Pumping and Workplace routine - originally posted in BF'ing Challenges sticky
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PUMPING TIPS
Make sure to read the Marmet (massage) technique to improve your pumping yield
http://www.lactationinstitute.org/manualex.html
I recently read that the ducts extend up to the armpits so you might want to modify the technique to include this area. On a message board I once read about an enhancement technique, I haven't seen it anywhere else since then but it does make a difference for me.
Move the horns a little off center in between massaging, in a pattern, (e.g. slightly up, slightly down, slightly right, slightly left) so that the suction is reaching ducts it might not otherwise reach. Try to follow the same pattern each time so you're less likely to skip an area. This increased the amount of "hind" milk I was able to pump, which has a higher ratio of fat and protein so it is probably more filling. Once I go through the first pattern (12:00, 3:00, 6:00, and 9:00) I run through a second pattern (halfway between 12:00 and 3:00, halfway between 3:00 and 6:00, etc.) I was really surprised at how well this worked for me. As much as I would rather just sit down and let the pump do the work it is much more of a "hands on" experience than I would like; but it does work.
If you are coordinated try experimenting with compressions and/or massage while you are pumping. This might save some time on doing that in between moving the horns around.
Also, if you’re blanched (white) after pumping you may need bigger horns (aka funnels, shields, etc.). Note that it is possible to have large nipples even if your overall size seems small(er). One of the Medela web pages used to have a picture of what it looks like if you are getting squished. But that page has changed yet again and I can't find it.
If anyone here finds it please let me know and I will edit this post to update the defunct address below.
Medela - Choosing a Correctly Fitted Shield
http://www.medela.com/NewFiles/faq/b...hield_fit.html
See the fhird paragraph for a picture with a link to a video
Finally, here are a couple of miscellaneous tips I read recently that I’ve never tried myself but may be helpful: 1) a hot shower between your shoulder blades before pumping. 2) non-alcoholic beer, and 3) smelling your baby’s head, looking at her picture (to facilitate Visualization), etc.
When my supply issues were the worst, I would nurse on one side and pump on the other before going to work. This has a couple of advantages: 1) Your Prolactin levels are probably higher, 2) You pump more efficiently this way if you are more conditioned to the baby than you are the pump , and 3) You may be squeezing in half a pumping that you otherwise wouldn't be able to.
Also, give some consideration to additional "conservation" methods besides those tips on bottlefeeding a BF baby. E.g.: storing milk in "serving sizes" to avoid waste if the caregiver isn't cautious about pouring out only what is needed. This is especially important for the milk that gets frozen because you only have 24 hours to use it once it's thawed. Try storing half portions for the same reason. If baby is extra hungry the caregiver won't always have to waste a whole frozen bag if only half a bag is necessary. Note, the serving size will probably change over time.
Depending upon your pumping routine you may be able to tell when you are pumping fore milk versus hind milk or a combination of the two. The hind milk usually comes in towards the end of a feeding/pumping it is higher in fat and protein and it looks more like whole milk. That milk tends to be more filling so you might want to put a little less of that in a serving size, and vice versa. So I mark the bag accordingly. As an added bonus, when DD2 was younger DH would notice she'd fall asleep more easily after a serving of hind milk which is nice for the caregiver when it comes time to planning a nap.
OVERVIEW OF MY WORKING & PUMPING ROUTINE
Depending upon the setup you have at work some parts of my routine might not work for you, but I hope you'll find some of this helpful. Sorry it's so long.
Although the milk will stay fresh for up to 8 or so hours at room temperature, I prefer to keep it cold so that I don't cut too much into that 8 hours. That way the caregiver can use that time if necessary to decrease the potential amount of waste. So if they give DD2 a 3 ounce bottle but she only drinks 1 or 2 ounces that milk can actually sit out for quite awhile.
Also, refrigerating it (or keeping it on ice) at work gives you a greater margin for error if you forget about the milk when you get home. I have left my milk on ice overnight a couple of times and still felt comfortable going on to store and use it (based on the temperature of the milk when I discovered it I was well within the temperature guidelines for refrigeration storage). Check Kellymom
http://www.kellymom.com/bf/pumping/milkstorage.html or Medela's site for the temperature guidelines. I use a digital meat thermometer for checking the milk temp when necessary. If you have more than one bag you don't even need to open one. Just put the bags in a cup or mug and then place the digital probe between the bags.
So here is my procedure. I have a rectangular Rubbermaid storage container large enough to contain my fully assembled bottles (roughly 11" x 8" x 3"). Because it is a casserole dish you would need a fridge door shelf deep enough to hold it standing up. For transportation and camouflage purposes I have it double bagged in a larger than average and thicker than average grocery type plastic bag. As you may remember, my pocketbook is large enough to hold this container so I keep the bagged container in my pocketbook on my way too and from work. Otherwise you might need a large zippered tote bag or something similar.
So, at the end of a pumping session I lay the double zipped milk bags side by side at the bottom of the Rubbermaid container, then I lay the fully assemble bottles on top of them with the bottles side by side. Depending upon the width of the container you might need to set one of the bottles so the bottom of its horn will nest on the top of the other bottle. Then I put the lid on it, bag it, loosely tie the handles without knotting them, and place it in the door of the fridge, standing straight up. If the door shelf isn't deep enough on your fridge then you might be able to use a tall "canister" type Rubbermaid container but it would probably need to go on the top shelf.
This method also gives you the flexibility of leaving the bottles partially full until the next pumping. Then you can bag the milk when the bottles are full.
Regarding washing. I am lucky to have a kitchenette near the mother's room but I'm still pretty careful about where I put the disassembled parts. So the Rubbermaid container doubles as a tray and wash tub. I use Dawn detergent and hot water to wash/rinse the lid, which then doubles as a tray. I then wash/rinse the disassembled parts and lay them all on the lid. Then I wash/rinse the tub, transfer the clean parts into the tub and close the container.
It is important to shake as much water off of the parts as possible before putting them in the container. I transport everything home and take the lid off so everything can dry thoroughly. The only thing I need to do is make sure that the parts are spaced for air flow, especially the small silicone parts. In the morning they are fully dry. All I have to do is wash and dry my hands, and assemble the bottles, and I'm ready to start again.
With DD1 they had Palmolive in the kitchenette at work but the Dawn they now have is much better at cutting the fat so everything rinses better. Before I had to use a paper towel to give the insides of the bottles a light scrub and I would actually thread the paper towel through the narrow opening of the flange. Now I just wash and rinse in really warm, almost hot water. Vinegar is also really good for cutting fat, either during the washing process or as part of the final rinse.
Of course you have the option of simply reassembling the bottles after the milk is poured out, putting them back in the container and washing them when you get home. I do this on occasion but I still use the Rubbermaid container to hold everything as it dries overnight.
I use the thermal storage bag that comes with the Medela PIS to take the milk home. I now use 2 packs of "blue ice" to increase the longevity of the milk and margin of error in case I forget to take the milk out when I get home. As mentioned above, I have been able to use milk left overnight with one blue ice pack but when you use two the ice remains partially frozen so I'm assuming the milk would stay even colder.
If you are short on freezer compartment space: I cut a cardboard box to fit the Lansinoh storage bags that I use. That way I can stack the filled bags and freeze them flat with a minimum of distortion, on the bottom shelf (drawer). Once they are fully frozen, I use tissue boxes to "file" them on their sides them by date. Periodically I double check to make sure that they are in the correct chronological order.
The "stack, freeze flat and file" method saves on freezer space and keeps everything better organized so it is easier to find the oldest bag in the right size. And since you are not pawing through a pile of lumpy bags they are less likely to get ripped or torn. This happened to me a couple of times when I would freeze them standing up in cups. When rummaging through them they would bang against the coated wire of the drawer and the bags would get damaged. I lost a small but significant amount of milk this way. It's also easier to tell at a glance how much milk you have.
I have seen a storage / filing system you can buy but it is much bulkier since the drawer segments have to be large enough to fit a full bag before the milk has frozen. My method takes a little more effort since you have to stack and freeze the bags flat, and then file them, but there is a minimum of wasted space.
LINKS
Getting Started BF’ing
http://www.kellymom.com/bf/start/index.html
Storage & Handling
http://www.kellymom.com/bf/pumping/milkstorage.html
Index of Dr. Jack Newman’s Articles -- includes links to videos showing proper tips and techniques for proper latching
http://www.breastfeedingonline.com/newman.shtml
Newman’s latching tips, including diagrams
http://www.breastfeedingonline.com/whenlatchingpdf.pdf
What is a galactagogue? Do I need one?...Herbal remedies for increasing milk
http://www.kellymom.com/herbal/milks...actagogue.html
Increasing Low Milk Supply
http://www.kellymom.com/bf/supply/low-supply.html
Let-down Reflex: Too slow?
http://www.kellymom.com/bf/supply/letdown.html
Marmet Technique
http://www.lactationinstitute.org/manualex.html
Choosing a Correctly-Fitted Shield
http://www.medela.com/NewFiles/faq/b...hield_fit.html
How to bottle-feed the BF baby
...tips for a breastfeeding supportive style of bottle feeding
http://www.kellymom.com/bf/pumping/bottle-feeding.html
Co-Sleeping – Making it Work and Making it Safe
http://www.kellymom.com/pantley/pantley21.html
BF’ing @ kellymom.com
http://www.kellymom.com/bf/index.html
How much expressed milk will my baby need?
http://www.kellymom.com/bf/pumping/milkcalc.html
Kellymom link: Herbal Remedies for Increasing Milk Supply
http://www.kellymom.com/herbal/milks...bal-rem_a.html
Also, label them because you'll want to work through your stash from oldest to newest.
In fact, DS is now 3 1/2 and I just foudn a couple of abandoned bags that somehow got lost at the back of the freezer and had to be thrown out. It was kind of bitter sweet remembering those crazy pumping days. 
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