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Tuesday, December 9, 2008

Breast Pumping

A woman I was caring for on the postpartum floor had an enormous amount of anxiety about breastfeeding. She was a first time mom, and just had herself wound so tight about whether breastfeeding was going to be successful or not. And of course, Murphy's Law was in full gear. Her baby would not latch. So we got her started with a breast pump, and I was very excited after a long explanation of how the first time a woman pumps that there may not be a whole lot that comes out but that doesn't mean she has "no milk", blah, blah, blah, to see that she filled the containers! This is such a positive reinforcement for these women, to see that their body has milk and that she is capable of giving sustenance to her baby.

When I was going on about how awesome it was she got so much milk on her first time pumping, she said, "Oh, that wasn't my first time pumping. I've been pumping for weeks."

"What?" I asked, baffled that a woman was breast pumping before she even gave birth.

"Oh, ya...I wanted to see if I had colostrum, so I have been pumping everyday for the last 3 weeks."

Oh, boy. I told her that obviously that is what helped increase her supply, but if she ever had another baby that she'd be hard pressed to find any provider that would encourage breast pumping while pregnant. It can cause premature contractions, or even premature birth, because one of the hormones involved with lactation also stimulated contractions (oxytocin).

"That must be why I always got so crampy when I was doing it," she said. She delivered her baby at 37 weeks, so she started the breast pumping around 34 weeks. Bad idea.


Loving Pecola said...

Ummm then why exactly did she think she would have a problem with breastfeeding? The latching I guess. Wow.

Amy said...

Eh, I nursed my oldest all through my pregnancy and for 9 months after my second was born (19 months age difference between them). Wouldn't want folks reading you to think that it's not safe to nurse while pregnant. It is. It sucks, though, so don't do it if you can avoid it.

I've been pregnant or nursing since November of 2004, and I'm currently weaning my second, who is now 21 months old. Moo.

Amy @

4daughters said...

Oh my!

Amber said...

I wonder what she did with all that colostrum, that might come in handy with a 37 week baby. I'm not even a health care provider and I know about breast pumping while pregnant!!

Labor Nurse said...

Amy, you make a good point, thanks for pointing out it is fine to nurse while pregnant.

In my experience, I have not seen women nurse for their entire pregnancy because the child ends up weaning themselves at some point during the pregnancy. But I know there are women who nurse their newborn and their older child at the same time, and all is fine.

But for a woman to start breast pumping during pregnancy, not a great idea.

Butter said...

I've nursed through pregnancy twice and tandem nursed my first two for 21 months and am tandeming my third and fourth currently. I've never had one wean during pregnancy. I know many, many people who have nursed through pregnancy. Many do not tell health care providers, however, because many do not understand that it is okay and does not cause pre-term labor in 99% of women.

There is a huge difference, though, between nursing through a pregnancy and starting to use a breastpump during a pregnancy. It's kind of like the uterus is just used to what happens when nursing and so ignores it. But when someone starts using a pump after having not nursed for months, the uterus will respond sometimes with preterm labor and such.

Jennylou's Projects said...

I'm another woman who nursed all through her pregnancy. Now I'm tandeming DD (28 months) and DS (12 weeks). She's down to usually one session a day, but she'd probably nurse every time the baby nursed if I'd let her!

womantowomancbe said...

I got pregnant w/my younger son when my older son was 10 m/o, and still nursing. He quit nursing when I was about 3-4 mo pregnant -- I think a combo of pregnancy hormones causing a change in the flavor of milk and a stuffy nose. But I remember when I was in that "hmm, wonder if I'm pregnant" stage, that whenever he nursed, I could feel my uterus having lots of small contractions, but I thought I maybe was noticing it because I was finally wondering if I was pregnant. I was slightly afraid of nursing causing a miscarriage, but not very much so.


Mama to Monkeys said...

I also nursed through my pregnancy. Monkey #1 sure did come in handy when my milk came in and I was super engorged! I never had any issue with preterm contractions, in fact I delivered at about 41 and a half weeks.

evil cake lady said...

I think Butter has the right idea. We do suggest pumping as a way to stimulate labor if a woman is getting close to an induction date, and I was a doula for a couple who used pumping to avoid a pitocin induction at the hospital. 20 min of pumping while being monitored, 40 min of walking, and repeat.

trish said...

I was not under the impression that breast stimulation of any kind during pregnancy is likely to bring on premature labor unless you are actually ready to give birth, or unless you are prone to preterm labor.

When you are nursing during pregnancy, it is common to have crampy sorts of Braxton Hicks contractions, but they are not likely to bring on labor. I'm not aware that there is any difference in the hormonal release you get from actually nursing a child during pregnancy, and the hormonal release you would get from using a pump. How about working and pumping mothers who happen to be pregnant? I've never heard of an LC recommend that a mother stop pumping milk for her previous child during pregnancy.

There might be other issues with a first-time mother pumping before birth. For instance, if she does it erratically, brings in a milk supply, and then fails to pump enough to empty her breasts, she might be more likely to get plugged ducts or mastitis.

I certainly don't think there are any great reasons to recommend that women pump before birth. But the fear of preterm labor just doesn't seem to be supported by any evidence that I have ever heard. Feel free to enlighten me, though, if you have evidence to back up your opinion, though!

trish said...

Ah ha. Found some good evidence-based info on pumping during pregnancy.

I think this backs up my previous comment. Pumping during pregnancy is not likely to bring on labor unless you are right around term and your body is ready to give birth (unless, of course, you have some medical issue that makes you likely to have preterm labor). So in the case you described, really, no harm was done to the woman.

Labor Nurse said...

trish, thanks for your input. I've never heard any provider or LC recommend women start breastpumping during their pregnancy. Nor have I heard any provider stay stop nursing your child when pregnant.

But this woman did have some things where pumping would be a bad idea- and she started at 34 weeks. Even if there were no risk factors for preterm labor, I can't imagine any provider saying "Sure, go ahead and start pumping now!" to a woman who asks. The fact that nipple stimulation and sometime breastpumping is used as a method for induction of labor makes many providers weary of using it just because.

But, perhaps I am wrong.

trish said...

It's not that you are totally wrong. You are right when you say that no one would recommend that a first time mother pump during pregnancy. It's certainly not necessary, and it really doesn't do any particular good. But when we use words such as "Bad idea!" it tends to come across as fear provoking. You are a CNM, so I just think you need to be careful that your words represent the evidence. In my opinion, while the evidence does not suggest that pumping during pregnancy for a first time mom is a "good idea", it's not really a "bad idea"either. It's simply not necessary. Too many women are led to believe that breast stimulation during pregnancy is dangerous, and many many providers are grossly uneducated about the evidence behind breastfeeding. I have met more women than I can count on my fingers and toes that have been told to wean during pregnancy, for no evidence or health-based reason. For that reason, I caution you.

Labor Nurse said...

trish, caution taken- thank you.

Drofen said...

Whoah. Really!??