Breast Pumping in Clinical Practice: What We’re Still Getting Wrong

Pumping should be simple. But for many mums… it becomes painful, confusing, and ineffective.

In this episode, Katie and Joh unpack what’s really going on when pumping “isn’t working” — and why the answer is rarely what you think.

Episode Summary

Katie and Joh take a deep dive into the reality of pumping, starting with one of the most overlooked issues in lactation support — incorrect flange/shield sizing. They explore why so many women are given the wrong size, how this affects comfort and milk output, and why going smaller, not larger, is often the key to effective stimulation.

The conversation moves into pump types, including hospital-grade pumps, double pumps, and wearable devices — where, for once, Katie and Joh don’t entirely agree. They explore the tension between efficiency and flexibility, and how the “best” pump depends entirely on the individual mother, her circumstances, and her goals.

They also unpack practical strategies to improve pumping outcomes, including timing, vacuum levels, switching between stimulation and expression modes, and why watching milk output can actually reduce it. Joh shares the now well-known “sock over the bottle” technique and the surprising impact of removing visual pressure.

Finally, the episode broadens into the emotional and psychological experience of pumping — from stress, grief, and NICU experiences to the importance of oxytocin and creating a sense of safety. They highlight that pumping is not just mechanical — it is deeply physiological and emotional, and support must reflect that.

In This Episode We Cover

• Why incorrect flange size is one of the biggest barriers to effective pumping

• Why smaller sizes often work better than larger ones

• The difference between hospital-grade pumps and standard pumps

• Wearable pumps vs traditional pumps — and where Katie and Joh differ

• Why pumping should never be painful

• How to set the correct vacuum level based on comfort, not numbers

• Timing: why 15 minutes is often enough

• Switching between stimulation and expression modes

• The “sock over the bottle” method and why watching output reduces milk flow

• Oxytocin and pumping — what actually helps milk release

• Why pumping can carry emotional weight, stress, or grief

• Why a pump session does not reflect total milk supply

• Power pumping — when to use it and when to stop

Want More From Katie and Joh?

Check out our courses for professionals:

Decoding the Suck: Gentle support for babies with sucking difficulties

https://thelatchrevolution.com

Breastfeeding & Lactation: The Fundamentals

https://katiejames.site

Pregnant or a new mum? Find more support from Katie:

The Feeding Couch® – Breastfeeding SOS

https://katiejames.site

Download the FREE 5 Gentle Questions booklet:

https://www.thelatchrevolution.com/gentle-questions

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Katie: @katiejameslactation

Johanna: @milkandmotherhood

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Medical Disclaimer

Disclaimer: The content of this podcast is for educational and informational purposes only. It is not a substitute for personalised medical advice, diagnosis, or treatment. Listeners should always seek the guidance of their own healthcare provider, midwife, or lactation consultant with any questions they may have regarding their own situation or that of their clients. Katie James and Johanna Sargeant do not accept responsibility for any decisions made based on this content.

Keywords

breast pumping, breast pump tips, flange sizing, pumping milk supply, wearable breast pumps, hospital grade pump, milk expression, lactation support, pumping problems, low milk output, oxytocin breastfeeding, power pumping, exclusive pumping, NICU pumping