The one thing I disliked about the antenatal classes that we attended, is that they were not allowed to talk about bottles or expressing at all. I had to learn the hard way that mix feeding is a very good option to help your baby get some of that precious liquid gold.
In my Nursing with Fibromyalgia article, I recount my first two experiences with nursing. After three awful days with my son, during which I had to hand express onto a spoon while he screamed next to me while alone (they refused to let my husband stay and the night midwives didn’t want to help as I wouldn’t have their help at home *sigh*) the midwives showed me to the expressing machine. I didn’t even know that expressing was an option. My mum nursed all of her five children and if babies weren’t nursed they had formula, I hadn’t heard of this middle ground!
I wish I’d known about this middle ground so I didn’t have to take a crash course when so sleep deprived and sore.
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Now I always include expressing/pumping as an option when I discuss nursing with Fibromyalgia because my number one tip with coping postpartum is to express early, go to bed early and then have a support person give the baby the next feed. As someone who cannot nap, I need those precious hours of sleep at night. So, I would express at 9pm, go to bed right after and then my husband would do the next one or two feeds (depending how early on it was and if he was going to work the next day). I would then wake after a few hours sleep in a row to deal with the baby for the rest of the night. We couldn’t do this for our second because his reflux was so bad that we had to keep each other company to get through the scream-filled evenings. And I suffered for it. There were nights when I fell asleep upright while feeding him.
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The Breast Pump and Supplies
For the first two I used a heavy duty hospital grade electric pump (Unimom, not currently available on Amazon UK or US). This is necessary if you are looking at exclusively expressing or regularly expressing.
If you are going to express semi-regularly, say a few times a day (at work perhaps) then a double electric breast pump, like this Avent one, is a good idea.
If you are going to express once or twice a day, like I plan to with number three, then a single electric breast pump, like this Avent one, is a good idea. This is actually on my Amazon Baby Registry, and as a third time mama not many things are on my to-buy list.
If you only plan to express occasionally, a manual pump, like this Avent one, may be the way to go. I didn’t like manual pumps, they hurt me to use (I only tried two brands that were given to me by the hospital to use when my son was sick), but the Unimom hand pump was the best for me for a tight spot. I want to try this Hakaa manual pump this time, this is more for catching let down from the other side while nursing or helping you out between feeds if you find yourself without a baby or a pump.
The reason I am so amped about using Avent this time is because their bottles are our favourite, we have used them for both of our first two and will use them for our third. I believe the shape of the teat helped Wyatt to avoid nipple confusion and enabled mix feeding. The anti colic bottles are what we used. Don’t forget to start off with the newborn teat size! We had no idea there were different flows with our first baby and that was terrible at first (far too fast a flow does not help wind!).
You can buy the Avent steam steriliser, which would make things easier, but we were on a budget with our first and found that a basic tub that we filled with water and put sterilising tablets in did the job. You should sterilise all bottles, teats and dummies for at least the first six months.
There are special bottle warmers that some people swear by, but we found a jug of hot water to be sufficient. Please don’t microwave your milk to reheat it, it may heat unevenly and burn baby.
If you are exclusively expressing then you need to express as often as the baby would feed, approximately three hourly. You will need to do this until your supply is established at around six weeks. After this you can try reducing the frequency (say once overnight) or four hourly or both. The trick with expressing exclusively seems to be keeping up with what baby consumes, you may need to express more often than they feed to keep up with the growing amounts they consume.
If you are mix feeding, then you choose which feeds you are replacing to express (say 9pm). If baby is due for a feed near the same time, then you can choose to pump before or after according to your comfort level or routine. This is best while you’re establishing your supply. You may be able to just always use formula at the late feed and your supply adjusts, just don’t do that with more than one feed at a time or you may find your supply reduced.
Sit as comfortably as possible, if you have a good pump then you just sit upright and time yourself for the 10-15 minutes. To get started it helps to massage your breast and it can help to look at baby or a picture of them to encourage letdown. Start on a lower suction level and gently work your way up (without getting too strong). I was advised to pump for no more than 15 minutes at a time with my hospital grade electric double pump, check what the recommendation for yours is.
If you’re feeling a bit lumpy or sore (like a clogged duct) a hot flannel on the breast can help as does massaging down toward the pump to help clear it out. I also gave myself a good massage in a hot shower when I had that blocked/lumpy feeling.
It’s also good to treat expressing like nursing directly and have a big glass of water and a snack. Hydration is important as is adequate nourishment.
When you are finished you can store the milk in a milk storage bag, like this, label it and put it in the freezer. They are useful with the zip close top for reopening if you are putting in multiple expressions before freezing.
A few tips
If you are expressing exclusively, or regularly that day, you can place all of the pump parts in a snap lock bag in the fridge between expressing sessions (so you don’t have to wash them all every time).
You can keep one milk storage bag in the fridge and put it into the freezer when full (or at the end of the day).
Generally you can keep milk in the fridge for three days and in the freezer for up to six months. This was great for me as I made an abundance of milk for my first baby very early on and was able to keep him exclusively breast milk fed for another four weeks after I stopped expressing. For more information about storage, see this article.
If you want to use previously frozen breast milk, put the milk storage bag in the fridge overnight. Use the thawed milk within 24 hours.
It takes several weeks for breast feeding to be established, but once this point has been reached you can generally reduce the expressing frequency. With my second I expressed four hourly during the day and once overnight to mimic how baby fed – but I did stop making the total amount he fed and that was OK because he had to have thickened formula for the bulk of his milk anyway.
I feel like my whole life was taken up by milk for my second baby’s first 12 weeks, between the expressing, the thickened formula (for the reflux) and the direct feeding. When I read the research that suggests even 12 weeks of partial feeding breast milk is protective against Sudden Infant Death Syndrome, I felt very proud. So please don’t think it’s all or nothing. If you can give 20ml a bottle like I did (it made the milk too thin if I put more than that in the bottle) – that’s amazing. If you manage to give baby only breast milk for six months, that’s amazing too. If you can’t manage to nurse and you give your baby formula – you’re still amazing.
I found it ridiculous when people tried to say that giving the bottle was more impersonal, I didn’t feed with the baby an arm’s length away – I cradled him as if I were nursing directly and I looked into his eyes, spoke to him and stroked his skin in the same way, however I fed. And as a bonus, my husband was able to feed him about as often as I was and they bonded beautifully too (not that they can’t bond without that!) just a silver lining. The biggest silver lining was that I was better able to bond with my first baby this way, nursing directly was so painful for me and it was such a strain on me physically and emotionally – I was so relieved when parenting no longer included my breasts. Your physical and mental health is vital, your baby needs you more than your breasts.
Please remember that all of my learning shared above is just that, personal learning through a lot of reading and personal experience with two children. Always seek support from a lactation consultant or midwife if you need help, particularly with latching. However, if you feel that those who are supposed to be supporting you are just forcing you to do something you can’t or don’t want to do, I hope the things I share help.
Do come and join the Pregnancy and Fibromyalgia Facebook group, we are happy to chat through nursing, expressing, whatever with you.
For more information about Pregnancy with Fibromyalgia you can read my book!