A student in class recently brought up “Power Pumping” as a tactic to help a mom with low supply increase her supply. This sparked a discussion about Power Pumping. Keep reading to learn what Power Pumping is and what evidence exists to support its use.
What is Power Pumping?
There are many definitions on the internet about what Power Pumping is. The one thing that all sites seem to agree on is that Power Pumping is meant to increase milk supply by mimicking cluster feeding. However, the method of doing this varies.
Lansinoh recommends a pattern of pumping and resting of 20 pump: 10 rest: 10 pump: 10 rest: 10 pump once per day 1. Happiest Baby recommends a pattern of 15-20 pump: 10 rest: 10 pump: 10 rest: 10 pump once or twice per day for 3-7 days 2. Ameda recommends pumping and resting continuously over an hour 1-3 times per day with at least an hour between pumping sessions for 3 days to 3 weeks 3.
Why would you recommend Power Pumping?
I asked several students why they would recommend Power Pumping. They responded that they had heard that Power Pumping could increase milk supply. One student said that she had been recommended to Power Pump when she was struggling with supply. While students aren’t necessarily wrong for recommending tactics that were recommended to them, they should never just recommend it without understanding the rationale and the research behind the recommendation.
Why research exists for Power Pumping?
The student mentioned that what she read online says that “82% of women had an increase in supply”. Let’s look at that finding.
The website states, “Dr. Fiona Jardine conducted a study of over 1,700 pumping parents, and in her research, she found that 82% saw an increase in their milk production” 4. This quote is misleading. If you click the link, you’ll be taken to an online article at Today’s Parent giving a little more detail into Dr. Jardine’s study 5. Here you see that of the 1,714 survey respondents, 60% tried power pumping and of those 60%, 82% found it “very effective”.
The first thing we should do is find the original research to understand WHO was surveyed (moms of premies, moms of full term babies, American moms, non-American moms, primips, multips, etc), WHAT exactly was asked in the survey (why moms were pumping, how moms were pumping, what moms were using to pump, etc), HOW exactly power pumping was defined in the study, and WHAT was the definition of “very effective” that was reported by 82% who used power pumping?
Problems With This Data
This research was never published. According to Dr. Jardine’s website, these findings could have been from her research looking at lived experiences of exclusive pumping mothers, which was her PhD research, but the sample size doesn’t match, so not likely. In Dr. Jardine’s list of published papers, no papers match this sample size. Without access to the original research, we are limited with how we can interpret these findings. Without this research being published, we don’t have the benefit of it having been peer reviewed or reviewed by a publisher. When research is not published in a peer reviewed journal, there is no accountability with the data presented.
Take Away
We cannot call this evidence. We cannot use this finding and apply it to our practice and call it evidence-based.
Why other evidence exists for Power Pumping?
Only one published paper about Power Pumping exists. In 2023, Kalathingal et al. randomized 78 mothers of VLBW infants with low milk supply in India to either routine pumping or power pumping 6. The objective of the study was to evaluate the impact on milk supply.
According to Kalathingal et al., “The idea of power pumping originates from the concept of cluster feeding of an infant during growth spurts. The increased feeding frequency at the breast provides increased stimulation for a higher milk production…This mimics an increased demand of milk, leading to a greater prolactin secretion, increased milk production and increased breast- milk supply,” (p. 4). These authors found a significantly higher milk volume on days 6 and 7 for mothers in the power pumping group compared to the routine pumping group.
At first glance, you might read these findings as evidence that power pumping is more effective than routine pumping. However, it is important to dig in deeper to understand exactly WHAT was studied and HOW it was measured to know how to translate these findings into your own practice.
The protocol for the site where this study was conducted is for NICU moms to hand express every 3 hours around the clock and to use a double electric hospital grade pump once per day only. The intervention in this study, power pumping, was described as mothers pumping for one hour in a predefined sequence (20 minutes pumping, 10 minutes rest, 10 minutes pumping, 10 minutes rest, 10 minutes pumping) once per day for 7 days. The control group continued pumping once per day for 15-20 minutes. Pumping volumes were measured for both groups each day for 7 days. The milk volumes were similar between groups for days 1-5. Milk volume for the power pumping group was significantly higher only for days 6 and 7 of the intervention. There were no other significant differences in milk volume (total milk volume during the intervention period, measurement periods after the intervention period, or weight at discharge).
This study showed a significant increase in milk volume in moms who had power pumped for 6 and 7 days compared to moms who were pumping once daily for 15-20 minutes only. However, this does not mean that power pumping is an effective means of increasing milk supply. Pumping only once per day is an unusual protocol for pump dependent mothers. Typically, moms would be encouraged to hand express during the colostrum phase and also pump every 3 hours starting within 6 hours of delivery if possible until Lactogenesis II occurs 7. Once the milk comes in, mothers would continue to pump every 3 hours around the clock and possibly do hands on pumping to facilitate milk output until breastfeeding is established.
Take Away
In this study, simply increasing pumping frequency beyond once per day could have led to the increase in milk volume on days 6 and 7, not necessarily the power pumping routine.
What is the theory behind power pumping?
According to Kalathingal et al., ”The analogy of enhanced secretion of prolactin when the infants cluster feed i.e. suckle frequently at the breast, underlies the principle of power pumping. Increased breast stimulation over a longer duration is expected to enhance milk production,” 6. When I learned about power pumping nearly two decades ago, prolactin stimulation was the rationale that was explained. However, the method I learned was 5 minutes pumping, 5 minutes rest, 5 minutes pumping, 5 minutes rest, 5 minutes pumping.
We do know that babies tend to cluster feed during growth spurts as a way to increase supply. However, the increase may be less related to prolactin and more to frequency and breast emptying. According to Hannan (2023), “Prolactin secretion is highest during the first few months of breastfeeding and then gradually declines. Although prolactin is the major endocrine stimulus for lactation, the rate of milk synthesis does not correlate with circulating concentrations of prolactin. Instead, the rate of milk synthesis in humans is positively associated with the degree of breast emptying during a breastfeeding,” 8.
Take Away
In my own practice, I rarely recommend power pumping as a tactic to increase milk supply. Increasing frequency of feeding and/or pumping AND ensuring breast emptying is more likely to have a positive impact on milk supply than by simply stimulating more frequently.
References
Hallas, A.-L. (2018, October 23). Power pumping: How to increase your milk supply. Lansinoh. https://lansinoh.com/blogs/breastfeeding-pumping/power-pumping-how-to-increase-your-milk-supply
Happiest Baby. (2023, August 8). Power pumping to increase breast milk supply. https://www.happiestbaby.com/blogs/parents/power-pumping
Power pumping: 60 powerful minutes to increase breastmilk supply. Ameda. (2022, September 1). https://www.ameda.com/milk-101/milk-101-article/power-pumping-60-powerful-minutes-to-increase-breastmilk-supply/
Young, T. (2024, March 11). Power pumping to boost Milk Supply. Acelleron Medical Products. https://acelleron.com/blog/power-pumping-to-boost-milk-supply/
If you’re worried about your milk supply, power pumping may be the answer. Today’s Parent. (2023, March 31). https://www.todaysparent.com/baby/breastfeeding/power-pumping/
Curriculum vitae. Fiona M. Jardine. (2023, December 5). https://fionamjardine.com/curriculum-vitae/
NEED CITATION
Kalathingal, T., Manerkar, S., Mondkar, J., Kalamdani, P., Patra, S., Kaur, S., & Khandekar, H. (2023). Comparison of two pumping strategies to improve exclusive breastfeeding at discharge in mothers of VLBW infants with low milk output – a pilot randomized controlled trial. Indian Journal of Pediatrics. https://doi.org/10.1007/s12098-023-04859-4
Hannan, F. M., Elajnaf, T., Vandenberg, L. N., Kennedy, S. H., & Thakker, R. V. (2022). Hormonal regulation of mammary gland development and lactation. Nature Reviews Endocrinology, 19(1), 46–61. https://doi.org/10.1038/s41574-022-00742-y
