supporting the many circumstances when pumps and bottles
are needed modern tools to maintain lactation.
Good luck to us all,
Margaret
[copied 2021 post pasted in here]
Nature never planned ahead for pumping. The pump isn't just sucking the
milk out-- it's stretching and stimulating the nipple to trigger the
oxytocin rush of a let-down, which can be blocked by stress hormones.
Some people are natural-born pumpers, while others need to find their
tricks to letting down milk to equipment. I described this quandary to
one mother, and left the room for some reason. When I came back, she
was cradling a teddy bear, and milk was flowing to the pump. It seemed
that her body needed the cue of something cute and soft (albeit furrier
than her baby) looking expectantly up from her arms. Parents are so
ingenious!
Once someone has faced disappointing pumping sessions, it's hard not to
enter subsequent attempts in a defeated, stressed state. Pumping can be
very stressful, as it wraps up primal fears about your baby being hungry
with this unpredictable technology.
So, yes, because pumping parents have very individual reactions,
continue to experiment with the speed and suction settings, flange sizes
and shapes. The current trend is toward smaller flanges, and sometimes
that tight focused pull is helpful, but also try larger. (Paula Meir's
research from way back -- and is there anything more recent? -- found
that a big percentage of pump-dependent parents did better with the
27mm)). The newer product of soft silicone "nipple cushions" may help
if someone has very stretchy nipple/breast tissue.
The hands-free rig is helpful, and as someone said, try a stretchier
bra, a homemade version, or unzip a little at the top, so the pumper can
reach in and periodically be very hands-on. Try putting a warm gel-pack
inside the bra.
But hands-free, they can also ignore the pump sometimes, and be
distracted and watch happy movies, read a trashy novel, and eat and
drink hot,( and favorite) foods, not staring at the bottles. (There were
Internet pictures of people putting a cute baby-bootie over the
bottles). Or get something else done, if it makes them feel productive
and happy. Try pumping in complete darkness, or by candlelight -- very
hormonal! Put on earphones with favorite music or an audiobook so they
don't hear the pump grinding away.
Try feeding the baby on one side while pumping the other side. (Kathleen
McCue's "Clinical Lactation" article had one idea for hands-free
"parallel pumping,"https://connect.springerpub.com/content/sgrcl/10/2/68
Or at least holding the baby skin-to-skin if one is exclusively
pumping. See if the cute baby triggers the let-down. Perhaps seeing
some milk flow to the pump will create more positive feelings for this
tool, that the parent probably views as just a source of frustration.
Our work has become very pump-focused, (and let's keep celebrating what
parents can give the baby with the normal act of breastfeeding too).
But families often have to rely on this tool to maintain their nursing
relationships in the modern world. So it's difficult that these
products are not a well-regulated piece of medical equipment where we
can look at a lot of independent research.
Good luck to all.
Margaret Wills, IBCLC, Maryland
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On 3/4/2024 12:00 AM, LACTNET automatic digest system wrote:
> There is 1 message totaling 31 lines in this issue.
>
> Topics of the day:
>
> 1. Unresponsive to pump
>
>
>
> Date: Sun, 3 Mar 2024 13:25:34 -0500
> From: Lisa Bell<[log in to unmask]>
> Subject: Unresponsive to pump
>
> I have permission to post. I have a mother whose baby can transfer 5 oz when breastfeeding but unable to get more than an ounce when pumping. (Spectra)This began a week ago when she decided to do more pumping in prep for returning to work. She gets a single spray of milk when previously she saw multiple pores spraying. We tried different sized shields- decreasing sizes and increasing, using HOP, heat, massage, going back and forth from side to side while pumping one side at a time, power pumping, with no improvement. She is going home and plans to watch videos of baby breastfeeding and covering up pumps in an attempt to decrease stress levels. This is a very laid back mother. Ideas?
>
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>
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