You might feel the urge to start pumping within your first few postpartum weeks, thinking you need to do it to stimulate your supply and establish breastfeeding. “Chances are, you don’t,” says Dr. Laurie Jones, a pediatrician and founder of Dr. MILK (Mothers Interested in Lactation Knowledge). 

Before you whip out that pump, it’s important to understand that doctors and lactation consultants recommend first-month pumping only in specific circumstances.

“You should only pump during these early weeks if this is the only way you can develop a breastfeeding relationship with your baby, which involves both establishing your supply and the baby’s latch,” Dr. Jones says.

That’s because the first seven days of your baby’s life—and the first three days in particular—are critical to getting off to a good start with breastfeeding, Dr. Jones says, and pumping might disrupt or even derail this process. 

Exclusively breastfeeding in the first four weeks is the ideal way to both stimulate your supply and ensure that it’s meeting your baby’s needs, she says. Early pumping and bottle feeding, meanwhile, can lead to accidental oversupply and breast refusal.

In certain first-month situations, however, pumping can play a vital role in establishing supply and breastfeeding. 

Perhaps your baby arrived preterm and is in the NICU, preventing you from direct breastfeeding on a regular schedule (or at all). Maybe your milk is delayed, or your baby has a physical latching constraint such as a tongue tie. Pumping then becomes the best tool to establish a supply, feed your baby breast milk, and hopefully set you and your baby up for future breastfeeding success. 

Here’s what you need to know about how to pump to help establish breastfeeding. 

Why you’re pumping now

Baby in the NICU

Being separated from your baby due to prematurity or illness can be disorienting and even scary. It’s normal to feel a range of emotions. 

When your baby is in the NICU, and a lot of things may feel out of your control, pumping can help you feel good about your contribution to your baby’s development. Even if your baby’s nurses are supplementing your breast milk with formula in a bottle, pumping can help establish your supply while providing your baby with nutrition and antibodies. 

Pumping during this period “may be hard,” Dr. Jones says, because it adds some additional responsibilities. These include sterilizing your pump parts between pumping sessions, and traveling between home and the hospital while your baby is in the NICU. Not to mention worrying about your baby.

“You may be asking, ‘Why am I doing this?’” she says. “Try to remind yourself that this is critical timing to establish your supply.”

As soon as you can (and thereafter), seek as much skin-to-skin contact with your baby as possible, and ask to meet with a lactation consultant to help you and your baby secure a good latch.

Your baby’s latch

When establishing breastfeeding, you might encounter issues that pertain to tongue tie or lip tie, or other physical impediments, such as illness, that make latching and breastfeeding your baby very challenging. Latch issues are particularly prevalent among premature babies in the NICU¹, and pumping and bottle feeding can help you get through the latch-troubleshooting period while establishing and maintaining a supply.

If your baby has a respiratory illness such as the flu, Covid-19, or RSV, your baby may be too weak to breastfeed; pumping and bottle-feeding can also help you get through this period, such that you can resume breastfeeding, once your baby has recovered. The pumped milk itself might also help your baby recover more quickly. 

“Milk will heal [babies] while you’re holding them and feeding them,” Dr. Jones says. “You are the pharmacy.”

Your supply 

Between 30 percent and 40 percent of first-time moms experience a milk delay. This is clinically defined as 72 or more postpartum hours before the production and release of transitional breast milk, which is thinner and whiter in consistency than the initial colostrum breasts release. 

To get things going and establish a supply, you may need to pump. 

“Ideally, you’d continue attempting to directly breastfeed to speed this up, but if it hurts to nurse, or there’s edema [swelling as a result of excess fluid], or you don’t have help, the only pain-free way to get milk out is through hand expression or pumping,” Dr. Jones says.

If your breasts do not feel more full and heavy by the end of your newborn’s third day or the start of the fourth, talk to your doctor or lactation consultant, get your baby weighed, and decide if you need a medical intervention with bottle feeding until your milk comes in.

Your health

It’s not uncommon for you to require medical assistance after delivery for issues such as high blood pressure, a uterine infection, or gallstones. You should have access to a hospital-grade pump, but because all U.S. labor and delivery units have manual pumps, you can ask for one as a backup. 

What to look out for during early pumping 

Oversupply 

If you are pumping to establish breastfeeding, you’ll want to make sure that you don’t develop an oversupply of breast milk. When you have an oversupply, the amount of breast milk you are producing exceeds your baby’s (or babies’) needs. 

Oversupply can put you at risk for engorgement, mastitis, and/or plugged ducts. And because pumping stimulates production, pumping too often leads to oversupply.

If you are experiencing engorgement and are stockpiling pumped milk in your freezer, you probably have an oversupply. It’s time to work on spacing out your pumping sessions a bit more. 

“Feed the baby, not the freezer,” Dr. Jones says. 

Accidental exclusive pumping

When pumping during the first postpartum month, it’s easy to inadvertently slip into exclusive pumping. Your baby may develop a preference for the faster, more consistent flow of the bottle nipple—and refuse to latch. 

If exclusive pumping suits you and your baby, that’s fine. But if your goal is to directly breastfeed, make sure that you’re getting the support you need from a lactation consultant to establish a latch and healthy breastfeeding routine when ready, thus avoiding exclusive pumping.

Undersupply

If you have an undersupply of breast milk—your milk is delayed, your supply isn’t well established, or your baby is underweight or too weak to breastfeed—your physician might encourage you to engage in “triple feeding.” 

The three sequential elements of triple feeding: breastfeed, pump, then bottle-feed, and repeat 8 to 10 times a day, during the daylight hours. This intensive practice helps increase your supply while giving your baby vital nutrients. 

Please note: Our experts caution that triple feeding should be undertaken only with medical guidance, and only for a short period of time, to accomplish specific feeding goals. It's a temporary stopgap measure to get your supply and/or your baby's weight to a healthy, workable level, Dr. Jones says. “It’s not tenable to do this around the clock, or for long periods of time.”

Learning your pump

Dr. Jones advises first-time pump users who need to pump during the first few postpartum days to initially use hospital-grade pumps. Once you’ve established a supply, she says, it’s safe to switch to another type of pump. Just note that even if you went through the exercise of preparing to pump while pregnant and making sure that your flanges fit properly, the fit can change at various intervals, including just after delivery.

If you are an inexperienced pump user, and the fit isn’t going well, Dr. Jones says you should be prepared to remeasure, swap out those flanges, and make whichever adjustments necessary to fully empty your breasts of milk while pumping. “When your baby is 5 days old,” and you are still exclusively pumping, you cannot risk 12 hours of poor emptying,” she says. 

It’s worth noting that most pumps (including Willow's) typically involve a bit of a learning curve to ensure that your flanges fit properly and that you’re fully emptying your breasts— especially if you’re a first-time pumper. 

What about formula

At some point during your baby’s first month of life, if direct breastfeeding is taking a backseat to establishing supply through pumping, your baby might briefly need to supplement your breast milk with formula. (This is often the case with preemies in the NICU.) 

“It can be a medically necessary tool for a baby who’s lost excessive weight in the first five days—and if the milk supply isn’t copious right away,” Dr. Jones says. “It doesn’t, however, rule out direct breastfeeding.”

How do I know when to stop? 

Exclusive pumping is often treated as a temporary intervention to help a newborn get healthy and ready to breastfeed—sometimes for a few days, sometimes for several weeks. Past this point, you can continue pumping while potentially moving toward a more “direct-breastfeeding relationship, and use a professional to help you wean off the pump,” Dr. Jones says. 

You will likely recalibrate your breastfeeding targets at several intervals—and for many moms, the baby’s departure from the NICU, combined with a newfound ability to directly breastfeed, is an important one. While some moms manage to shift to exclusive direct breastfeeding after this early period of exclusive pumping, others shelf their pumps while developing a good breastfeeding rhythm with their baby, then move to a combination of pumping and direct breastfeeding when their little one is 4 to 6 weeks old.