By Dr. Kathleen F. McCue, FNP, IBCLC and Katie Ralls
As the customer service rep for Simple Wishes and Pumping Essentials, I wanted to share my
story, in hopes of helping other mothers out there who might face similar challenges.
My story begins with being diagnosed with Vasa-Previa (overlapping blood vessels next to the
inside of the cervix) when I was 22 weeks pregnant, I was placed on hospital-based bedrest for
the rest of my pregnancy.
This story, however, has a happy ending. Baby Harper was born at 33-weeks gestation via C-
Section when my liver function tests sky-rocked and I felt really sick. I intrinsically knew there
was something wrong and am thankful my nurse listened to me and acted quickly. We have a
voice within us that tells us what to do, but listening to that voice can be an art form, especially
when we’re pregnant and everything is new.
While on bedrest, I was given non-stress-tests twice a day with the plan of an eventual C-
section. All in all, I spent a total of nine weeks in bed and was only able to get up twice a day for
walks and brief trips to the bathroom. This was one of the most difficult times I ever could have
Thankfully, with enough advanced planning, I had been given two rounds of injected steroids at
24 and 32 weeks; this helped mature my baby’s lungs in anticipation of her early delivery. I had
no “Golden Hour,” where I could breastfeed my baby and be skin-to-skin, as she was whisked
away to the Neonatal Intensive Care Unit so she could be given the best chance possible of
survival outside of my womb.
Harper was born weighting 3 lbs., 2oz. and was only 15.25 inches long. She spent her days in a
NICU isolette being monitored 24 hours a day. My husband and I spent our days watching and
On day three post-partum, I literally thought my breasts were going to explode. I woke up with
breasts that were twice their normal size, tender and rock hard. Thanks to a class I had taken
prior to delivering, I learned and remembered the method of hand-expression to relieve
engorgement. Although I had access to a hospital grade pump, at this moment in time, this is
what felt right to me.
Hand expression. How could a hand be better than this super expensive breast pump? Am I a
cow? I feel like I could fill a swimming pool but I only have little drops my first day.
I think hand expression is the best thing to use, second only to the baby itself. Breast massage.
Pull back, compress, release, repeat. You can use it anywhere at any time. You do not need a
plug, battery, clean flanges. You always have your hands with you.
It’s really interesting to know that my first experience performing hand expression involved two
breasts that were NOT my own. Yep, I milked another woman. I had learned all about it in my
classes with Evergreen Perinatal and at WIC where I worked for five years. How hard could it
be? I had all the confidence on the outside and all the nervous shakes on the inside. My friend
was in pain. She had forgotten her pump at home and we had just walked out of the Raider’s
Stadium in Oakland, CA. We were making our way to the parking lot when she looked like she
might cry. Can I help her?!?! Ok what did they say to do again? Massage around. Feel for lumps.
Made a “C” hold. Why weren’t my hands bigger?! Ok now push back….. And compress. And
again…. Push back and compress. Oh my gosh it is working! After spraying milk everywhere
there was a sigh of relief. I had done it!
Again, not too long after the previous incident another friend had forgotten her pump at a
family party. Welp… looks like I am going to attempt this again. This time in a bathroom sink.
Once again, It worked! Having said that, learning to hand express, hand expressing your friend
and hand expressing yourself are not the same.
When my own daughter was born at 34 weeks, I knew I needed to get my milk flowing right
away. I was so hopped up on Magnesium, pain meds and morphine… … I was all thumbs…. So
this is what it supposed to feel like? I was amazed that it worked. 2, maybe 3 droplets came out.
Breakfast, lunch and dinner! Haha! I am joking. It didn’t feel great, to be honest as I had bruises
all over my breasts which my husband got the stink eye for from a nurse later that day. Sorry
I knew the facts about hand expression. When using hand expression correctly you could
express more milk than you could with any pump. You did not need a magic bra or a magic
breast pump to express milk. My baby was too small and premature to latch and have milk
transferred. It was up to me to get it going.
The lactation staff at the hospital where I was admitted for observation had a video about what
to expect in the first few weeks. How you could potentially go from syringe feeding (another
technique rather than a bottle) to possibly breastfeeding directly when the baby was “ready”.
Unfortunately, my baby was not cleared to breastfeed until she was 6 months old due to silent
reflux (a danger for aspiration). Her epiglottis was under-developed which caused her to inhale
thinner liquids. This was heartbreaking.
As the months went on I used hand expression in many different circumstances. If I forgot my
pump, if an outlet was not available, in the shower for comfort, to release plugged ducts, to
express milk into my baby’s eye if it had discharge (it happens). I will be forever grateful for the
knowledge I had and the confidence that was built by my experiences and training. I believe
every mother should learn how to hand express for these very reasons.
I remember using a video clip that was on the Standford.edu website to encourage many moms
to use this technique over the breast pump.
The method is to start with clean hands and sit down in a place where you can relax and get
comfortable. By the way, this should be the case whether you’re nursing, pumping, hand-
expressing, or simply holding your baby. You need to build a nest of sorts. Gather a container to
catch your milk, then gently massage the breast your expressing in a circular motion from chest
wall down to the nipple. Heat can also be an added benefit. In order to stimulate your let-down
(a reflex that starts the milk squirting out of the nipples), you’re going to need some rolling of
the nipple between your thumb and index finger. You will then place your thumb on the top of
the areola (the edge where the darker color ends and your breast begins) and your index finger
at the bottom (same placement). Spread the skin back toward the chest wall, squeeze in and
gently but firmly pull, aiming the nipple into the collection container. There is a sweet spot that
you will have to find. Some moms find that the area needing compression is either closer to the
nipple or further back on the areola. It will take practice. Remember, they’re not faucets! You
will get faster with practice and yield more milk as you gain confidence.
By Dr. Kathleen F. McCue, FNP, IBCLC
It’s fair to say that I spend most of my clinical days regulating maternal milk supply. The number one complaint is “I don’t have enough milk,” Sometimes, I’m in agreement but other times, I find maternal expectations, for how much milk one is supposed to produce is pretty unrealistic. Although we don’t want to be living paycheck to paycheck (milk-wise), we also don’t want to open a Dairy Queen. I’ve discovered slow gaining babies with what we call “inadequate weight gain,” can be a result of moms who are “feeding the freezer.” They need a stash.
There are so many things that come into play when helping women regulate supply: Storage capacity of the breasts (meaning amount of glandular tissue and milk-making alveoli within the breast itself); adequate nipple stimulation to help moms produce prolactin (a hormone that promotes milk production); suckling ability of the baby (big strong baby or small jaundiced baby with a low birth weight); frequency of stimulation by either baby or breastpump (moms with less storage capacity (smaller breasts) will most likely be feeding more frequently and sometimes for longer sessions. This is not an exact science.
Trouble usually starts when moms either start on any type of hormonal contraception or return to work outside the home. Keep in mind that empty breasts make milk, so if you don’t have any significant reason for a decreased supply, you basically need to keep emptying the breasts.
Here’s the checklist that I give my consultants to work with moms with this complaint.
Keep in mind that some moms will fall outside the bell-curve and do just fine with their insurance pumps but, since this article is about low milk supply, those moms aren’t even reading this blog. Insurance pumps that you own are sometimes called “hospital grade” but in the world of lactation consultants, we mean pumps that you rent from your lactation consultant or hospital. My favorite is the Medela Symphony because it’s only seven pounds and has a soft stimulation phase that helps moms produce prolactin. Again, you will need to trial different pumps to see what works best for you.
If you’ve ticked through this entire list and are still unable to increase your milk supply, visit your local IBCLC or schedule a telehealth at Metropolitan Breastfeeding. Our website is and there’s no doubt we can help you.
Breastmilk production relies on supply and demand. Every baby is different, but between the ages of 2-4 months, and again around 6 months, you may notice a change in your baby's sleeping patterns. As your baby begins to sleep longer stretches at night, you may find yourself questioning how to best keep up your milk supply. Most parents are thrilled at the idea of getting more sleep, however, if you decide to skip that night feeding, your body will notice there is less demand for breastmilk and will begin producing smaller volumes.
You may be thinking... why do I need to keep up my supply if my baby's demand is less than before? Well, sleep patterns are not linear. As your baby grows and develops you may notice that there are some challenging sleep regressions along the way. Most commonly, these regressions occur at 4 months, 8 months, 12 months, 18 months, and 2 years. Thanks to growth spurts, teething, and other normal developmental milestones, your baby may wake more frequently at night again. Keeping a healthy supply will allow you to keep up with fluctuating demands and provide baby with exactly what they need to get through it.
This is where a breastpump comes in handy! Pumping at night during what would have been a nursing session will help send signals to your body to keep that liquid gold coming. If you are not already using a breastpump, now may be a good time to consult with a lactation consultant about your options and needs. At Metropolitan Breastfeeding, we offer hospital-grade pump rentals (is a hospital-grade pump is right for me?).
Stay Focused on Your Breastfeeding Goals:
-Commit to replacing a missed nighttime feedings with a pumping session.
-Why is breastfeeding important to you? Keep a list handy of all the benefits of breastfeeding to help remind you of your why.
-Keep a journal. Write down things your baby does when you are feeding them. Did they giggle? Smile? Caress you? How is your baby changing day to day and what sweet things did you notice? Look back on your entries whenever you lack motivation.
-Get an app to keep track of feedings. Patterns will emerge and this can help you adjust your schedule as your baby's sleep patterns change.
Build Your Support System:
-Work with a Board-Certified Lactation Consultant. A lactation consultant is a health professional who specializes in the clinical management of breastfeeding and can help you and your baby overcome breastfeeding challenges.
-Work with a Certified Gentle Sleep Coach to work through those sleep regressions.
-Work with a Postpartum Doula. A doula isn't only for birth support! A postpartum doula can provide you with support, motivation, confidence, and education while you embark on your parenting journey.
-Friends, Family, and Community. Don't be afraid to ask for help with daily tasks so you can get quality rest and have more time to stay focused on meeting your breastfeeding challenges head-on.
Lastly, BE GENTLE WITH YOURSELF. You're doing great!
Researching all of the various types of breast pumps out there can feel overwhelming. Why are there so many? A variety of choices allows every mom to find the right pump for her – but how do you know when a hospital-grade pump is right for YOU?
Hospital-grade breast pumps have powerful motors (but a lot more comfortable) and are designed to be long-lasting and reduce contamination, so they can be used by multiple people in a medical/hospital setting (each with their own accessory kit). These pumps are much better than the pumps you can buy retail or receive from your insurance company. This extra strength mimics a baby’s natural sucking stimulation and allows for more efficient and shorter pumping times – this is especially helpful in the postpartum period when you are establishing your supply and maximizing your potential for milk production.
A few reasons we may recommend a hospital-grade pump:
Contact us today to discuss your options and do a little trial. Most of our services are covered by insurance, including rentals of our hospital-grade equipment! We also have plenty of personal use pumps available for purchase.
This year has been especially challenging for everyone with the outbreak of COVID-19. With a surge in cases right now, parents with babies born during the pandemic are more concerned than ever about the health and wellbeing of their children. When it comes to breastfeeding, you may be wondering if it’s safe to do so. The short answer is yes! You can start and continue to breastfeed during this time with some recommended safety measures.
COVID-19 is transmittable through close contact with an infected person when they cough, sneeze, or talk. Currently, the COVID-19 virus has NOT been detected in breastmilk. This tells us that breastfeeding can continue despite the rise of COVID-19 with many benefits to you and your child.
Benefits of breastfeeding during a pandemic
While there is not enough information available to know if breastmilk protects babies from COVID-19, we do know breastfeeding provides your baby with numerous protections against infectious diseases. It also releases the hormone oxytocin in mom’s body helping to relieve the excess stress and anxiety a pandemic can bring. Need another reason to breastfeed right now? It’s free and readily available – this is particularly helpful during a pandemic when so many are unable to safely work or make trips to the grocery store.
What to do if you have symptoms or test positive for COVID-19
In addition to the CDC guidelines, these steps will help you avoid spreading the virus to your baby:
Wash your hands before touching your baby
Wear a cloth face covering while feeding at the breast
Wash your hands before touching pump or bottle parts and clean all parts after each use
Connect with your pediatrician and a lactation specialist
Symptoms of COVID-19
If you or anyone in your home is exhibiting any of the following symptoms, contact your healthcare provider:
· Fever or chills
· Shortness of breath or difficulty breathing
· Muscle or body aches
· New loss of taste or smell
· Sore throat
· Congestion or runny nose
· Nausea or vomiting
Source: Centers for Disease Control and Prevention
Maintaining your supply while isolating
If you test positive for COVID-19, the current guidelines suggest isolating for a period of 10 days from the onset of symptoms. If you choose to isolate you can pump regularly to keep your supply up. Make sure you are washing your hands before handling any pump equipment and bottles and clean your pump according to the directions for your brand. Have a healthy caregiver feed your baby when possible, making sure they thoroughly wash their hands for at least 20 seconds before handling bottles.
For more information and guidance for multiple scenarios, visit the CDC website
Build your support team and have a plan in place for emergencies. Your support team can include:
· Friends and family
· Pediatrician & other healthcare providers
· Lactation consultant
· Postpartum doula
We can help you maintain your breastfeeding relationship safely as we now offer virtual support! You don’t have to go through these challenges alone, give us a call.