Brittany’s Guide to Pumping During Residency

A Completely Non-Evidence-Based and Entirely Personal Opinion Driven Tale of Trying to Feed a Baby
Breastmilk During Chief Year of Residency
My sweet Willow was born on May 5, 2019, just before I was going to start my final year of OB/Gyn
residency. This guide started as an idea to serve as my own reminder of how the heck I managed this
whole breastfeeding journey and as a small tool for my co-residents who desire babies in residency. I hope
this can be helpful to people like me who had NO STINKING CLUE about pumping/breastfeeding before
their journey.

Caveats are as follows:

1. All opinions/tips are my own and I will cite absolutely no evidence/data to back them up
2. I will do my best to reserve my comments/opinions about the conditions in my own workplace that did or
did not facilitate a healthy postpartum environment. Some folks may read this guide and think their own
conditions are far superior or inferior such that the advice I provide is completely irrelevant, and that is
okay.
3. I have no endorsements from the products that I will name and provide photos of in this guide, but I am
a financially strained resident so if anyone wants to get my some endorsements I am ALL. ABOUT. IT.
A Note on Exclusive Pumping (EP)

I first used a breast pump when my baby was 1 month old in preparation for returning to work. This was a
lot of trial and error and we did not really reach out for help with pumping schedules, supplies etc. For my
family, exclusive pumping became our reality when my baby was about 4 months old. I was on a rotation at
this time that just was completely incompatible with feeding her at the breast. Before this rotation, I would
breastfeed her in the mornings and in the evenings, but this also became challenging with trying to get
enough sleep to function like a somewhat normal human during my chief year of residency. This guide will
mostly refer to exclusive pumping, though I have the utmost respect, support and admiration for mommas
who maintain a breastfeeding relationship.

A Review of My Favorite Pumping Supplies

(some of which are necessary and others of which are bougie luxuries that I love)

• The Pump
o We are getting really personal here as each individual and their breasts will have an
opinion on what is the best pump. I tried the Medela InStyle and then the Spectra S1
Plus. I am a huge believer in the Spectra (Special shout out to a Midwife friend on L&D
and an MFM Fellow who BOTH donated their Spectras to me!).
§ Why am I a spectra fan? The spectra has a timer, a night-light,
is rechargeable, highly portable, very adjustable as far as speed/strength and
“closed system.”
§ Based on my love affair with Spectra but also the fact that the
hospital I work at has Medela, my pumping equipment is interchangeable
because if I ever forget my Spectra or if (FORBID IT) it were to break, I would
need to use a hospital Medela
o Buying a pump
§ Most insurance companies will allow you to purchase a pump through a
preferred supplier and then it will be mailed to you. I called my insurance
company and this was very easy to arrange. The entire process took about a
month.
o Wearable pumps
§ The Elvie and the Willow are two popular wearable pumps. The main reason I did
not buy these and will not talk about them any further is that I felt I could not
afford them and risk that they would not work well for me. I will say that as a
very busy OB/Gyn resident, I have been able to pump without these “wearable
pumps” very effectively. I will also say that I have been known to tie my Spectra
to my waist and use a pumping shirt (described in another section below) to
make a hands-free-wearable Spectra from time to time at work.
#Iwishthiswasajoke #itworkedgreat
• The pumping shirt/bra
o As an exclusive pumper, my goal is to be the most efficient when it is time to pump. In my
experience, it was completely inefficient to put on a pumping bra. So, I have the Rumina
Pump and Nurse Tank in every color
o How it works: I wear this ever day under my scrubs or under a sweater/jacket. When in my
scrubs, I pull my scrub shirt up, connect the flanges, and then the tank top completely
 holds the flanges in place while I can work on the computer/have my hands totally free.
My scrub top protects my cleavage and acts as a nursing drape so I do not wear one of
these and I feel completely covered because the tank totally covers my stomach. I cannot
describe how crucial this tank has been to my pumping journey and how much time I am
sure I have saved from having to put on other various pumping-wear to try to feel
covered.

Above: Rumina Pump and Nurse Tank. $25 on Amazon

• What you need for your pump
o Charger/plug
§ Consider if you would like an adapter for your car
o Tubing
o Connector/adaptor from tubing to flange
o Flange
§ Sizing: Either have an LC help you or look on the Medela Website for sizing

Both images above are from Medela’s website on flange sizing

§I have 6 of these (3 pairs). I use one pair in the morning, rinse them off and
keep them in the refrigerator to use at home that evening again. I use two for
work and then I have an extra two so if I forget to wash or switch out the others,
I am not scrambling.
o Bottles/something to store milk in
§ I have both 5 oz and 8 oz medela bottles that I pump into. I have 4 of the 8 oz
bottles and then 8 of the 4 oz bottles.
• In reality, the 5 oz bottles hold almost 7 oz. The 8 oz bottles hold
probably close to 10 oz
• I use the 8 oz bottles in the morning given that this is when my supply
is the most robust and the 5 oz bottles at all other times
 § After I pump, I pour milk from the bottles into Lansinoh bags. These bags hold
more volume than the Medela bags and are economical. I buy my bags on
Amazon. I then label the bags with a permanent marker so I can freeze excess
milk. I use about 4 bags per day and the box has 100 bags for $11, so it is
about 1 box per month.
§ I also sometimes keep the milk in the Medela bottles, but the down side of this is
carrying more bottles to work, which I find clunky and the bags are easier to
travel with.
§ Some mommas prefer to use the “Kiinde System.” I will describe it and then talk
about why I did not do this.
• The Kiinde system is a way to pump directly into bags that you then use
to put into a bottle system to feed the baby
• Benefits: Way fewer things to wash so very convenient, the milk is not
being transferred so frequently to other containers so contamination is
minimized, the bags are pretty fancy
• Why I do not use them: I was an oversupplier, so the bags were not big
enough. The bags are expensive. My baby did not like the Kiinde bottle.
I felt like I had more power to put different amounts of milk in a bottle
without the Kiinde Bags
• If you want to try the Kiinde system, go to their website and you get a
free sample pack!

Image above is from Kiinde Website

• Pump Bag
o I am a believer in the cute and expensive Sarah Wells bags. These bags are specially
made for pumping moms. I am especially a believer in the “Pumparoo” Wet/Dry bag. This
bag is waterproof and I would keep my flanges/bottles in this bag during the day in the
refrigerator between pump sessions. Could you use a Ziplock bag for the same purpose?
Probably. I felt like the Pumparoo bag was more durable.
 § A note from the CDC: The CDC recommends cleaning pump parts after each
pump. I did not do this. See below for more.

Image of Pumparoo bag from Sarah Wells Website

• Cleaning Supplies
o The dishwasher. We wash all pump parts in our dishwasher.
o The CDC recommends cleaning all pump parts after each pump. I found this completely
not doable. One alternative would have been to bring enough pump parts to work to
always use new parts. For me, if I pump 3 times at work (conservatively), this would be 6
bottles and 6 flanges. That being said, our baby was full term, healthy, and only was
taking pumped milk when she was older than 6 weeks. This is a personal decision, but
using our dishwasher and rerigerating parts during the day is what worked for us
o Drying the parts
§ I don’t know what it is about this little lawn thing, but it is AMAZING for drying out
pump parts. We have two of them. (Photo below is of Boon Drying Rack on Amazon)

• Baby bottles
o We use Dr. Brown Original 4 oz and 8 oz bottles with Level 1 nipples. We felt that the
level 1 nipples still allowed us to preserve a breastfeeding relationship while still letting
the baby eat without getting frustrated that the flow was slow
o We have 8 of the 4 oz bottles and 4 of the 8 oz bottles. We clean them also in the
dishwasher.
o
Image above from Amazon of Dr. Brown Bottles
o A word of caution: these bottles leak because they are designed to let air escape to
prevent colic. Keep them upright. We found this out the hard way.
o For daycare, we label the bottles with these totally magical labels called “Name Bubbles.”
These labels are dishwasher safe and use a wax pencil to write the date on them, which
many daycares require with breastmilk. We have had these labels now for 6 months and
they are AMAZING. $20 for 16 labels through their website and worth every penny.

Image above from Name Bubbles Website

What is in my workbag in relation to pumping?
• Pump charger
• The pump with attached tubing and bottle connectors
• A “wet bag” with two flanges and two bottles
• A mini-cooler with an ice pack
• Lansinoh bags
• Permanent marker
• Hand sanitizer
• Trail mix
• Dried mangoes
• Gatorade
• Bamboobies reusable nursing pads

What is in an emergency bag that I keep at work?

• Extra charger
• Extra Lansinoh bags
• Extra two Medela bottles and two flanges
• Extra pump tubing
Breastfeeding at the hospital postpartum:

• Take advantage of the Lactation Consultation (LC) assistance

o Have their number next to your bed!
o Be prepared with how to reach someone after you leave the hospital
§ On postpartum day 5, I was in an LC’s office with HORRIFYING nipple pain (silly
latch issue that was easily resolved, praise!) and I was super stressed about
how the make the appointment because I did not think about this ahead of time
• Bring a breastfeeding pillow with you to practice with an LC at the hospital
o I really love “The My Brest Friend Original Nursing Pillow”, which you can purchase on
Amazon for about $30 (see a photo below from Amazon)

o
§ I liked this pillow better than the Boppy because it was firmer for my floppy
newborn, it had a clip so secure it around my waist, it has a mini-pocket to hold
my Gatorade or snacks or dog treats (#guilty)
• Bring home any supplies they will give you for free
o Okay, maybe this is the financially-strained-resident voice here, but there are pumping
kits at many hospitals with bottles, flanges etc and if they are willing to give you one for
free (or more) then take them
An Example Work Day Pumping Schedule

• 4am - 5am: Wake up and pump/direct feed (if I have a 7:30 OR case, I will wake up at 4am for my
first pump of the day)
o Use two new flanges, pump. Rinse off flanges and put in the refrigerator
o Make daycare bottles for baby. We first sent her with four- 4oz Dr. Brown bottles with
Level 1 nipples and then when she was about 6 montsh we sent her with 1-8oz Dr.
Brown bottle and 3-4oz bottles.
• 7am to 8am: Pump after morning rounds or before going to the OR
o rinse equipment and return to fridge
o put milk in bag and refrigerate or bring mini-cooler
• 11am to 12pm: Pump and try to eat something between OR cases
o rinse equipment and return to fridge
o put milk in bags and refrigerate or bring mini-cooler
• 2pm to 3pm: Pump and try to eat something between OR cases
o rinse equipment and return to fridge
o put milk in bags and refrigerate or bring mini-cooler
• 5pm to 6pm: Pump during sign out and before going home (or don’t pump if you will try to direct
feed when home)
o rinse equipment and return to fridge
o put milk in bags and refrigerate or bring mini-cooler

• 8pm to 9pm: Pump before bed or direct feed the baby

How long does it take for me to pump?

• I can feel empty in 10-15 minutes. This is different for every person. I also take what I can get…
so if I can only pump for 7 minutes, I have done that too.

What do I do in the middle of the night?

After I stopped breastfeeding and was exclusively pumping, we kept a cooler in our room with bottles for
the baby overnight. This minimized my husband needing to go up and down the stairs to make bottles
when the baby was fussing. We started to wean her night feedings when she was 6 months old so that she
was not longer eating at all overnight. This is, again, VERY personal as to what will work best for you and
for your family. For us, it worked that my husband would feed her and I would sleep. The other way this
worked was that the baby was used to drinking cold milk. We never warmed her pumped milk and she got
used to it quickly.

Creative ways to modify the above schedule

• Pump while you drive either in the morning on the way to work or on the way home from work. I do
not like doing this because I feel like I am distracted, but it is also a way to double-task.
• If you are concerned about your supply or feel like you cannot make it from 8pm to 4am without
pumping, you can wake up to direct feed your baby or pump in the middle of the night
A word of solidarity to close

The schedule that I just wrote out never actually works out that way. I pump at all times and in all places to
just make it work. Sometimes, I go 10 hours without pumping during the day and then I cry thinking that I
am a bad mom who cannot even stop working to provide for my infant. My mom guilt is heavy and real and
probably my biggest struggle. So, to all you hardworking mommas, let me put a word of solidarity out there
that we are doing the best we can in a situation that does not allow us to be completely present mommas,
doctors, partners and friends. By even attempting to pump this liquid gold for our littles, I think we are such
badasses. We can do this.