Exclusively Pumping Breast Milk
I wish so much that I had known about Stephanie Casemore’s book Exclusively Pumping Breast Milk when my second daughter was born that, now that I have finally read the book, I simply cannot stop talking about it. Everyone who needs to use a breast pump for more than an occasional use would benefit enormously from the knowledge in this book.
My pumping story began seven years ago. I was part way through my second pregnancy when I discovered, during a routine ultrasound, that the baby I was carrying would be born with a cleft lip and palate. It was a cold shower surprise that sent me into shock, mostly due to the manner with which the diagnosis was delivered. A diagnosis of a cleft lip and palate is not so serious in the scheme of things, but the diagnosis was not given in reassuring terms. Part of my personal process of coming to terms with the diagnosis, and making peace with it during those last months of pregnancy, was researching and preparing a feeding plan. Breastfeeding was an important topic for me – I was already well into a training programme to become a breastfeeding peer-counsellor. Along with finding a cleft team for the cleft lip and palate surgery, I was intent on finding out how I would be able to feed this child. At the time, there was not much information available on breastfeeding with a cleft lip and palate (and there is still not that much more) and I didn’t yet have access to the internet. From the information that I had managed to gather, my plan was; attempt latching first, pump second, supplement via syringe, and then see.
The night our daughter arrived, when I felt the preparatory contractions turn into something more tangible, we washed and sterilised the breast pump. Miriam was born at home. I had everything set out waiting for her; breast pump on the bedside table, cleaning and sterilising instructions pinned to the kitchen wall beside the sink, hand drawn tables on which to note quantities of milk pumped, quantities drunk, weight gain, number of wet nappies. I was ready for action. All that planning was a little surreal, but this little baby meant business too, and just under two hours after labour began with an explosion of amniotic fluid, Miriam came barrelling into the world, to be caught just in time by Ivana and Gabriella, the two attending midwives.
Miriam was born with a unilateral cleft lip and palate. She latched briefly, but not effectively, so I began pumping. Pumping, with a teensy newborn in my arms was the last thing I felt like doing in that warm, honeymoon glow of afterbirth. Pumping is a mechanical, and I presume a left-brained activity whereas breastfeeding, what we are primed to do, is right-brained. What I would have needed at that moment was someone who could have led me by the hand through the steps that I had rationally outlined, but was no longer in a position to follow. What I also didn’t know then, was that hand expression would have been a more effective way of removing colostrum and stimulating my milk supply. Nor had I known about prenatal colostrum expression which may also have helped my supply, helped me learn hand expression, and would have taken some of the pressure off producing enough milk to meet the needs of a hungry baby. I hadn’t read Exclusively Pumping Breast Milk which covers all of this and more.
I had to remind myself to pump. I pumped as often as I could, around the clock. Pumping, I discovered, can become a tunnel – a dark tunnel divided into approximately three hour intervals. Pump, store, heat milk, feed baby, repeat. Sleeping was limited to snatched moments. Often my partner would feed the baby, while I pumped. Our elder daughter, who already knew how to breastfeed her dolls, now added syringe feeding and pumping to her parenting skills. I swear, I did not feed my baby flat on her back, the way she is doing in the photo though!
Before Miriam was born, I had made a list of more or less everything I did around the house and handed it to my partner along with the words ‘these are the things I won’t be doing for a while’. I knew that we would have to survive on the bare minimum of housework. I taped the pump cleaning and sterilising instructions to the wall so I could ask other people to do it for me. When visitors came, they would head to the bathroom to unload the washing machine and hang the laundry on the line. There was always someone ready and willing to hold the baby and feed her a bottle. For reasons I can barely fathom, I would let them feed her, retreating to the kitchen to wash the dishes and a few moments of alone time. In afterthought, that signals to me that things were out of balance. I should have retreated to the bedroom with my baby for a little alone time with her. Nursing a baby facilitates attachment, bottle feeding was facilitating my detachment. I felt myself swimming upstream and had to make a conscious effort to bond. Thanks to the bottle, and her temperament, my daughter had an eating and sleeping rythm that made her ‘easy’ to care for – I could practically toss her into the pram that we used as a daytime crib (due to some early choking problems I kept her nearby when she was asleep, wheeling her around the house wherever I was). There was no lingering with milk drunk baby asleep on my breast this time around. As soon as she was asleep, I had to put Miriam down so that I could pump, clean equipment, or do one of those things on the very small, but indispensible list.
I’m writing all of this as, at the time, I felt that very few people, even those who visited, really understood the implications of full-time pumping (I don’t call what I did ‘exclusive pumping’ as I did manage to teach my daughter to latch, and she was partially breastfed at-the-breast for 3 of the 7 months I pumped). Reading Stephanie Casemore’s Exclusively Pumping Breast Milk was validating for me, as well as being particularly useful for breastfeeding support workers (IBCLCs, peer-counsellors, etc.) who haven’t had a personal experience of long term or exclusive pumping. Exclusive or long term pumping is tough,it’s a job (which Stephanie in her beautifully optimistic manner describes as a labour of love) and this is the much needed manual. Pumping when your infant also has feeding difficulties, such as a cleft, is particularly complicated. This book would have made my efforts simpler. I would have learnt how to cut down the time taken to organise my day, how to pump efficiently and maximise my milk supply by utilising strategies such as power pumping, hands-on techniques, and galactagogues. I also would not have felt so alone. Stephanie has a thriving online community (one of a growing number), and although I did not have internet access at the time, this may have been the nudge to get that earlier or, at least, knowing that I was not alone would have been comforting.
There is so much in this book that I can barely begin to describe the topics covered. If you consider The Womanly Art of Breastfeeding the go-to manual for regular breastfeeding, then Exclusively Pumping Breast Milk is the equivalent for those who need to express their milk on a regular basis. This book has up-to-date information on milk production, milk composition, storage and handling of breast milk, a discussion of feeding methods (such as paced bottle feeding), trouble-shooting, donating milk and donor milk as an option, formula, weaning your baby, weaning from the pump, the emotional aspects of exclusive pumping and fitting pumping into the dynamics of family life.
For anyone who is expecting a baby who has been diagnosed with a congenital difference, such as a cleft lip and palate or Pierre Robin Sequence, which may require temporary or long term use of a breast pump, this book is a must have. For anyone supporting a parent who is pumping long term this book is also a must. It can be very difficult to communicate the complexities of pumping to your support network when you are in the midst of it. Health care professionals, family and friends, do not always realise that exclusive (or long term) pumping is more challenging than an ordinary breastfeeding experience. This book is a welcome voice in advocating for the kind of support that challenged parents require and a brilliant resource for pumping parents, written by an author who really knows her material (a one time pumping mum herself). Stay tuned for more posts on how to avoid using a pump in the first place,
*Disclaimer; the ony affiliation I have with the author is a review copy that I personally requested – I am an Amazon afilliate and therefore receive a comission on puchases made after following the book link to Amazon.
Kendall-Tackett, K., Mohrbacher, N., Breastfeeding is a Relationship:Breastfeeding the Right-Brained Way, (http://tinyurl.com/qfsh9qr accessed 13.12.2013)
Soper, D.M., Expressing Milk Before Birth: A Tool for Use in Special Circumstances, (https://breastfeedingusa.org/content/article/expressing-milk-birth-tool-use-special-circumstances accessed 13.12.2013)