Thursday, June 23, 2011

MiM Mailbag: Pumping during fellowship

Hi, I’m so glad to find this group! I’m starting GI fellowship in 10 days and trying to figure out a pumping plan. My husband (a surgeon) and I have a 12 week old son and we’ve just moved across country for fellowship. I have the Medela freestyle, which I love. However, I stored up enough expressed milk to only last us maybe a couple weeks. My program is supportive of my need for pumping, but given the amount of conferences and rounding on a daily basis, my only time to pump is essentially in two 2-hour blocks when I need to see consults and perform endoscopy (unless I’m in clinic). I’m trying to decide whether I should try and pump during the day or just switch to pumping bid (morning and night). I feel like formula supplementation is inevitable. I’ve already noticed my supply go down with changing to pumping 4x/day in anticipation of fellowship starting. Any advice?


  1. Pumping 2x/day, I managed to get my daughter to 9 months of age before supplementing with formula. My supply was pretty good, esp in the beginning.

    I currently have a 6.5 month old son. Due to a worse schedule, I have only been able to pump once per day (usually early/mid afternoon). Between that pumping and my frozen stash, I got my son to 6 months before supplementing with formula. I can currently only get about 8 oz in that single sitting and he uses more than that at daycare. My frozen supply is exhausted now. I'd rather try to pump twice a day again, but it feels like a losing battle once the supply starts going down. Also, I just don't have time.
    (attending heme/onc)

    Use it or lose it.

  2. If you've got a convenient place to pump, do it, or a least give it a try and see how it goes. I found I was able to pump in about 15-20 minutes (often while I was dictating). I also brought two sets of shields and didn't wash anything until I got home, to save time.

    OTOH, if you have to supplement with formula, don't beat yourself up. The baby will be just fine.

  3. I'm just finishing a fellowship and while my program was supportive, like yours, I just didn't have the time in the day, like you seem you might. I pumped 3 times a day (twice at work, if I was lucky) but I only made it to 10 weeks before I was only getting 2 ounces per session...which made it more frustrating than anything. So formula it was.

    (ps. go storebrand if you need to supplement with formula. it's cheaper and the same because the federal government regulates formula so strictly. I saved $8/can using storebrand.)

  4. Do not stop pumping. When I was a resident and my intern were both nursing mothers on the same team. We disappeared at the time for as long as needed to keep pumping every 3 hours. We told our attending and no matter how attending did not like it, he had to lead rounds, etc for 15-20 minutes. We were both proud of what we did, and put our kids first.If I had to do it again, I would never consider "schedule" a barrier. Women in this country are not getting any maternity support their counterparts in other developed coutnries get anyway. Do not humiliate yourself by giving "schedule" a priority over your baby. Being in this country you do not know better, but most other countries allow nursing mother to stay at home a year or more. If you believe in breastfeeding, do it.

  5. Any time I try to decrease the number of pump sessions my supply goes WAY down, but everyone is different. I would say try to pump as often as you can, then if you occasionally can't fit in as many sessions, you may find that you will just express more milk at each session. I also use some weekend days off to "recharge" and pump after as many of her feedings as possible.

    I also echo the "don't beat yourself up for needing formula." I got to 6 months without formula but that included me setting alarms in the middle of the night to fit in extra sessions while my daughter was sleeping (among other ridiculous things).

    I find it so encouraging to see so many moms trying to figure this out at work! Good luck and congrats on your fellowship!

  6. I was able to pump for almost 8-9 months, the only thing one needs to get used to is multitasking, maybe if you have a private office with a computer, you could either check emails or labs while pumping, if not do it while eating. It is one of the biggest challenges I faced in the first year of fellowship, stressful but all worth it in the long run. My daughter now three years old, did not have any illnesses in the first year of life, so go for it.

  7. I agree, don't beat yourself up about supplementing but I also think that should should put your needs and your child's needs first and demand time to pump. I echo, don't stop pumping. Formula is second best and exclusive breastfeeding is healthier than supplementation. Stand up for your rights because no one else is going to do it for you. (3rd year FP resident, pumped in the past).

  8. I pumped as a resident, fellow and attending (2 kids) - easiest was as a resident, then attending, last fellow... all the responsibilities, none of the actual authority/control. anyway, I'd second all the comments above re trying at least. Also, don't forget your hospital might have a "pumping" room near their maternity and/or nicu wards - with a hospital grade (=faster/more powerful) pump that all you need to bring is attachments and bottles. Also remember, even just pumping for 5-10 minutes (while dictating or reviewing labs or whatever) can help keep up supply. Depending on your location specifics, might be worth checking into a small (dorm-size) fridge to stick your milk in if you'll be pumping regularly where there isn't a breakroom w fridge available. Good luck!

  9. One additional obstacle: if you pump frequently at work, then unexpectedly get caught up in a procedure, the breast engorgement may make you physically ill. This was a challenge for me. Depending on how much down time you have it may be practical to let your mild supply deminish a bit. My advice, formula is not poison. Supplement as needed and give your baby what breast milk that you can.

  10. Agree with all above...please don't give up before you even get started! go into this with the attitude that you are going to make it work, and then do your best; if you have to supplement, no guilt, but its certainly worth trying. There is often more flexibility and downtime during most days than you expect---you can always sneak off in between seeing consults, or come a few minutes late to noon conference (everyone is late ANYWAYS), or let the attending finish patient notes while you pump.

    I always pumped the minute I got to work & right before I left. that's 2 sessions right there. If you can fit in 1-2 more, you're golden. You have to be flexible with it---with the Medela freestyle + hands-free apparatus, I could pump in 10-15 minutes, and get some reading/emails/charting done simultaneously. To save time, I just pumped where I could---supply closet, empty clinic room, lactation room in hospital, someone's office. I had one of those bags that you pop in the freezer the night before & keeps things cold, so I could cart the milk around until I got back to the breakroom freezer; also the pump parts are fine to just wipe down between uses and thoroughly wash at home in the evening.

    Be up front with your co-fellows & attendings from the beginning---people are a lot more willing to step up and help out when you are honest about what you are doing & why. "I have an infant son that is exclusively breastmilk fed, so I'll need to take 2-3 15 min breaks during the day to pump milk for him this year" Of course, you can reciprocate now or in the future by offering to cover for their own appointments/illnesses/etc...

    You may want to remind them that you could pump 4X a day for a month and still not miss as much work as you would taking a couple of days off for a sick child (and given your husband's profession, its likely that you may have more flexibility to do this?)

    All that being said, my supply dried up around 6 months & we had to use formula; but I knew that I tried as hard as possible for something I truly believed in, and that really helped ease any guilt I may have had about the whole thing.

  11. I would just add to the above, don't underestimate the wonderful example you will be setting for all the female residents, students, (and yes, attendings) you'll be working with when you take time to pump. I'm only a lowly medical student, and am about to finish my year of pumping (for this baby anyway), which I just blogged about here:
    If you're not too shy, pumping under a cover with a hands-free bra can allow you to pump while you make phone calls, catch up on email, etc.

  12. Depending on your commute, think also about pumping in the car. I got a simple car adapter for my pump, and I made a hands free device with an old bra. I also added an evening session just before I went to bed which was a few hours after my son went down. Actually worked very well, and my body was able to adjust to different pumping times. I also became a fast pumper and could do the whole thing in 10 minutes flat so that helped during the day. Ultimately, I was able to pump during fellowship but agree with the others - whatever ends up working for you will end up working for you. If that's pumping, great. If formula tides you over, great. Good luck!

  13. I, too, returned to a busy fellowship. My son was 8 weeks old. I told everyone what I would be doing with my pumping schedule. I would get in 15 min early and pump, even if I had just nursed him, so I could round for 3 hours before the next session.

    Also key: drink a lot of water! I pushed almost 100ounces at times. I took fenergrek with my second child that seemed to help.

    I nursed my first for 21 months and currently nursing our one year old.

    No matter what, be proud of yourself! You've done great!

  14. When my daughter was 6 months old, I was on a very demanding rotation, so I mostly retired my pump. I was able to go another 6 months with nursing in the morning, right after work, and before bed, mostly using formula for nutrition. It definitely lowered my stress level and I still got the bonding time, which was super important to me. But on this schedule, my supply was very small.

    If you can pump another few months till your baby is taking solids, that would be great. But considering you're new to the fellowship and haven't established yourself yet, it might be harder to take time out to pump. I encourage you to try, but like everyone said, you should never feel guilty about using formula.

  15. About to be a third year:

    My tips:

    When you are pumping, squeeze and massage your breasts. It speeds the process, so you empty faster, which gets you done sooner, and you also get more out (at least I feel like I do).

    I do get up at least once in the night. I do not feel exhausted, and I got used to it. I would set up pumps beside my bed, so I literally sit up, pump, and leave the milk, because it can sit for about five hours in room air no problem. Then it goes to the fridge.

    Definitely get a car adapter for the car. You can pump in the parking lot before you go in if you are going right to the floor without stopping. It allows you to pump in the a.m. before you leave the house, pump again right before you go in, which gets you another session in. Bring a hooter hider in the car with you, and you can be discreet. I just pull my scrubs up and kind of use my coat to hide the sides. It's super easy.

    I like the Mother's Milk tea - it's a comforting way to get some fenugreek in, and you can make it at work when you chart.

    Also, for whatever reason oatmeal is also said to boost supply. I noticed a gain in my supply when I started eating some each day.

    Also, when you do have time to really take some time with a pump, halfway through - pull a picture out of your baby and see if you can get another letdown. I can get even more than normal out a pump if I can get a second letdown, but you have to focus on thinking about your baby, and it really is a mental thing from my experience.

    Hope these tips help. Also, are you consulting I bet they have more great tips for maximizing when you can pump for pumping moms.

    And good luck and congrats on fellowship. I am so far from where you are, but you are an inspiration to those of us behind you in school that are moms too.

  16. there are some good pumping tips in this blog- i referenced it often

  17. Great question. The answers and discussion are helpful to so many of us!

  18. I agree with so many of these suggestions. I'm only a med student, so I can't speak to your crazy schedule, (which seems to be the bulk of your question..) but I have nursed my son for 16 months, and still going strong, without having to supplement at all. My best suggestions are to peruse and Both are great resources. Get a car adapter and hands free device for multi tasking (including driving if you've got a commute; hook up before you start driving and just leave it on til you stop and you will never take your eyes or mind off the road), drink water every chance you get, pump even if for just five minutes and even if you just pumped an hour ago, eat oatmeal, and nurse as much as you can while with your son. But my absolute best suggestion if breastfeeding is a priority for you is to cosleep (if you feel comfortable about being able to do it safely). We started cosleeping once ds was a few months old and it allowed me to reverse cycle a bit without having to even wake fully to feed him. So my supply stayed high because I was nursing during the night without even really remembering (still doing this today actually!)
    Another piece of advice I found was that you shouldn't use a freezer stash unless you, for ex, spill some pumped milk. Every ounce you give your son from your freezer is being detracted from your body's current tally of how much he's drinking. So start using that supply and you're going to start the slippery slope of decreasing your milk production. If you don't pump enough one day, he'll drink more when you get home and your body will get the message to step it up.

  19. Do. Not. Decrease. Pumping. Frequency.

    Safest way of decreasing milk production. Production is negatively regulated by intraductal pressure.

    Also, see KC's latest post for motivation, loved it. Doing what's best for you, although it conflicts with what is expected of you...

  20. Do your best and leave the guilt at the door. Try to drink fluids as much as possible and add extra pumps at home.

  21. Yes, I already left one anony comment, but definitely definitely definitely do extra pumps at home. Get in two pumps before you even go into the hospital in the a.m. Do some extra at home. Even if it isn't time. That will help tremendously.

    Also - don't beat yourself up if you go too long a few times between pumps. Make up for it later when you DO have time. You are going to have times when you can't pump as often as others. I have been exclusively pumping for over four months now, and my supply has INCREASED despite moments when I have to go long between, because you can make up for it by pumping more frequently when you are home and have time and letting the pumps sit on your breasts for longer than a normal pump etc. at those time periods. You can do this! Don't let the naysayers tell you that you will lose your supply with pumping. Keep trying! Some may, but that doesn't mean you will!

  22. Definitely agree about pumping in the car. Also, make sure you have the hands-free pumping bra, this will allow you to pump while doing something else. I was living in LA when I had my first baby and spent my time in traffic pumping without any problem.

  23. I want to add my experience. I went back to work(surgery residency) when my son was 6weeks old and tried to pump. I found it overwhelming to find time/location. I thouhgt I could pump in the resident lounge or locker room - but the pump is so loud! I quickly found that pumping during the day kept me at work longer, meaning less time at home with an awake baby. We used up our stash and transitioned to formula pretty soon after. My child is now 2 - and doing great. When he was first born, I felt like feeding him formula was evil and he would grow up fat, and stupid...and that was very stressful for me. But he is fine :)
    My advice is do whatever gets you a good fellowship experience then home to your child to be a good mom. 12weeks of breast milk is awesome and he has already gotten so much benfit. Do what you can - but dont let it make you feel stressed ( resulting in less milk) or feel bad about yourself!

  24. You're all WONDERFUL! I appreciate the thoughtful comments and personal experiences. We just got settled into our new place, and I start orientation in 2 days. Will keep a copy of your replies with me :)

  25. I was a surgery chief resident pumping until 1 year. This was hard to do since our turnaround for cases were about 30 minutes and in between cases I had to check patient's information, talk to family, consent, oversee my juniors etc. I could squeeze in about 10-15minuts pumping but with all the preparation involved that takes more time setting up, washing etc. What I did was wear the handsfree band under my bra during the day so I could slip the shield under my scrub quickly. Also, I kept a big cooler and just kept the parts assembled and refridgerated so I could pump and reuse if I was doing it in my office since the lactation room was on the other side of the hospital. I had about 6 sets of spare pump parts so that I could always pump right away and then spent about 20 minutes at night doing all the washing and assembling of pump parts for the next day. I have also pumped while driving to and from work. If you wear a baggy sweater or even a poncho, it is not noticeable at all. I didn't even mind the traffic if it took 30minutes to get home since I was pumping the entire time. Also when I got home, I was ready to play with my little one or put him to sleep. He took a bottle during the day and I fed him directly 2x during the night. I've read that babies of working mothers tend to keep up with the night feeding longer. I've never discouraged it because some weeks, this was the only time I got to see him! Good luck with your efforts.


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