I have a question about how those of you in the hospital are acheiving hands-on double pumping in the first few days. Research seems to show that when mother use their hands to massage and compress their breasts while pumping right away, they produce more milk. However, most women do not have a pumping bra on day 1 in the hospital. To do this well, you really need 4 hands, two to hold the pump and two to massage the breasts. Not everyone has a support person willing or available to hold the pump, and not all moms are comfortable with that. But if they are, I know that's a valid option. I have found it best to give the information and present options to the mom and let her decided. One thing I've found works sometimes is single pumping one breast with hand massage for 15 min, and then switching over and single pumping the other breast with hands-on pumping, and best case is if they follow with a few minutes of hand expression on both breasts. Jane Morton's research showed that the mothers who made the least milk were just putting the pump on their breasts and leaving it there, next best was hands-on pumping x 8 per day, and the very best was hands on pumping x 8 per day plus hand expression x 5 per day. So I tell the moms that is what is best to shoot for, give them options and we support what they can do because some people have had very difficult deliveries with complex medical problems. But I think as a professional I need to make the recommendation and try to help her acheive it. Also, the single pumping also seems to work well for moms with a c-section who can't sit completely upright due to abdominal pain. I have them sit up as far as possible and then have them turn side lying until the pump is able to point downward. Otherwise they tend to lie back too far and the pump is pointed upwards and the milk does not flow down the tube. 
However, had disagreement with another LC who said that mothers should not be single pumping at all in the beginning because all the research showed that double-pumping was better and mothers should always be pumping both breasts at the same time. However, when I reviewed the research that she had, it was a study that did not use any hands-on pumping or hand expression. It was merely examining putting the pump on the breast and leaving it there. And when they did that, they found that putting the pump on both breasts, versus one breast at the time made more milk. But hand expression and breast massage were not used at all in this study. Just using common sense, I have a really hard time believing that putting the pump on both breasts and leaving it there without during any further breast massage is preferable to single-pumping with hands-on pumping when I can see that they usually get twice as much milk that way. Plus in Jane Morton's video she states that this is a valid way that mother's may choose to do hands-on pumping, by either single pumping with breast massage one breast at a time, or by using a pumping bra, or by having someone else hold the pump. Also, they should then be tipping the pump horizonal in front of the breast after pumping and hand expressing some more milk out after the feed. The LC's argument to me was that single pumping would take twice as long and the mother would become exhausted. I said, well maybe we could tell them just to put the pump on initially in the hospital both breasts without massage, but then do several minutes of hand expression after, but then it ends up being about the same amount of time and I think the mother's interest and stamina is going to vary from person to person and the mother should make that decision about what works best for her.
I haven't seen any studies comparing double-pumping, no breast massage, vs. single pumping with breast massage, is there any? I would love to hear if anyone has found a good way to acheive the x8 pumpings with hands-on pumping, and x 5 hand expressions that are recommended in the hospital, especially how do you do that on day one. It seemed that important point of the research was that the first 5 days are really a critical time for milk production and we would want to do as much hands-on pumping during this time period as soon as possible. So is anyone achieving this? And if so how? Thanks for your help!
Tricia Shamblin, RN, IBCLC




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