Will power pumping, breast compressions, and hand expression after pumping help you built your supply?

Why and how do women power pump?

Power pumping is often defined as a period of frequent pumping which is designed to mimic baby's cluster feeding. You might hear that power pumping is a good way to increase your supply. You might even hear that power pumping increases your prolactin levels, which increases your breastmilk supply.

This is not a science-based method, and the schedules women receive for power pumping are variable. Sometimes you might hear that you should power pump for an hour, something like 20 minutes pumping, ten minutes rest, ten minutes pumping, ten minutes rest, and a final ten minutes pumping. Sometimes these numbers are shortened to fit into a half hour power pumping session.

Is power pumping effective?

There's no research to show that power-pumping schedules are effective. The science does tell us, however, that levels of prolactin are not related to how much milk a woman can make. If we are pumping, we're not aiming to boost prolactin levels, but to remove milk from the breast so that the breast is stimulated to make more milk.

Things to be aware of when you are advised to power pump

When you do need to use a breast pump, it's best to mimic the irregular, frequent and flexible patterns of a direct breastfeeding baby. That means that you may pump for just ten minutes or so (using a double pump) just as often as you can, at least 12 times in a 24-hour period. Long pumping sessions are a less efficient use of your time, since 60% of milk is transferred in the first two letdowns.

In my experience, giving you a 'prescription' to power pump is likely to worsen the burden of your occupational fatigue. That is, prescribing power pumping can make women even more stressed and tired, without benefits for them and their family!

I think it's much more important that

• You're educated about what frequent and flexible breastfeeding is

• Your breastfeeding support professional is helping you sort out the underlying clinical problems that make you worried about your supply, and

• You know how to substitute frequent and flexible direct breastfeeding with frequent and flexible milk removal, if that becomes necessary.

You can find out about frequent and flexible breastfeeding here.

Do breast compressions help during pumping?

Breast compression during pumping

Compressing your breasts during pumping can result in an obvious increased flow into the collecting bottle during the time you're doing it. However, compressing or massaging your breasts during pumping hasn't been shown to increase the amount of milk collected over a 24 hour period of using your pump, if you have a term baby.

You might also hear it said that breast massage or breast compression increases the fat content of your expressed breast milk. Although there may be some immediate change in fat content in response to breast massage, there is no evidence to suggest that breast massage alters the fat or energy content contained in your milk over time.

Women who have generous breasts, in particular, may find that breast massage and compression during pumping really does seem to help move the milk from different parts of their breasts, which are otherwise subject to some compression from the effects of gravity.

Is there a role for hand expression of milk?

There's no evidence to show that hand expressing after pumping improves your breast milk supply if you have a term baby, although this may be a strategy which improves your milk output if your baby is preterm.

I suggest that you experiment with what works for you, taking into account your baby's needs, what's working for you on any particular day, and what feels most comfortable. You might find you like to hand express your milk sometimes as well as pump. Hand expressing doesn't need to occur directly after pumping. A big study looking at methods of milk expression also came to the same conclusion: it's best for breastfeeding women to do what feels right and most effective in their own unique situation, whether that's pumping or hand expressing or a combination.

Again, the most important thing is to understand what a pattern of frequent and flexible milk removal looks like, and to do that regardless of whether your pumping or hand expressing at that moment in time.

Selected references

Becker GE, Smith HA, Cooney F. Methods of milk expression for lactating women 2016 update. Cochrane Database of Systematic Reviews. 2016:DOI: 10.1002/14651858.CD14006170.pub14651855.