Breast pump 2018: a year-in-review pseudo-paper

Abstract

I’m going to give up pumping at work in 2019. I can’t wait! It may be a right-off-the-bat thing, or it may take a few weeks, we’ll just have to see. This post is a retrospective of my year-long pumping-at-work experiment.

Motivation

Throughout 2018, I have spent an inordinate amount of my life thinking about breastmilk. My first child Skyler was born in September 2017, so specifically, I’ve been thinking about how to deal with breastmilk when I am away from her and how to ultimately get it safely back to her. I’ve been tracking everything in a Google Sheet all year, and now you get to see the outcome in this pseudo-paper blog post writeup.

Results

Behold: two visualizations from my year of the breast pump!

pumped-total
Figure 1 – All pumped and consumed (bottle-fed) breastmilk in 2018. If it came out of me and went into a bottle or a bag, it’s in this bar graph. Spilled or otherwise discarded milk is not included, and was thankfully negligible.
pumped-weekday
Figure 2 – The same as Figure 1, but only for breastmilk that was consumed during M-F 9am-5pm while I was at work and milk that was pumped for intended consumption in the same workday timeframe. This typically meant the milk was stored in a refrigerator.

A few interesting trends stand out. First, you can pretty clearly see the two instances when I traveled away from Skyler in February and March (once for vacation, and once for work). It’s worth noting that she did consume breastmilk in the late February vacation “gap” in Figure 2, but it was freezer milk, so it doesn’t appear here. There is a corresponding “bump” in Figure 1, which includes all pumped and bottle-consumed milk.

There are regular gaps on weekends and slightly larger ones that correspond to holiday weekends or vacations/trips. On those days, I nursed instead of pumped. Early on, Skyler always wanted more milk than I could pump during the workday (more on this in a bit). You can also see that the quantity of breastmilk consumed and produced gradually decreases with time! Skyler began eating some solids in April, so it’s interesting to see the lag between that introduction and the subsequent milk tapering.

Figure 3 shows the changing quantity of freezer milk over time. The space between the two cumulative distributions represents my freezer stash. Until late June, in addition to pumping milk at work for Skyler to consume the next workday, I was also pumping a few ounces in the morning for the freezer. (Somehow I singlehandedly managed to nurse, change a diaper or two, shower, pump, eat breakfast, put clean clothes on myself and a baby, and keep said baby mostly entertained each weekday morning between 7–9am. My husband was in charge of evenings.)

cumulative-pumped
Figure 3 – Cumulative distribution of frozen breastmilk. The farther apart the lines, the greater my freezer reserve stash.

If I had evening commitments that prevented me from nursing at bedtime, Skyler would have a bottle made from frozen milk and I’d nominally replenish it in a late-night pumping session. In reality, she was always eager to drink a bit more milk from a bottle than I could readily pump. The pre-work pumping sessions from January–July helped make up the deficit.

Figure 3 also shows the two trips I took in February and March, as well as an early summer freezer surplus followed by dwindling supplies that eventually settled into a new, smaller equilibrium. My period returned in early August and does seem to have a small negative effect on milk production, but this short-term effect isn’t readily apparent in any of the Figures. Figure 3 doesn’t show any of the pumping I did prior to January, which was obviously nonzero! I worked hard while Skyler was 1–3 months old (October–December 2017) to build up enough of a freezer stash to support both my return to work and my eventual trips away from her.

Pumping Technique

I use a Spectra S1 breast pump (actually, two of them; one lives at home and the other at work). A “pumping session” consists of taking my pump and peripherals to a private non-bathroom location, attaching a Bravado pumping bra accessory to my nursing bra, ensuring the pair of bottle assemblies are clean and put together correctly (each assembly consists of a flange + duckbill valve + backflow protector + bottle), lining up the flanges on my breasts, connecting both bottle assemblies to the pump with tubes, and applying a bit of heat via microwaved flaxseed pillows or a battery-powered hand warmer.

One set up, I turn the pump on to the initial massage mode for 30 seconds or so before switching to the express mode. Early on, I used it at suction level 2-3 at 46 cycles/second, but more recently I use it at level 4 at 50 cycles/second. I pump for about 20 minutes with occasional hand massaging. Otherwise I am “hands free” and able to do something on my phone or laptop. I always get more milk from my left side than my right. I time the pumping session with the Hatch Baby app.

When I’m done, I disconnect everything, pour the milk into a single bottle (for refrigeration) or bag (for freezing), and put all the dirty parts away. If pumping more than once at work, I refrigerate the dirty parts to use at the next pumping session. The backflow protectors stay with the pump since they don’t contact milk and don’t need washing regularly. Everything else gets washed by hand at the end of the day. Finally, I plug the pump back into an outlet to charge for the next use.

Lessons Learned

You get to experience a lot of extreme scenarios with a new baby. I had no idea if nursing or pumping was going to work for Skyler and me, but I wanted to give it a solid try. She got formula a couple times in the early days (September–October 2017) when my milk was slow to come in, and again during my February trip when the freezer stash ran critically low. We visited lactation consultants several times in 2017, which was essential.

Breastfeeding is learning an entirely new bodily function when you’re more sleep deprived and hormonally unbalanced than you’ve ever been. It’s hard. It’s kind of like you’d never urinated your whole life and now you have to figure out how toilets work on zero sleep, only you love the toilet and it needs your urine to survive and your bladder really doesn’t like being overfull.

Anyway. As if all that weren’t enough, then I went back to work! For me, that happened when Skyler was just over 3 months old, in January. For the next 6 months, I spent three ~20 minute sessions pumping milk at work (and that doesn’t include the setup, teardown, and additional time needed for all the context switching). I used a small windowless telecon room very close to my shared office, and nobody ever barged in on me! One time the lock on the door broke and got stuck in the locked position, so my officemates kindly vacated our office when necessary until it was fixed. My “Pumping in progress / Do not disturb” door sign definitely paid for itself multiple times over.

When Skyler was 9 months old, in June, I switched to pumping twice daily at work, and felt like an almost normal functional human for the first time in ages. It is hard to overstate how restrictive it is to always be planning pumping sessions into your day… around meetings and meals and social events and heaven forfend you ever need to use the bathroom! When she was around 13 months, in October, I went down to once daily, which is once again an order of magnitude less restrictive than before.

Travel

My husband and I took a week-long cruise vacation in February and left Skyler with her grandparents. It was one of the hardest and best possible things we could have done (and I can’t wait to do it again in 2019, but without the non-trivial side quest of bringing breastmilk home!). Exclusively pumping feels very different from nursing or even a combination of nursing and pumping, but it does the job if you’re consistent. You have to be so consistent. I pumped on a catamaran, I pumped in a restaurant, I pumped during a concert. That week away deserves its own writeup, but instead I will point you to the amazing Experiments in Pumping blog, which is all about traveling pumping and getting pumped milk home. We lucked out and nobody cared when we checked a bag containing a soft-sided cooler full of chilled milk and ice in bags. I later learned you are not allowed to check “wet ice” (as opposed to dry ice, which is OK in certain situations). I don’t know what I would have done if that bag hadn’t made it home… best not to think about it.

I also went on one work trip in March without Skyler. I made my pumping needs known and was able to get a hotel room with a refrigerator without much difficulty. The Caltech facility hosting the meeting (the Cahill Center) had a very good lactation room, and I only had to jump through a few hoops to get access to it. Most of the main events were being live-streamed and I really appreciated being able to tune in remotely. I used MilkStork to ship breastmilk home and my work paid for it.

I went on one additional work trip in August, which was a full week (versus just two nights in March). For this trip, I arranged to bring along Skyler and my husband. Skyler’s grandparents opted to come too and babysat for free so my husband could work remotely while I attended the conference. The logistics for this trip were very challenging and we wound up paying over $1000 out of pocket (not counting the cost of Skyler’s grandparents coming along). On hindsight, I would have rather skipped it.

Conclusions

It is worth noting this retrospective only captures part of my breastmilk story with Skyler. Figure 1–3 don’t include the most tumultuous first few months, and they don’t capture any of the nursing we have done throughout her life. She nurses morning and night, presently for about 12 minutes (6 minutes on each breast). In the past, those sessions could easily stretch to 30 minutes or longer. At some point in the year (I believe between July and October), she stopped nursing when I got home from work. As of December, she gets breastmilk three times daily: first thing in the morning around 7:15am, midday before her nap, and around 7:45pm immediately before bed.

Overall, I am very glad my breastfeeding and pumping journey with Skyler has gone as it has. It has been a very positive thing for both of us, despite the incredible time commitment, cost, and complex logistics.

If I had to do it over, I would probably make some small changes, such as which bras to use, insisting on a separate fridge at work, choosing a smaller/more portable secondary pump, or skipping a work trip. But overall I did a lot of research, did my best to listen to my body and to Skyler, avoided mastitis, and felt like I made well-informed choices. I am particularly thankful to have the flexibility, resources, and support to follow through on those choices, and I recognize many birth parents do not. This includes choosing to gradually ramp down my nursing/pumping as Skyler gradually gets more of her nutrition from solid foods past the one year mark. It’s been quite a journey, and we’re both better for it.

Acknowledgements

My husband cleaned all of the bottles, valves, flanges, and miscellaneous “pump parts” the vast majority of the time. He also does most of the cooking and all of the dishes. And he had zero overnight work trips in 2018. Nothing written here would have been possible without him! Skyler is pretty great too; she was born on her due date and I am thankful the difficulties we had with breastfeeding were reasonably standard (though, for the record, that doesn’t mean they were easy). If you have a breastfeeding and/or pumping parent in your life, please tell them how much you appreciate their hard work, whether that work involves parenting, the workplace, or something else.

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