Does pumping before birth help milk come in sooner after birth?

Breast Pumping Before Birth and Its Effect on Milk Production

Breast pumping before birth is not recommended as it does not help milk come in sooner after birth and may potentially interfere with the natural process of lactogenesis.

Understanding Lactation Physiology

Lactogenesis (milk production) occurs in two stages:

• Stage I: Begins during pregnancy with breast preparation
• Stage II: Occurs after delivery when milk "comes in" (typically 2-5 days postpartum)

The onset of lactation is primarily triggered by hormonal changes after delivery, specifically the drop in progesterone following placental delivery, rather than by breast stimulation before birth.

Evidence on Pre-Birth Pumping

The American Academy of Pediatrics (AAP) does not recommend routine pumping before birth for healthy pregnancies 1. The AAP guidelines specifically mention that pumping is recommended in special circumstances such as adoption or surrogacy, where advance preparation through hormonal stimulation and breast pumping is needed to establish milk supply 1.

Research on pumping shows:

• A randomized clinical trial found that breast pumping between 24-72 hours after cesarean delivery did not improve milk transfer and may negatively affect breastfeeding duration among first-time mothers 2
• Early pumping is primarily recommended for specific situations such as:
  • Critically ill infants 3
  • Adoption or surrogacy cases 1
  • When there are difficulties with direct breastfeeding

Potential Risks of Pre-Birth Pumping

Pumping before birth carries several potential risks:

• May stimulate uterine contractions prematurely
• Could interfere with the natural hormonal cascade needed for lactation
• May create unnecessary anxiety about milk supply
• Could lead to nipple trauma or discomfort before birth

Recommended Approach for Optimal Milk Production

For optimal milk production after birth:

1. Early initiation of breastfeeding: Begin breastfeeding within the first hour after birth when possible
2. Frequent breastfeeding: Feed 8-12 times per day (every 2-3 hours)
3. Skin-to-skin contact: Practice immediately after birth and frequently thereafter
4. Proper latch and positioning: Ensure effective milk transfer
5. Avoid unnecessary supplementation: Formula supplementation has been associated with increased exclusive formula feeding at discharge 1

When Pumping After Birth Is Beneficial

Pumping after birth is appropriate in specific circumstances:

• When separated from infant (NICU admission, return to work)
• To increase milk supply if concerns arise
• For infants with latch difficulties
• For mothers of preterm infants to establish milk supply

Common Misconceptions and Pitfalls

• Misconception: Pumping before birth will ensure adequate milk supply

  • Reality: Milk production is primarily hormonally driven after birth

• Misconception: Low pumped volumes indicate insufficient milk supply

  • Reality: Pumped volume is not always representative of actual milk production capacity

• Pitfall: Focusing too much on pumped volume rather than infant feeding cues

  • Better approach: Monitor infant weight gain, wet/soiled diapers, and feeding satisfaction

Conclusion

While pumping is an important tool for many breastfeeding mothers after birth, there is no evidence supporting the practice of pumping before birth to help milk come in sooner. Instead, focus on early and frequent breastfeeding immediately after birth, which is the most effective way to establish milk supply.