Breast Pumps

Over the course of the past two years many reports have come to us from women on the protocols regarding the efficacy of pumps from different manufacturers. Based on these reports, a hospital grade double electric breast pump is recommended for the process of induced lactation. Many mothers have found that the top end products have been the most reliable.

The favored pump by women who can afford to purchase a pump is a double electric pump with a strong motor, portability, variable speed control, hands free option, battery pack option, and ease of use.

For women who intend to rent a pump, the favored choice for women on the protocols has been a double electric breast pump with a strong motor, portability, hands free option, and ease of use.

Breast pumps may be rented from lactation consultants, local hospitals, or medical equipment suppliers. If the mother is intending to pump for more than 3 months, it is more economical to purchase a pump.www.healthchecksystems.com offers pumps at very reasonable prices.

Breast Compression

The purpose of breast compression is to continue the flow of milk to the baby when the baby is only sucking without drinking. Drinking (“open mouth wide—pause—then close mouth” type of suck—see also the video clips) means baby got a mouthful of milk. If baby is no longer drinking on his own, mother may use compressions to “turn sucks or nibbling into drinks”, and keep baby receiving milk. Compressions simulate a letdown or milk ejection reflex (the sudden rushing down of milk that mothers experience during the feeding or when they hear a baby cry—though many women will not “feel” their let down). The technique may be useful for:

1. Poor weight gain in the baby
2. Colic in the breastfed baby
3. Frequent feedings and/or long feedings
4. Sore nipples in the mother
5. Recurrent blocked ducts and/or mastitis
6. Encouraging the baby who falls asleep quickly to continue drinking not just sucking
7. A “lazy” baby, or baby who seems to want to just “pacify”. Incidentally babies are not lazy, they respond to milk flow.

Compression is not necessary if everything is going well. When all is going well, the mother should allow the baby to “finish” feeding on the first side and offer the other side. How do you know the baby is finished the first side? When he is just sucking (rapid sucks without pause) and no longer drinking at the breast (“open mouth wide — pause — then close mouth” type of suck). Compressions help baby to get the milk.

Breast compression works particularly well in the first few days to help the baby get more colostrum. Babies do not need much colostrum, but they need some. A good latch and compression help them get it.

It may be useful to know that:

1. A baby who is well latched on gets milk more easily than one who is not. A baby who is poorly latched on can get milk only when the flow of milk is rapid. Thus, many mothers and babies do well with breastfeeding in spite of a poor latch, because most mothers produce an abundance of milk. However, the mother may pay a price for baby’s poor latching—for example: sore nipples, a baby who is colicky, and/or a baby who is constantly on the breast (butdrinking only a small part of the time).
2. In the first 3-6 weeks of life, many babies tend to fall asleep at the breast when the flow of milk is slow, not necessarily when they have had enough to eat and not because they are lazy or want to pacify. After this age, they may start to pull away at the breast when the flow of milk slows down. However, some pull at the breast even when they are much younger, sometimes even in the first days and some babies fall asleep even at 3 or 4 months when the milk flow is slow.

Breast compression—How to do it

1. Hold the baby with one arm.
2. Support your breast with the other hand, encircling it by placing your thumb on one side of the breast (thumb on the upper side of the breast is easiest), your other fingers on the other, close to the chest wall.
3. Watch for the baby’s drinking, (see videos) though there is no need to be obsessive about catching every suck. The baby gets substantial amounts of milk when he is drinking with an “open mouth wide—pause—then close mouth” type of suck.
4. When the baby is nibbling at the breast and no longer drinking with the “open mouth wide—pause—then close mouth” type of suck, compress the breast to increase the internal pressure of the whole breast. Do not roll your fingers along the breast toward the baby, just squeeze and hold. Not so hard that it hurts and try not to change the shape of the areola (the darker part of the breast near the baby’s mouth). With the compression, the baby should start drinking again with the “open mouth wide—pause—then close mouth” type of suck. Use compression while the baby is sucking but not drinking!
5. Keep the pressure up until the baby is just sucking without drinking even with the compression, and then release the pressure. Release the pressure if baby stops sucking or if the baby goes back to sucking without drinking. Often the baby will stop sucking altogether when the pressure is released, but will start again shortly as milk starts to flow again. If the baby does not stop sucking with the release of pressure, wait a short time before compressing again.
6. The reason for releasing the pressure is to allow your hand to rest, and to allow milk to start flowing to the baby again. The baby, if he stops sucking when you release the pressure, will start sucking again when he starts to taste milk.
7. When the baby starts sucking again, he may drink (“open mouth wide—pause—then close mouth” type of suck). If not, compress again as above.
8. Continue on the first side until the baby does not drink even with the compression. You should allow the baby to stay on the side for a short time longer, as you may occasionally get another letdown reflex (milk ejection reflex) and the baby will start drinking again, on his own. If the baby no longer drinks, however, allow him to come off or take him off the breast.
9. If the baby wants more, offer the other side and repeat the process.
10. You may wish, unless you have sore nipples, to switch sides back and forth in this way several times.
11. Work on improving the baby’s latch.
12. Remember, compress as the baby sucks but does not drink. Wait for baby to initiate the sucking; it is best not to compress while baby has stopped sucking altogether.

In our experience, the above works best, but if you find a way which works better at keeping the baby drinking with an “open mouth wide—pause—then close mouth” type of suck, use whatever works best for you and your baby. As long as it does not hurt your breast to compress, and as long as the baby is “drinking” (“open mouth wide—pause—then close mouth type” of suck), breast compression is working.

You will not always need to do this. As breastfeeding improves, you will be able to let things happen naturally. See the videos of how to latch a baby on, how to know a baby is getting milk, how to use compression.

Breast Compression, February 2009©
Written and revised (under other names) by Jack Newman, MD, FRCPC, © 1995-2016 
Revised by Jack Newman MD, FRCPC, IBCLC and Edith Kernerman, IBCLC, 2008, 2009©

This handout may be copied and distributed without further permission, on the condition that it is not used in any context in which the WHO code on the marketing of breastmilk substitutes is violated.

Recipe for Increasing Milk Supply

If the mother is interested in increasing her milk supply and is not adverse to the idea of domperidone and herbs, here is a recipe for success.

If you are already on one of the Newman-Goldfarb Protocols, skip to step 2. 

1. If the mother is an adoptive breastfeeding mother or an intended mother and is not already taking domperidone, it is a good idea to have a look at the Accelerated Protocol now. 
2. If the mother has a medical contra-indication for taking the birth control pill she may want to consider domperidone and herbs alone. She can start with domperidone 10 mg 4 times a day for 1 week and then if she is not too tired and her stomach isn’t too upset, increase the domperidone to 20 mg 4 times a day. It’s a good idea to take domperidone 1/2 hour before meals and at least an hour before pumping. The mother should not start the herbs until she is comfortable with the domperidone...have her wait at least a week at the maximum dose of domperidone before adding the herbs or the mother can get a really upset stomach. And if the mother is already taking herbs...have her stop until she is comfortable with the domperidone. 
3. The mother should empty the breasts 8 to 12 times in 24 hours by either pumping, breastfeeding or both. She can keep a cooler with an ice pack by her bed at night so she can hand express (see appendix 1) her milk (if pumping is not an option) into a bottle and keep it in the cooler until morning when she can transfer it into a bag and either use it in the supplementer if she is breastfeeding or freeze it. You can also use this cooler idea at work if you don’t have a fridge available to you. Freeze the milk when you get home or use it in the Lact-aid. Keep in mind that it may take a while for your breasts to get the message. You could be pumping and getting very little for days and then suddenly...boom you have a lot more milk! 
4. When the mother is ready to add the herbs, the recommended dosages are: Fenugreek seed (610 mg per capsule) and Blessed Thistle herb (390 mg per capsule). 3 capsules of each, three times a day with food. 
5. Drinking water to thirst is good for milk supply as it prevents dehydration from the body’s normal excretions. Avoid caffeine, it’s a diuretic. 
6. Many of the women on the protocols have found that eating oatmeal for breakfast 3 times a week is good for milk supply. 
7. Above all, if the mother is breastfeeding, the number 1 most important thing is to have a good latch and position. If the baby is not Starting Out Right, he/she will not be able to get the milk that is available no matter how much the mother has. It is a good idea to work with an International Board Certified Lactation Consultant who will check the baby’s latch and suck as well as teach the mother how to use the supplementary feeding device.

   According to Dr. Newman, "When a baby is getting milk (he is not getting milk just because he has the breast in his mouth and is sucking), you will see a pause in the chin after he opens to the maximum and before he closes, so that one suck is (open mouth wide-->pause-->close mouth). If you wish to demonstrate this to yourself, put a finger in your mouth and suck as if you are sucking on a straw. As you draw in, your chin drops and stays down as long as you are drawing. When you stop drawing, your chin comes back up. This pause in the chin represents a mouthful of milk when the baby does it at the breast. The longer the pause, the more the baby got. Once you know that, you know also when he is notgetting milk. And once you know that, you know that 20 minutes on each side, for example, is nonsense. A baby who does this type of sucking (open mouth wide-->pause--close mouth), steadily for 20 minutes won’t take the second side. A baby who nibbles for 20 hours will come off the breast hungry." 

8. If the mother has to supplement the baby’s feedings, she should use a supplementary feeding device. This will help her milk supply while at the same time keep her baby breastfeeding. It may seem silly to state the obvious but a baby learns to breastfeed by breastfeeding. If the bottle is introduced, it will teach the baby that there is another way to get nourishment which can cause a problem at the breast. This doesn’t mean the mother can’t ever go out and leave her baby with a caregiver to handle a feeding. Consider other ways of supplementing such as the infant cup and limit outings entirely in the first 6 weeks and to a maximum of once in 24 hours in the next 6 weeks to 3 months. Breastfeeding a baby takes commitment and time. The rewards are worth the effort! 
9. Don’t make yourself nuts over this. There is more to breastfeeding than breastmilk. Your baby only needs a small amount of breastmilk with each feeding in order to benefit. For more information on increasing milk supply, see “Dr. Newman’s Protocol for Not Enough Milk" at this site: breastfeedingonline.com.