Why bother with hand expression? You may be surprised to learn that in many situations, hand expression can more effective than the best of our high-tech breast pumps. Pumps use suction to extract milk, while hand expression involves compression, massage, and touch. The warmth and pressure of a mother’s own hand will often trigger a more effective letdown reflex than a pump. A mother is able to target each compartment of the breast as she rotates her hand, which drains the breast more thoroughly. Hospitals are beginning to take note of this: I’m hearing about more hospitals that routinely teach hand expression to new mothers. When babies must be separated from their mothers, such as in NICU hospitalization, studies show that hand expression in the first few days is more effective at providing milk for the newborn than pumping.

As a lactation educator, I have taught hand expression to many mothers. But I’ll admit, I never learned to hand express effectively. I gave up quickly before the milk let down and switched to the pump. I concluded that it just didn’t work for me. And, maybe a little like my friend, I felt uncomfortable with it. But now I’ve learned more about it and seen it in practice, I realize I missed out.

Reasons to learn hand expression

• Your hand is always available. If your pump breaks, if you forget to bring it to work, or if you have an unforeseen separation from your baby, you’ll always have a way to remove the milk.
• You can use hand expression while breastfeeding to improve milk transfer.
• Expressing while breastfeeding can help a sleepy newborn feed more quickly and effectively.
• If you ever get a plugged duct, hand expression is a good way to work the plug out.
• Many mothers who practice hand expression find it works better and faster than a pump.
• Hand expressing after breastfeeding a newborn can bring in a bigger milk supply, if you’re concerned about having enough milk.

How to hand express

About.com has a great video clip showing hand expression close-up.  This video has good instructions to learn how to position and move your hand. We don’t see the mom do it long enough to get a good flow going, though, so you can’t see how effective hand expression can be at removing milk. Note that she says it can take 3-5 minutes for the milk to let down. . . this is why hand expression didn’t work for me, I just needed to do it a little longer!

This hand expression video from ibreastfeed doesn’t have as much instruction, but this lady gets into a good rhythm. She’s obviously experienced and you can see the start of a good flow of milk, which she collects in a bowl.

I’m determined to master the art of hand expression with my next baby. With practice and a little more time, I think it will be a great tool to complement feeding at the breast and pumping.

Moms, have you used hand expression? How did it work for you?

In reality, this doesn’t mean enormous savings for moms. Not all working moms have flexible spending accounts, and even though they may still be able to deduct the expense, most income tax filers take the standard deduction rather than itemize. The savings is unlikely to determine whether or not a mother can afford a breast pump and feeding equipment.

But this decision is about more than dollar savings. For the mothers who are eligible and likely to take advantage of it, yes, it’s a good incentive. It’s also about awareness of a mother’s options. The incentive of the tax break may get women thinking about providing breastmilk after returning to work. Many women don’t think breastfeeding is an option if they plan to work just a few weeks after giving birth. But perhaps the greatest benefit of the IRS decision is the growing recognition in our society of the importance of breastfeeding to mother’s and baby’s health. For mothers to succeed in breastfeeding, we need to have all parts of society stand behind breastfeeding to make it a manageable option for all mothers: pediatricians, employers, hospitals, families, media, public health agencies, and government. This is a huge step in the right direction for our society.

What do you think about the IRS decision? Will you take advantage of the tax deduction for your breast pump?

But what about pumping in public? This issue doesn’t come up as often as nursing in public. If you’re out with your baby and she gets hungry, she’ll need to eat regardless of where you are. The pump doesn’t scream and cry, so there’s usually a bit more flexibility in timing so you can get to a more private place. But there may be times that you get to a point where you’re working or traveling and you have to pump: your breasts are swollen with milk or you need to keep on a schedule to maintain your milk supply, and you can’t wait any longer.

It’s tough to pump discreetly. When you pump, you’re exposed and vulnerable. Pumping shows a lot more skin than breastfeeding. And for people who aren’t used to the idea, it looks a little weird.

A few months ago, I attended a day-long conference where they offered a pumping area right in the open, behind the rows of chairs in the conference room. Mothers who feel comfortable with this could pump without missing any of the speakers. It was a breastfeeding-related event, so I’m sure most everyone would have been totally cool with a woman sitting there pumping, but I couldn’t bring myself to do it. Maybe if there were some sort of privacy screen or curtain. Instead, I headed across the hospital for a private space.

At a La Leche League meeting I recently attended, several moms talked about how they get an extra pumping session in by pumping while they drive. I’ve also known plenty of moms who had to pump in a parked car.  I’ve heard of women pumping at the airport gate, waiting for a flight, and even pumping on the airplane. And I can’t remember where, if it was a personal friend or a blog I read, but I know of someone who has pumped while teaching in front of a college classroom.

So what about you? Would you pump in public? Ever had to? How did it work for you?

Check out the other posts on this week’s Breastfeeding Blog Hop topic: Nursing in Public

Helping Mama unpack the breast pump

My son is a year old now, and we have officially entered the world of “extended breastfeeding.” In my last post, I explained a little about my decision to continue nursing my son.

But as a full-time working mom, a big part of breastfeeding is pumping. I’m away from my son for over 10 hours at a time on my working days. For the past several months, I have faithfully pumped breastmilk 3 times every day at work.

Nearly all the working, breastfeeding mothers I have known have stopped pumping by their child’s first birthday, if not before. “If you’re ready to ditch the breast pump or pricey formula, you’re right on schedule,” I read today in my daily What to Expect email, targeted to the birthdate of my son.

In our society, fully breastfeeding to a year is a rare accomplishment, but pumping beyond a year is even more unusual. Nursing a toddler at the breast is often as much, or more, about the close relationship and enjoyment of breastfeeding as about the nutrition of breastmilk. In comparison, pumping milk is strictly business. There’s little enjoyment in sitting hooked up to a machine and washing pumping equipment through the day. Since at a year, babies can drink cows milk, mothers who have been pumping can quit without having to use infant formula.

I don’t love pumping. But I DO love breastfeeding my son when we are together. With long workdays, my milk supply might drop quickly without daytime pumping.  I intend to breastfeed to at least 2 years, and I want to maintain an ample milk supply. Drinking pumped breastmilk gives my son the best nutrition possible, and that’s important, but what motivates me the most to keep pumping is that it helps to maintain our nursing relationship.

So my decision is to keep pumping, but now I don’t have to pump quite as much. There were times in the first year when I thought I would run out of milk, and now I no longer have to worry about milk supply. If there is an office party during the lunch hour, I will skip pumping without guilt or stress.  I will probably drop gradually to pumping twice a day, then once a day, over the next year.

I would love to hear from other moms who have pumped milk. How long did you pump? Did you continue breastfeeding after you stopped pumping?

A new use for my breast pump?

Playing around after dinner, my husband pretended to call our son on the phone, saying, “Ring ring . . .Ring ring.” The baby scanned the room for the nearest phone-like object to pick up his end of the call, chose his new “phone” and started babbling into it while I snapped this picture.

Related Post:   Meet my new breast pump

Showing off my new pump

I was thrilled to hear from Judy at A Mother’s Boutique Mommy News Blog that I won a giveaway for an Ameda Purely Yours breast pump. The giveaway was part of her Blogiversary Celebration, with several more great giveaways you can still enter.

I will soon have to return my borrowed hospital-grade pump (a Medela Lactina) that I’ve been using since my son was 3 days old. I pump 3 times a day at work during the week, and every night before going to sleep. Every day, I carry the heavy pump with me to work, and bring it home at the end of the day. It has traveled with me twice on cross-country flights to 3 different states. It’s been a big part of my life, especially in the early months when I was pumping exclusively, then when I was using it 8 times a day after breastfeeding to build my milk supply. But I’m ready to say goodbye.  I no longer need a hospital-grade pump, and the thing is so heavy and awkward to carry around.

For the past 3 days, I have used my brand-new Ameda Purely Yours breast pump. It’s working great for me.

Here are some of my favorite features:

• It’s small, very lightweight, and it’s so easy to carry. The bag is attractive.
• I love the ability to control not only the suction (the only control I have with my former pump), but also the speed. Who knew. . .slowing the speed all the way down actually empties the breasts faster!
• The parts are easy to clean. There aren’t many crevices in the collection pieces where, in my former pump, milk would get stuck, and no finger, brush, or sponge could reach in to clean it out.
• The bottles fit securely into holders on the pump. This feature is good for me: I have knocked over bottles of my freshly pumped milk more than once because there was no secure place to set them down.

My baby is turning 1 soon, so I won’t be pumping quite as often, but I plan to keep pumping once or twice a day for many more months!

Thanks, Judy! I love the pump.

(this one's much nicer than the bathroom I pumped in)

The other day, I pumped milk in a public restroom. I was out of my normal routine, and there was no one to ask for better accommodations within a reasonable timeframe.

My choices were either the bathroom or the industrial kitchen, sitting on the cold cement floor in the dark, or skip pumping and become engorged. The bathroom was a single stall, with an electrical outlet, toilet with a tank and closing lid, and a cement floor. I chose to pump in the bathroom, and I will never do it again.

Yet many women find the bathroom the only private place to pump milk at their workplace, like the woman in Ohio who was fired for her unscheduled pumping breaks  (see the CNN video here, including discussion of using the restroom to pump). Before I tried it myself, I thought it would be unpleasant, but I didn’t realize how unsanitary it can be. Let me present to you my analysis of the disgusting details I hadn’t considered before I was faced with this experience myself.

Bathroom surfaces are filthy.

We all know about the aerosol effect of toilet flushing right? You may not see or feel it, but the contents of the toilet spray out with every flush. The little bacteria-laden droplets go airborne. Here is a quick video showing the spray out of a toilet bowl. It is safe to assume that all surfaces surrounding the toilet are coated with droplets of urine, fecal matter, and bacteria or mold present in the toilet bowl.

Pumping in the bathroom is a juggling act.

While pumping in my home or in the office, where I have plenty of clean space, I hardly think about this, but here are the dilemmas I went through in the bathroom at each step of pumping :

1. Where to place the pump: The toilet in this particular bathroom had a tank with a level top, so that’s what I used, although it was  small. Most public toilets don’t have this feature. Alternatives would be resting on the toilet paper rolls, or (if your pump has long tubing) on the floor. There’s no good option.
2. Where to sit: This bathroom had a lid that covered the toilet bowl, so I closed it and sat on it. Most public restrooms don’t. You’d have to sit directly on the toilet seat. People pee on the toilet seat. Maybe you could stand up. I don’t know about your breast pump, but the tubing on mine won’t reach that far.
3. Assembling the collection pieces: Between leaning forward to pull pieces from my pump bag, pressing the flanges into the connectors, turning around backward to plug everything into the pump, I found it difficult in this small space to assemble the pieces without brushing my arms or the tubing against some surface of the bathroom. And where do you set down the first side while assembling the second side?
4. Where to set down the bottles/bags full of milk: At some point you have to set the bottles/bags down while you button up and pack everything away. In my office, I place the bottles full of milk on my clean desk until I’m ready to carry them to the refrigerator in the break room. In the restroom, I guess the best option is to put it in your lap and hope it doesn’t fall into the toilet or onto the floor.

Other mothers might experience it differently, depending on what kind of pump and case you have. Mine doesn’t have any special holders or compartments that helped with bathroom pumping.

It ties up the bathroom for others who need it.

Especially if there’s only a single-stall restroom available. A pumping session takes longer than your typical bathroom break, and it’s hard to rush. It’s awkward to walk out and face the other women lined up, waiting for you.

It’s unpleasant and uncomfortable.

This isn’t the worst thing in the world, but still, who wants to spend all their break time in the bathroom? It smells bad. It’s ugly. Whether pumping standing or sitting on the toilet, it’s hard to relax, which can inhibit the milk ejection reflex.

Sanitary lactation space should be a working mother’s right.

In many US states, it is a right. Several states have breastfeeding laws that require employers to provide facilities for pumping milk, “other than a toilet stall” which you can see in this compilation of state breastfeeding protection laws. Women should not have to pump in a bathroom to provide food for their babies. Some workplaces may not have the luxury of setting aside an entire room for pumping, but there must be some space that could be partitioned off when the pumping employee needs it.  I have been in two offices that used cubicle dividers to create a small pumping room. The room I pumped in while on jury duty was actually a  large closet adjacent to the restroom, and that worked fine.

If you are a mother who pumps milk in a bathroom, please don’t be offended. I commend you for enduring the unpleasant surroundings to provide the best food for your baby. I realize that, where there are no laws to mandate a designated pumping area, you might not have any choice. Maybe you’ve found a way to keep everything clean and you’ve got the routine down. But you should be entitled to a better space.

Moms, have you had to pump milk in a public bathroom? How did it work out for you?

After a month of full-time work, I’ve been forced to find ways to cope. Like other working mothers, my days are packed and I wish I had more time with my baby. A month ago, I wasn’t sure I could handle it, but it’s getting more comfortable. Here are a few tips that I want to share- the things I didn’t start out with and have discovered along the way.

Use a hands-free pumping device.

It has revolutionized my pumping experience. The first time I tried one, it was awkward to put on, and in the time it took to get it secured with the pump parts in the right place, I could have been done pumping. So I didn’t start using one consistently until a few weeks ago. After using it a few times, I was able to put it on in seconds. It helps me pump within my allotted break time since I can pump and eat at the same time. I can also read books, write emails, and blog. (Yes, I am pumping as I write this). And I noticed a surprising result: I get more milk.  Apparently, the milk flows better when I can sit back and relax. Some people find these a waste of money because they can rig up their own version like this one (I haven’t tried this, so let me know if it works for you). Here are a couple examples of hands-free pumping bras that I know of, at Easy Expressions and Simple Wishes.

Don’t waste time washing the pieces after each use.

I made this mistake at first, and it was cutting into my work time. Instead, between pump uses, you can just grab all the pieces, stuff them into a clean bag and put them in the refrigerator or insulated bag with your ice packs. (I do a quick rinse first so the milk doesn’t get stuck in the hard-to-clean places). I only do a full washing with soap and hot water at the end of the day, and I leave all the parts in my office until the weekend.

Enjoy it.

Pumping is the only time I have to myself during the day. That’s why I can’t bring myself to be productive during this time. No going online and paying bills, scheduling appointments, or catching up on my job-related work. I often look forward to the days when I don’t have to pump, I can socialize with my coworkers on breaks, and not worry about lactation accommodations at conferences and special events. But for now, I enjoy these few minutes to get away and breathe. I may even find myself missing it some day.

For a great collection of posts on working and breastfeeding from other bloggers, check out the September Carnival of Breastfeeding on working and breastfeeding. Scroll down to the bottom of the post for the links.

What suggestions or questions do you have about pumping at work?

My related posts:

Life after maternity leave

Back-to-work nursing strike

Jury duty wrapped up today. Other than the initial phone experiences, the Clara Shortridge Foltz Criminal Justice Center, in downtown Los Angeles, has done a great job of accommodating breastfeeding.  Since my last post, the accommodations have only improved.

The courtroom attendant, a kind but awkward gentleman, checked in with me several times to make sure the timing of our breaks was ok with my pumping schedule.  “Juror number 9? [lowers his voice nearly to a whisper] I talked to the judge about your [voice drops even softer] . . . situation. . . ”

The judge offered to open the juror deliberation room, right behind the courtroom, for my pumping. It saved me a lot of walking and made the process much faster. I got to sit back in a comfy chair with a huge window-wall overlooking the city of Los Angeles as I pumped. Not bad.

I’m sure the other jurors wondered what was up with me, why I was being called aside, escorted out of the courtroom through a different door, and why did I carry that gym bag around everywhere?? I would have been more than happy to tell them about breastfeeding, but nobody asked. I remain a mystery . . .

After my discovery that California law allows breastfeeding mothers to postpone jury duty for more than a year, I called the court again to see if I could reschedule for this winter. Since I had been given wrong information before, I was prepared to cite the law and demand my rights. Instead, when I explained the reason for my call, the woman on the phone said pleasantly, “that’s right, we can postpone your service until mid-March.”

March? That’s great! But wait,  that’s my husband’s spring break. Our only chance to travel for months. Can’t I come in January or February? No, they have no openings until March. It’s either serve now and pump, or skip vacation.

So I reported to jury duty today. And I am happy to say that the accommodations for my need to pump have exceeded my expectations!

The security guard paused as my breast pump rolled through the X-ray machine, but after calling another guard over to look at it, they let it through without a comment and without opening it. I was assigned to a juror assembly room on the 11th floor, while the pumping room was on the 5th floor. They immediately transferred me down to the 5th floor for easier access to the room. The room itself was really not very impressive: small, cold, and no lock on the door. But it had a comfortable chair and an electrical outlet. They made me a “Do Not Enter” sign.

The judge whose courtroom I was assigned to is amazing. The courtroom clerk privately informed the judge of my need to express milk. My fellow potential jurors didn’t know that the reason we were dismissed early for the day today was because I needed to pump. She will be making the breaks for the entire courtroom longer so that I have enough time to pump. I wonder if this judge was once a breastfeeding mother?

No more worries about losing my milk supply or having to pump in a bathroom. I’m now rather excited about fulfilling my jury duty!

To read about what happened when I served on the jury panel, breast pump and all, read Pumping on jury duty: Final update.