Exclusive pumping with Dr Kelsey Bianca

This week, I’m pleased to be joined by Dr. Kelsey Bianca, an academic researcher and certified lactation counselor from Maryland, USA. Dr. Bianca shares her personal experience with breastfeeding and exclusive pumping, which inspired her PhD thesis - a qualitative study of women who exclusively expressed milk. She discusses her research work involving pumping, the decisions parents face, and her studies on children’s literature about breastfeeding. The conversation delves into practical aspects of exclusive pumping, attitudes of society and statutory protections in the US and UK. Dr. Bianca's insights shed light on the importance of understanding and supporting parents on their exclusive pumping journey.

My picture book on how breastfeeding journeys end, The Story of Jessie’s Milkies, is available from Amazon here -  The Story of Jessie's Milkies. In the UK, you can also buy it from The Children’s Bookshop in Muswell Hill, London. Other book shops and libraries can source a copy from Ingram Spark publishing.

You can also get 10% off my books on supporting breastfeeding beyond six months and supporting the transition from breastfeeding at the Jessica Kingsley press website, that's uk.jkp.com using the code MMPE10 at checkout.

Follow me on Instagram  @emmapickettibclc or find out more on my website www.emmapickettbreastfeedingsupport.com 

Find out more about Dr Bianca on her website https://drkelseybianca.com/

And read her research here https://www.nature.com/articles/s41599-023-01666-2 

This podcast is presented by Emma Pickett IBCLC, and produced by Emily Crosby Media.

Transcript

This transcript is AI generated.

[00:00:00] Emma Pickett: I am Emma Pickett, and I'm a lactation consultant from London. When I first started calling myself makes milk. That was my superpower at the time because I was breastfeeding my own two children, and now I'm helping families on their journey. I want your feeding journey to work for you from the very beginning to the very end.

And I'm big on making sure parents get support at the end too. Join me for conversations on how breastfeeding is amazing and also sometimes really, really hard. We'll look honestly and openly at that process of making milk, and of course, 

[00:00:40] Dr Kelsey Bianca: breastfeeding and chest feeding are a lot more than just making milk.

[00:00:45] Emma Pickett: Thank you very much for joining me for today's episode. I'm excited to be talking to Dr. Kelsey bianca. Kelsey is an academic researcher and a professor of psychology. She's based in Maryland in the USA. She's also a certified lactation counselor, and her research focuses a lot on pumping, so expressing breast milk and the decisions parents make around infant feeding.

She's also done a study on children's literature and breastfeeding, which I'll be excited to talk about, and I'm really happy to be talking to you today. Kelsey, thank you so much for joining me. 

[00:01:16] Dr Kelsey Bianca: Thank you so much for having me. I'm excited to talk with you today. 

[00:01:20] Emma Pickett: It's always super thrilling to meet an academic who's also focused in lactation and, and the world of, of breastfeeding and pumping.

So it's gonna be really great to hear your insight in that area, particularly. So tell me a little bit about what you're doing at the right, at the minute. So you're, you teach as well, don't you? So you teach psychology as an academic, as a professor based in a college, and you also do research. How do you kind of divide your time?

[00:01:43] Dr Kelsey Bianca: Um, the institution I work at is a teaching college, so we are not a four year institution. We're a two year community college in the United States. Okay. Um, so the majority of my time is spent teaching and then I do research sort of on the side as fun little side projects, um, but not a requirement like at other institutions.

[00:02:01] Emma Pickett: Okay. Okay. You say fun little like you're not doing, I looked at the list of all the research you've published and you've done a fair amount considering it's your, your side hustle. So, so very well done. So in this, in the Britain, we don't really have community colleges as such. We have, there are sort of local further education colleges and, and people can do mini courses, but all I know about community colleges is some sort of, um, goodwill hunting.

I think Robin Williams' character worked in a community college. That's all I know. So, so the psychology students that you teach in your college, they're not necessarily anything to do with lactation or, or breastfeeding. You're not, you're not talking about your work in that setting. You're talking sort about general psychology.

[00:02:42] Dr Kelsey Bianca: No, often I do use my studies. So for example, I'm teaching a social psychology course and I use my studies to show, I ask them to do their own research and I like to be able to say, I'm not asking you to do anything I can't do myself. So they're doing smaller projects obviously, but I use, you know, my research articles and I'll even give them.

Samples of my data to show them. I'm not expecting you to do anything. I haven't done myself. So I do bring in my research to the classroom, but yet none of the courses I teach are specifically lactation or breastfeeding. They're more general psychology courses. 

[00:03:14] Emma Pickett: Okay, excellent. So you're bringing it in to influence the future generations, which is, which is good to.

And you're also a certified lactation counselor. Tell me a little bit about, tell me a bit about your history in the world of breastfeeding. Are you a mother yourself? Have you breastfed yourself? What's your story? 

[00:03:28] Dr Kelsey Bianca: Yeah, so my firstborn was born in 2016 and we had a lot of breastfeeding difficulties. Um, I went into it like a lot of new parents thinking it would be easy thinking, it would be natural because that's what I had been told.

So it kind of sounded like something that wouldn't be a problem. And it was, we had a lot of struggles. He was what people call like a lazy eater. He would latch and it was a good latch and then he kind of just lose interest and be lazy. And we ended up triple feeding at one point. It's very interesting actually.

I asked at the time about lip ties or tongue ties. Um, I had multiple lactation professionals look at him. Pediatricians, they said, no, no, no, we don't. See any of that. And now he just turned nine and we're looking at getting braces and some dental work done and he does have a very strong lip tie to the point where it's impacting his orthodontics.

So we actually fell into exclusive pumping because of our breastfeeding struggles. And at the time I had my master's and I was a professor and I thought, there's gotta be research out there, right? That would help me with what's the schedule I should be following, you know, what is most effective, what shouldn't I be doing?

And I found one review article. Um, Johns and colleagues in 2013 did a review article of exclusive expression, and at the time it was around, I think it was around 20 studies were done on the topic, which as someone who was trained in research, was pretty surprising that there really wasn't anything out there.

[00:04:58] Emma Pickett: Yeah, 

[00:04:58] Dr Kelsey Bianca: so when I moved on from my master's to working on my PhD, I went into it knowing I wanted to study exclusive pumping because there was so little research. 

[00:05:07] Emma Pickett: Yeah, I mean, exclusive pumping is something we hear people talking about all the time. I mean, it's a big part of the, the options that parents have.

So it's amazing to hear how, how little is out there about it. I remember when I first started training as a lactation consultant, we talked about Stephanie Case, Moore's book. And, and some of her work around pumping and exclusive, pumping, but there's very, very little information out there, I guess partly because people have individual stories when it comes to their milk supply and, and their structure and their routine.

And we'll talk a bit more about that in more detail, but it can feel very isolating, I think, um, when you are exclusively pumping and, and you don't find a community who's, who's out there helping you feel, um, supported. Can I ask you a little bit more about your, your own personal experience? So, so it's interesting to hear you talk about lip T tie.

So, in the UK we don't really look at lip tie in conjunction with lactation. The NHS, um, will not be dividing a lip tie. Um, the Association of Tongue Tie practitioners in the UK have a statement that we don't feel there's evidence that supports the idea of doing ellipti division in conjunction with lactation.

But dentistry and lip tie is, is definitely recognized. And we do find that as children get older sometimes, um, we'll find that there are pediatric dentists who will divide a lip tie. When you say you fell into exclusive pumping, it makes it sound like it was easy. I'm guessing it, it wasn't easy. Um, tell me a little bit about the, the days when you gave up breastfeeding entirely.

Do you remember making that decision? How did you go about making that decision? 

[00:06:36] Dr Kelsey Bianca: Yeah, so like I said, we thought it would be, you know, natural and easy. So we tried breastfeeding when we were still in the hospital and we came home and wasn't, it just didn't seem to be working. You know, we had lactation professionals come to our house, do home visits, and it was one of those things that was frustrating.

'cause at the time, you know, he'd get a good latch and do a good feed and we do the before and after waits. But then after the lactation consultant left, we would, you know, the rest of the day would be a struggle. So we were doing direct breastfeeding and then after a feed I would pump and then we would feed that, we would add formula.

We were doing that for a couple of weeks, um, and we had a really great pediatrician. She herself was exclusively pumping she because of her demanding hours at her job. So she told us that, and it kind of like sparked something that was like, well, this is an option. At the time before having a baby, I thought it was just formula or breastfeeding.

I didn't really, I knew I'd be pumping a little bit going back to work, but I didn't know that pumping exclusively was really an option. I hadn't thought of that. I hadn't never heard of that. I hadn't ever heard someone talking about that. Because we had a pediatrician who wasn't pushing it on us, but just said, you know, this is what I'm doing.

Just so you know, this is an option. It kind of sparked something and once we went a couple days with exclusive pumping, it was so much easier. He seemed happier. My son, I was, I mean, it is hard. Exclusive pumping is hard. My dissertation I did on exclusive pumping definitely reveals that it's a struggle.

Um, but it seemed to be also an option that worked for us at the time. 

[00:08:06] Emma Pickett: Okay. So it sounds as though making that decision felt like a relief. Yes. You didn't feel as though you were, well, I'm not, I don't wanna put words in your mouth, but it sounds as though you weren't doing a lot of mourning of the loss of your breastfeeding journey because actually you found a solution that worked for you and it and it, and it met you, met your goals and that felt positive rather than negative, which is, which is great to.

Tell me about a practical day. Let's whiz back in a time machine to, to you doing that exclusive pumping. How old is your son when you started exclusive pumping? 

[00:08:34] Dr Kelsey Bianca: About two weeks. We switched from the triple feeding, the trying to breastfeed to just going straight to exclusive pumping. Um, so at that point, from what I found online, which was not, like I said, not research or evidence-based at all, it was people's stories on like Facebook and social media.

People had recommended eight to 12 pumping sessions per day, regardless of what my infant was feeding. So I downloaded an app, and honestly I couldn't tell you what the name of it is now, but there's a bunch of apps out there that allow you to track how many sessions you've had per day, how much time you spent in each session, how much you had pumped.

So I used an app and kind of came up with this mental, you know, every two to three hours I would pump, including overnight. And again, even if he wasn't waking up to feed, I would wake up and pump. And we went with that. And again, I found online this recommendation that you do that for around three months until your milk is regulated, which is, that's a whole nother, you know, yeah.

Topic. Um, and then from there I slowly dropped pumps and then sort of spread out my schedule and we made it to, I stopped pumping when he was 11 months, but I had frozen milk, so he got frozen breast milk up until he was 14 months old. 

[00:09:43] Emma Pickett: Okay. Wow. So pretty much 10 months of exclusive pumping, which is incredible.

Amazing. So I hope you feel incredibly proud of that. And obviously it's not my job to tell you to feel proud, but I hope you do 'cause that's such an amazing achievement. Okay, so thinking about that eight to 12 times, I think you and I can both agree that's an enormous ask of a new parent, especially as someone who's a single parent, for example, or someone who doesn't have a support network or someone who's got other kids.

Very hard to make that work. I can see why people say that because everyone's worried that if you start exclusively pumping at the beginning, you're not gonna get that, that simulation, you're not gonna get those prolactin receptors switching on. You'll be told to almost over pump to make sure that your supply's being switched on.

Just like when a baby's in nicu and we are, we're starting to pump, people are told to get to a thousand milliliters, even though the baby's not gonna need anything like that. Just to, to overdo it, to switch everything on, and then. It's interesting. They pick three months. I'll ask you a bit more about that.

But then after a certain amount of time, you can then start to find what Nancy, more backer calls your magic number. What you, mm-hmm. What you need to do. Because obviously everyone's storage capacity will be different. Some people will need to pump more than other times. How did you pump? Eight to 12 times in 24 hours.

How did you manage that? You had family supporting you, I'm guessing someone's holding your baby. What's your baby's name by the way? 

[00:10:59] Dr Kelsey Bianca: He's Lee. 

[00:11:00] Emma Pickett: Lee. So someone's holding Lee while you're doing all this pumping. What did that look like? 

[00:11:04] Dr Kelsey Bianca: Well, I'm in the US so I went back to work. I had him on December 10th and I went back to work.

Um, like January 15th. Maybe four weeks later I went back to work. At the time, this was in 2016, the wearable pumps were just coming out. So insurance in the US wasn't covering wearable pumps. So my pump was a plug into the wall pump, or I did get an adapter for my car. So for me, a lot of my pumping was either sitting on the couch with my son on like one of those round pillows and kind of playing with him or somehow managing to hold him and feed him while pumping.

Or pumping like in the car on the way to work or on the way home from work or hiding somewhere at work to pump. 

[00:11:47] Emma Pickett: Wow. So you are finding a space in a teaching college to pump in between classes and you've just given birth four or five weeks ago. 

[00:11:56] Dr Kelsey Bianca: Yeah. 

[00:11:57] Emma Pickett: That is pretty astounding to imagine that. So you must have had a whole system of collecting milk and transporting it backwards and forwards.

And, and to tell me a bit about the pump that you were using. I, we obviously aren't here to advertise particular brands, but did you feel good about the pump you, you were using? 

[00:12:13] Dr Kelsey Bianca: Yeah, I had a model pumping style. Okay. Um, kind of the classic of its time. Um, and like I said, I had the adapter, I did have lots of coolers, ice packs, you know, a whole system of keeping things Cool.

Because I'm at a college and they did have a pumping room, but it was pretty far away from the classes I was teaching in. You know, coming and going. At one point I even had a schedule where I taught in the morning and then I taught in the evening. So I was going in the morning and teaching, coming home and then going back out to teach a class.

So a lot of things, and if you forget something like 

[00:12:46] Emma Pickett: house, oh my goodness. So when you get home from work, it's not even a you're home for the rest of the evening type thing. It's, 

[00:12:51] Dr Kelsey Bianca: yeah. One day a week I had that schedule because I wanted to be home with my son. Um, so I took a night class on my schedule so that my husband could come home from work and have our son, and then I would go back out and teach.

[00:13:02] Emma Pickett: Okay. So who, who was looking after him normally? Did he go to a nursery on, on a working day? 

[00:13:08] Dr Kelsey Bianca: Um, I'm very lucky. I have my grandmother watched him up until he was two years old, so he went to her house. Okay, that's lovely. A couple days a week. Yeah. 

[00:13:17] Emma Pickett: Okay. Okay. Gosh, so lots of driving around, lots of car adapters and volumes of milk, and obviously at that age, at four weeks, he's dependent on a huge volume of milk and you are very much presumably worried about blocked ducts and mastitis and pumping output.

But it sounds like it worked. Did you, did you have any wobbles of thinking you weren't making enough milk for. 

[00:13:38] Dr Kelsey Bianca: No, it worked. Um, there was some times when I would drop down, like I would go from, I think the biggest change I saw was when I went from like five pumps a day to four. For me personally, that's when I saw a huge drop, which was a bigger drop than I saw from like eight to seven or seven to six.

Which sometimes makes you anxious that, you know, maybe, maybe you stopped too early, you know, you see a decline for a couple days and you're concerned, is this gonna continue, this decline or is it just sort of everything regulating. Yeah, so sometimes there was anxieties. There was also times when like I would forget, um, I would forget bottles at work or something, you know, I'd have all the pump parts and everything, and the pump itself, and then I'd forget the bottles or there'd be one thing I'd be missing that would get in the way of pumping for that day.

If I was away from home 

[00:14:24] Emma Pickett: and you didn't have any pump, pump fails, you didn't have a moment of not having the right part or a valve failing or anything like that. 

[00:14:31] Dr Kelsey Bianca: One time I forgot a bottle I had, I had two. Bottle. You know, my pump had two bottles that were supposed to connect, and I only remembered one.

So I pumped into a water bottle. I bought a water bottle from a vending machine and dumped it out and pumped into that. So I made that work. I think one time I forgot the adapter, so I just couldn't pump that day. I didn't have the, you know, the connection between the pump and the bottles. 

[00:14:53] Emma Pickett: Okay. Imagine your breaths.

Didn't appreciate that if they were very much, uh, used to pumping. No. So when you were pumping, and I appreciate sometimes it was sort of catching a moment, did you have a kind of routine in sort of a mental preparation? What did, what were you doing during a pumping session to sort of get you the best results?

[00:15:10] Dr Kelsey Bianca: Usually I would either read or watch a television show, a couple, um, couple series of months. I would find a show that was around 20 minutes long per episode, and that gave me something to do. While I was pumping. 

[00:15:22] Emma Pickett: Oh, so do you get, do you get a letdown reflex when you hear the Gilmore Girls theme tune then?

Is that, is there anything that happened? 

[00:15:27] Dr Kelsey Bianca: Something like that? Yeah, 

[00:15:28] Emma Pickett: I saw something online about somebody who was pumping when their husband was gaming. So whenever she hears the PlayStation thing set at start, she always gets the L letdown reflex happening. 

[00:15:38] Dr Kelsey Bianca: I did notice I could not do at work, I could not like respond to emails or do anything work related.

It just, I needed to do something that was relaxing, even if it was reading a book or. Watching something on my phone, I could not work while pumping. I needed that 20 minutes of like relaxation. 

[00:15:54] Emma Pickett: Okay, so you are doing eight to 12 pumping sessions initially when you very first went back and then you're gradually reducing.

How did it feel when you stopped pumping overnight? Was that, did that feel a scary decision to make? Or you, you were feeling pretty positive and that was straightforward. 

[00:16:10] Dr Kelsey Bianca: I am a, my husband will attest to this. I am a person that needs sleep. So it felt amazing to not have to wake up because at one point, um, I think it was probably when I was pumping five or six times a day, one of those was overnight.

So it would be like three or 4:00 AM and that's really hard to wake up. And my son did pretty good sleeping through the night. So there was times I was getting up and he wasn't at all. So it was nice to be able to sleep through the night. I felt like, um, I kinda got myself back in terms of like sleep and feeling normal again.

[00:16:39] Emma Pickett: Yeah. 

[00:16:40] Dr Kelsey Bianca: Yeah, definitely a different version of me. 

[00:16:42] Emma Pickett: I bet. I bet. So. So I'd like to ask you a little bit about sort of the attitudes of other people, if that's okay? Mm-hmm. So one of the things when I've had conversations with exclusively pumping parents before, one thing they've kind of said to me is that they feel sort of torn between two worlds.

The breastfeeding world doesn't quite get it. What do you mean? You started exclusively pumping that early on. Did you work with enough lactation consultants? Did you try hard enough? You know, what were you really looking at? The underlying issues? 'cause come on, you know, most people can breastfeed. And then you've got the other camp people who choose to formula feed, feeling quite judged by your decision to, to express the amount of effort you're putting into not giving your child formula.

What are you saying about formula? Something pretty powerful. What do you say to people who are feeling sort of torn between those two worlds and is that something you felt as well? 

[00:17:26] Dr Kelsey Bianca: Yeah, I think going into it, like I said, I, I kind of thought of it as directly breastfeeding or formula. Even if directly breastfeeding usually involves some form of pumping.

I didn't know about exclusive pumping. And there's other studies that most people who go that route who end up exclusively pumping, they weren't planning on it. They sort of fall into it after maybe an issue with breastfeeding or an illness themselves or their child. Um, so I didn't know about it. And even the way we ask questions of new parents, I think we sort of.

Force those two, you know, breastfeeding or formula. So like I struggled at the pediatrician's office. I did have that one pediatrician who was very understanding and she was pumping herself. But when they ask, are you breastfeeding or formula feeding? It's kind of hard to answer that question because especially if they word it breastfeeding or bottle feeding, because if you're exclusively pumping, you are feeding human milk.

So you're sort of, you are breastfeeding, but you're also using a bottle to do it. So sometimes those questions are really hard to answer and you feel like you're answering something. That should be a very short answer with this very long explanation of, oh, I'm exclusively pumping. So it's kind of both.

So I think even medically we kind of frame it as two options when there is this other third option that many people, I think there's an estimate, it's like around 1.6 million Americans at least are exclusively pumping or pumping the majority of the time. So that's a lot of people. 

[00:18:45] Emma Pickett: Yeah. And did you have any friends or family saying, what are you doing Kelsey, for goodness sake, just use formula?

What were other people saying to you? 

[00:18:52] Dr Kelsey Bianca: I didn't have any negative, you know, attitudes. My family, my husband has been very supportive. And I never really heard anything, but I do know people here, you know, why are you sticking with it for so long? Just get formula, you know? I know people do hear that. I was lucky that I didn't have, you know, those kinds of negative attitudes.

[00:19:11] Emma Pickett: Yeah. 

[00:19:11] Dr Kelsey Bianca: Surrounding it. 

[00:19:12] Emma Pickett: So you talked about how you finished actually pumping and then you moved to going through your freezer stash. Do you remember the day when you gave him his last bag of milk? How did that feel? 

[00:19:21] Dr Kelsey Bianca: Um, I remember the bag, I wrote a little note on it with like a heart, and I wrote the date of my last pump.

Um, I do have a picture. My husband took a picture of me in the nursery, in the rocking chair feeding the last bottle of milk, but it was kind of bittersweet. And I know other people have said similar things, that it's, it's like it the end of one era, the beginning of the next, but it is also, you know, you're sad and you kind of mourn that you're done with that part of.

Your baby's life. 

[00:19:47] Emma Pickett: Yeah. Goodbye to that face of parenting. It's tough, isn't it? However, whatever that looks like. So you were lucky in terms of you didn't get mastitis, you didn't get blocked ducts, you didn't have any kind of breast health problems. 

[00:19:56] Dr Kelsey Bianca: Not with my first, I did with my second, have mastitis twice.

[00:20:01] Emma Pickett: Okay. 

[00:20:02] Dr Kelsey Bianca: Um, 

[00:20:02] Emma Pickett: tell me about your feeding journey with number two. 

[00:20:05] Dr Kelsey Bianca: Um, with number two, he was born in 2020, like three months into COVID. And because I had exclusively pumped my first, I sort of expected my second to be very similar. I think sometimes as parents we have that mentality of like, whatever happened with the first, it's gonna be exactly the same with the second.

And it was not, I tried directly breastfeeding in the hospital with my second just just to see and just for comfort. And he was a champ and he knew exactly what he was doing. So I went into it thinking I would exclusively pump and he breastfed for six months and then we sort of transitioned to more pumping.

Um, but it was a totally different story with him. Also it was COVID time, so a lot of us were home and I had the luxury of being home and teaching from home. So that kind of changed things as well, that we had the time and the leisure and the privilege to do that. 

[00:20:54] Emma Pickett: Okay. Yeah, I was gonna say, how do you manage to directly breastfeed for to six, for six months with going back to work so soon?

But you, in that case, you were at home for a bit longer and you were able to do more direct breastfeeding. 

[00:21:03] Dr Kelsey Bianca: Yes. 

[00:21:03] Emma Pickett: Wow. And when and when you fed your second, did you then. Review back on your first breastfeeding Jo feeding journey in a D in a different way, how did that change how you felt about number one's feeding journey?

[00:21:14] Dr Kelsey Bianca: Yeah, there was definitely that mental comparison and that's what made me, you know, even all these years later, made me wonder about my first, I knew he was born a couple weeks early, like two weeks early, which is not, you know, a huge deal, but jaw, muscles take, they're kind of the last thing to develop. Um, so between that and now knowing he has a lip tie, all of those things and the comparison between my first and second, um, my second is definitely what I thought breastfeeding would look like.

Um, so it's understandable why. With my first, we struggled. Um, but yeah, I do mentally sometimes think of those differences between the two. 

[00:21:47] Emma Pickett: Yeah.

I had love to tell you about my four most recent books. So we've got the story of Jesse's Milky, which is a picture book from two to six year olds that really tells the story of little Jesse and how his breastfeeding journey may come to an end in one of three different ways. Maybe there'll be a new baby sister.

Maybe his mom will need to practice parenthood weaning. Maybe he'll have a self. Weaning ending. It's a book that helps your little people understand that there are lots of different ways breastfeeding journeys might end, that we are there to support them through all of them. And also we sometimes have needs to also on endings, we have supporting the transition from breastfeeding, which is a guide to weaning.

That really talks through how to bring breastfeeding to a close in a way that protects your emotional connection with your child. There are also chapters on different individual situations like weaning an older child when there's still a baby, feeding, weaning in an emergency, weaning in a special needs situation.

Then we have supporting breastfeeding past the first six months and beyond. That's really a companion to sit alongside you as you carry on breastfeeding through babyhood and beyond. What are the common challenges? And how can we overcome them? And let's hear some stories about other people who've had a natural term breastfeeding gym.

Me. Then we have the breast book, which is a puberty guide for nine to 14 year olds. It talks about how breasts grow. It answers common questions. It talks about what breastfeeding is. I talk about bras. I really want to leave a little person feeling confident and well-informed as breasts enter their lives.

So if you want to buy any of those books, I am eternally grateful. If you want to buy one of the supporting books, you can go to the Jessica Kingsley press website. That's uk.jkp.com. Use the code mm p 10 to get 10% off. And if you have read one of those books and you can take a moment to do an online review, I would be incredibly grateful.

It really, really makes a difference. And as you can tell from the fact I'm making this advert, I have no publicity budget. Thank you.

Okay. Let's talk a little bit about your sort of professional hat and and your research at looking at this. What was your first sort of dipping your toe into the area of research with when it comes to pumping? 

[00:24:07] Dr Kelsey Bianca: So, going into my PhD, I already had my master's and I went into my PhD. I knew I wanted to study exclusive pumping.

So my dissertation ended up being a qualitative study, interviewing mothers who are exclusively pumping, and I wanted to look at their experiences, but with a focus on the potential positive. Um, so during my PhD I looked into research. I did a literature review that's now been published looking at women's experiences with exclusive expression.

And a lot of the research focuses on the negative. So like pain, like physical issues or, um, like you mentioned, the mourning of the breastfeeding journey, which does exist, but in my mind as someone who had experience with it, there were the negatives, but there also were the positives, like you mentioned, being proud.

In my dissertation, I actually found of my participants, almost all of them use the word pride or proud to describe their pumping journey. Um, so I wanted to look at that. I wanted to look at, from my perspective, there were positives and I wanted to look at that, to add that to the literature, which seems to be missing that recognition that it's, it's not all bad.

[00:25:07] Emma Pickett: Yeah. How did you find your part? 

[00:25:10] Dr Kelsey Bianca: I used Facebook. Um, I know I listened to one of your podcasts with Joelle Morgan and she also used Facebook. It is a great place to find kind of a hard to reach population who if you were doing like in-person interviews, it would be really difficult to find people. Um, so my participants I found through Facebook groups on exclusive pumping.

[00:25:28] Emma Pickett: Okay. And were they mainly Americans or were, or did you get a mixture of nationalities? 

[00:25:32] Dr Kelsey Bianca: Um, mostly American women. I did have, I think it was either one or two from the uk. Um, which were a really great comparison and interesting perspective on exclusive pumping. Um, the participants from the UK talked about when they had questions, a lot of their answers were coming from people in the US and their pump parts were coming from the us.

Yeah, so they kind of saw pumping as a US. Thing. Actually I use that quote in my dissertation that it's seen as something that's a US thing, um, that they were participating in. 

[00:26:02] Emma Pickett: Yeah, that doesn't surprise me actually, because I dunno how much time you've had to look into what happens in the uk, but it would be rare for someone to go back to work at four weeks in the uk.

That would be unusual. People who have, tend to have much longer maternity leave and, and therefore, hopefully longer time to sort out feeding problems when they do have them. We have lower breastfeeding rates than the states, so people will start formula sooner and are more likely to use formula earlier on.

But yet we don't have lactation consultants. People don't tend to get pediatrician contact unless something's very wrong with their baby or their baby's very unwell. And the access to actual equipment is very different. So we don't tend to have such a wide variety of, of flange sizing. Very recently, we've had more conversations around flange sizing, but it's much more difficult to get the smaller sizes in the states.

That's much more standard. And you do seem to have more of a, what we might call a pumping culture, I think going alongside, um, your working culture. But you've also got protection for pumping in a way we don't have here. Tell me, tell me a bit about the, the law in the UK and the US if you're going back to work and, and the ways that parents' rights are protected.

[00:27:11] Dr Kelsey Bianca: So for larger companies and organizations, I forget the exact number, I think it's like 50 or more employees. Um, companies are required to provide a place for someone to pump that's not a bathroom. They can't just say go to the bathroom. Um, it needs to be a place, usually places use like a storage facility, like somewhere where files are stored or equipment or goods.

Um, and they have to provide a place. The place. Usually, I think the law says that it needs to be somewhere that's secure. Like you need to be able to lock the door so people can't walk in on you. Um, and they need to also provide a place to store your milk like a refrigerator. And they need to provide time to pump, um, within your workday.

Um, but smaller companies don't have to follow that. Um, they can, they can say, no, we can't give you time because of the nature of your job. Or We don't have a space because we're a smaller company. Okay. Um, so there's a lot of loopholes and obviously people don't always adhere to the law, but the law is supposed to protect pumping in the workplace.

[00:28:03] Emma Pickett: And presumably you've got state laws that vary in different places as well as federal law. So it's, you'd sort of, it'll be different in different places, presumably. In the uk we have no requirement to provide pumping breaks by law, the health and safety executive. Talk about, you know, good practice and, um, you know, you'll have recommendations for what's good practice, but you don't have to be given a pumping break.

You don't have to be given a place. Um, none of that exists in the uk. Which is unusual compared to most countries worldwide. We, we have very little, we've got some case law, um, where people have argued that for their own health and safety they should be able to pump. But actually statutory law that says this law is set down already is, is very, very weak in the uk.

Which may be affects what happens in terms of pumping possibly, I dunno. It may be one of the reasons that our, our breastfeeding rates and breast milk feeding rates taper off. Um, I should imagine that that protection makes a difference. And then you also have the ability to buy pumps for your insurance as well, don't you?

Which we do isn't something that exists over here. So you, you mentioned that wearables weren't covered in your early days of parenting. What's the story when you want to buy a pump through your insurance now? 

[00:29:16] Dr Kelsey Bianca: So right now through insurance, usually most insurance companies, they give you sort of like a catalog of pumps that you can choose from.

And right now, because pump technology has advanced and the cost has gone down, there's usually a pretty good selection of choices right now. Like wearables are usually covered by insurance and they're usually pretty good brands, pretty, you know, durable, um, well-known brands. But when I had my first in 2016, I think I only had the option of like four pumps.

Okay. Um, I think just there wasn't as many out there and none of them, like I said, were wearables. Now. Wearables are included. Um, and even just, not even just insurance covered pumps, like if you go to a pharmacy like down the street, they'll have like some of the bigger brands like model, they'll have like flanges extra bottles, um, like the membranes, the parts you might need to replace.

I know that might be a difference. 

[00:30:04] Emma Pickett: Yeah. I have never seen a membrane for a pump. For sale in the, in a pharmacy or a, or a store in the uk People are buying 

[00:30:11] Dr Kelsey Bianca: online? Yeah. We have pharmacies. Or even like, we have those big stores like Target and Walmart. They sell multiple brands where you can just go in and buy pump parts.

[00:30:19] Emma Pickett: Wow. That's in 

[00:30:20] Dr Kelsey Bianca: the store. 

[00:30:20] Emma Pickett: That is interesting to hear. That says a lot. Okay, so you're talking about, um, obviously the, the, the federal protection and the state level protection and people going to work and taking their pumping. But does, does that mean it's always. Accepted. You mentioned that at work you were kind of sometimes finding a little nook and cranny to sometimes pump.

Do you think there is a culture of acceptance for expressing in the states and people feel positive about it? Or is it still sometimes something people struggle with? 

[00:30:48] Dr Kelsey Bianca: I think things are changing. I think more people are talking about it. I think it's becoming something people are more open with, but because pumping usually requires, you know, at least partially undressing, um, I think the privacy aspect does keep it hidden.

That's understandable, right? That people are like, I was pumping in my car outside of work instead of finding somewhere in a building. It was easier. I felt more private just doing it in a parking lot, um, in the backseat of my car. Um, 

[00:31:17] Emma Pickett: did you have something over the windows? I can't imagine That was super relaxing.

[00:31:20] Dr Kelsey Bianca: I had tinted windows in the back, so they were a little bit darker, so it felt a little more private and I would always park somewhere like under a tree where it seemed like nobody else was around. I think things are changing, like people are talking about it, but I think mothers are still doing those things where they're, they're pumping really quick somewhere.

Trying to do it discreetly. I think the wearables help that people can pump. Um, I've seen, I went to a corn maze. This is something, it's a very, I think American thing. We have corn mazes where you, you take your kids and they make a maze in the corn field and you have to go from the start to the finish. I saw him on pumping at a corn maze.

Because the wearables, you can kind of just, you know, put 'em on. As long as you're wearing something big enough on top, you can't really tell. 

[00:31:58] Emma Pickett: Yeah. 

[00:31:58] Dr Kelsey Bianca: So I think that might be changing a little bit, but I do think people are still very private when they're doing it. 

[00:32:03] Emma Pickett: Yeah. Which is, which is fair enough. And I guess it's their right to be.

Just asking a little bit about wearables. One of the things I think that we sometimes see in in the UK is wearables don't necessarily get quite the same quality of pumping or the same results. I think partly because people can't necessarily get different sizes of flanges. I think partly people's brass are too tight and they're squashing breast tissue, and that's not great.

Getting great results. And we do seem to find that some wearables seem to fail and people have to get replacements. And, um, when someone says, oh, I, I want to exclusively pump with a wearable, I sometimes feel a little bit nervous. Do you think that's That's right. To feel a little bit nervous? 

[00:32:43] Dr Kelsey Bianca: Yeah. Um, I had with my first, just the pumping style, that plugin that was really durable, lasted a long time.

It actually lasted, I kept it, I used it with my second, I had that on hand and I used that often at home. Um, but in my dissertation interviews with moms, a lot of them talked about having multiple pumps. So not even just having the one having multiples. Like some people had one at work and at home. Some people had one, if they had like a two story home, they'd have one downstairs and one upstairs.

Oh wow. Just for ease. Some people had one, they'd have like a wearable that they knew wasn't getting the highest quality, you know, it was not as strong and they weren't getting as much as they normally get. But it was something they could wear when they were running around after a toddler. Yes. Needed to get housework done.

Um, so people often talked about needing multiples. Um, and often the wearables not being as good as others was discussed. Um, yeah, I think it's kind of widely known that they might not be as good, but they do serve a purpose. 

[00:33:38] Emma Pickett: Yeah. And actually what you're saying about if someone's got other children, I think that's when a wearable is particularly useful because if you, if you know that, you know, let's say you're doing eight pumping sessions and two of them are not gonna be great, they're gonna be the kind of B minus pumping session.

At least you're gonna make up for that at other times, and that B minus still makes a big difference when it comes to, to, you know, making sure that you've got that stimulation over a 24 hour period. 

[00:33:59] Dr Kelsey Bianca: Yeah. 

[00:33:59] Emma Pickett: Let's talk a little bit more about your subjects. There's, look, there's a huge variety of experiences when it comes to exclusive pumping.

Did you meet anybody who. From birth knew they were going to be exclusively pumping and didn't latch on for a moment. And that was the choice they made from the very beginning. 

[00:34:13] Dr Kelsey Bianca: Yes. So I had 12 participants in my study. One knew from the beginning before giving birth that she wanted to exclusively pump.

Um, I'm not sure that she didn't give the reason, but I know in some of the research people who've had, um, sexual trauma in their past might go into it. Um, and in my case, like with my second I went to it 'cause I just expected. That's what was gonna happen. So some people, especially for like second or third children go into it just because of previous experience.

But I did have one participant who said she knew going into it, that's what she wanted to do. But the others all had originally wanted to directly breastfeed. So they had gone into things thinking that's what they would do. Many had pumps already because they knew they'd be returning to work. 

[00:34:54] Emma Pickett: Okay. 

[00:34:55] Dr Kelsey Bianca: But they did not anticipate exclusively pumping.

[00:34:58] Emma Pickett: Okay. And in terms of sort of the experience that people had, I mean, you talked about you starting with the eight to 12 pumping sessions. What's the kind of range, let's imagine someone's pumping at like four, four or five months, for example. How can those days differ in terms of what that pumping experience might look like?

[00:35:17] Dr Kelsey Bianca: I think for me personally, and also from what I found, people usually get into a groove where. Um, they start to learn what works. Like they'll know when they can pump or can't pump. Like my example of like, I knew I couldn't do work emails when pumping 'cause it just, I was too tense and, um, I needed to do something to relax.

I think people usually, if they've done it from the beginning by four or five months, usually they get into a groove. They have, they have a good schedule. Um, they know what. They need to do. Um, and they kind of have that to go off of. Um, a lot of people talked about at the beginning it was a lot of trial and error and looking things up online.

One participant even talked about how she was kind of fiddling with the pump parts and trying to figure it out. And her husband was like looking things up online at the same time and running out to buy parts after some sessions. And they were kind of figuring it out. But by, you know, four or five, six months, she had a really good groove going and it felt easier 'cause she had figured things out.

[00:36:10] Emma Pickett: Yeah, I'm always a bit worried about people's freezers because you are, the freezer is a precious thing. If someone has a power cut, it's not good news. So presumably people have like backup systems and, and extra freezers and you dash to your mum's freezer if something terrible's happening. It, it must feel quite scary when you're dependent on electricity, essentially.

[00:36:30] Dr Kelsey Bianca: Yes. 

[00:36:31] Emma Pickett: You haven't spoken to anyone who's gone through the experience of having a power cut or, or, you know, being left, homeless or anything like that. 

[00:36:37] Dr Kelsey Bianca: No, but I live in Maryland and we do sometimes get hurricanes or the leftover remnants of a hurricane storm. So we sometimes do lose power for a couple of days, and it is anxiety producing, thinking about a storm is coming, and there is a lot of frequent, um.

Like we have, we have a chest freezer. I know that's an American phenomenon probably, but we have a, we have an appliance that's just a freezer. It's like three by four feet and it's in our basement for excess food. Um, and I would routinely run down multiple times a day if we had a storm just to make sure if the power flickered, it didn't turn off the freezer in the basement.

So I would imagine, especially in places where people's power is less reliable or constantly cuts in and out, I would imagine that would be very anxiety producing, thinking there's a potential for. Your milk supply to just be wiped out and Yeah. Hawed. Yeah. 

[00:37:24] Emma Pickett: And, and the recommendation, um, just to clarify for anyone who's in this position, if the, if your power does go out, you don't open your freezer because they are, they are well insulated.

And if that freezer stays closed, chances are that temperature will stay low enough for a long time. And if you do open your freezer and they're, they are semit thoughted, as long as they are, they still have some ice crystals in. Mm-hmm. They can be rozen. Um, 

[00:37:45] Dr Kelsey Bianca: yeah. 

[00:37:45] Emma Pickett: So you don't have to throw away milk, even if it's a little bit slushy, because it can be, it can be rozen at that point.

Okay, so let's have a think about some of the other people in your study. Was there any story that really surprised you? I mean, you're going into this research as somebody who was, who'd experienced exclusively pumping yourself. What did you learn that you weren't expecting to learn from, from doing that research?

[00:38:05] Dr Kelsey Bianca: Um, one of the big things that stood out to me was of my 12 participants, about four of them were donating their milk. So they talked about how many of them talked about how they went into it, thinking they would directly breastfeed. They ended up kind of. Falling into exclusive pumping and they sort of mourned the loss of direct breastfeeding.

They felt they had kind of these issues of learning something they didn't anticipate they'd need to learn, but that on the other end of things, they could pump and if they had extra milk, they were donating it to milk banks and they felt like they were sort of giving back to other babies. And they said that was something they wouldn't be able to do if they were only directly breastfeeding or formula feeding.

They felt like this feeding method allowed them to do this. And they felt like their milk was sort of benefiting babies beyond their own, which I thought was really interesting. And I didn't expect so many people to be donating their milk when I went into my studies, that really stood out to me. 

[00:38:58] Emma Pickett: Yeah, that's, that's really special.

And the idea about giving to the community and giving back I think is something that really, really will stay with somebody throughout their life that is really special. We often see online American mums with whopping grape freezer sts and having huge volumes. I dunno what else is happening, which means you guys producing so much milk.

I, I suspect you're just very comfortable with the pumping and the pumping process and it's, it's working really well for you. Yeah. And most of the people you spoke to were using non wearable pumps, or was any, anyone, does anyone hand express an exclusively pump, exclusively express? 

[00:39:32] Dr Kelsey Bianca: Um, one participant had a haka, um, that like silicone and attachment, that's, it's not necessarily a pump itself, but she would sometimes use that, like if she felt like she was getting a clog, she would kind of use that.

It wasn't like her main method of collecting milk, but it was a technique. She felt like if she had a clog and she was gonna massage anyway, she might as well attach. That and collect whatever came out. Um, but most participants had multiple pumps. They had like kind of a favorite, um, one they use more often.

One they might use on the go, like a wearable that, like we said, wasn't necessarily the best, but it was something, yeah. Most participants talked about. 

[00:40:07] Emma Pickett: Okay. And then obviously bottle feeding is the other part of this story. We're not just the pumping itself and, and when you're bottle feeding express milk.

As everyone talking about paste bottle feeding, we wanna make sure that babies aren't taking more milk than they necessarily need. 'cause obviously volume is sort of protected and important. What's happening with Tet size? Are people whizzing up through the Tet sizes as babies get older? Or are we keeping on the smaller tets?

What's the sort of bottle feeding experience? 

[00:40:35] Dr Kelsey Bianca: I didn't ask too many questions about the bottles themselves, um, or the feeding of the bottles. Um, a lot of my focus was on maternal experiences, so they're, you know, physically, emotionally, in terms of their social support. Um, but that would really be really interesting and I'm sure we're missing that in the literature about feeding itself.

[00:40:55] Emma Pickett: So after your PhD, what else did you go on to look at? What, tell me about some of your other research. 

[00:41:00] Dr Kelsey Bianca: So in addition to that dissertation with interviews with moms, I did a study looking at children's literature, um, that depicts breastfeeding. It actually started because, um, I was pregnant with my second and we got a bunch of books out from the library about what to expect with a new baby for my son, um, who was four years old.

We wanted, we wanted him to be prepared. It's something we do anytime we like. Go on a trip somewhere, we'll get a book out about that place. Or if something new is happening, we get a book. So we wanted to do that. And I noticed a lot of the pictures with a new baby only showed bottle feeding. They didn't show breastfeed, they didn't talk about breastfeeding, they didn't show it just kind of as like a thing happening in the background of the pictures.

So I started wondering like, are there books that depict. Breastfeeding or like specifically about this, or even just show it in the background as something that's happening. So I did a study that included 50 children's books that had representations of breastfeeding. So some of them, it was intentional.

The book was about. Breastfeeding or weaning. Some of the books just happened to depict it. Some of the books were very animal focused. It was like breastfeeding across different animals. Um, so I did a study basically looking at if breastfeeding exists in these books, what does it look like? And then hopefully that maybe could inform like movie representations or other books, maybe for other populations of people.

So that was a study I did looking at children's books. 

[00:42:22] Emma Pickett: Did anything surprise you about that? What kind of hit you? 

[00:42:25] Dr Kelsey Bianca: Um, I thought it was interesting that there were so many words used to describe breasts or breastfeeding. A lot of the books would use different words, um, and sometimes they would use a word that maybe a family would use and then would like use the actual term breastfeeding.

Um, but it was interesting the language that was used. It was also interesting the number of times breastfeeding was compared to other animals. Also feeding at the breast. Which kind of makes sense for children's literature, right? A lot of times animals are used to describe a concept and children tend to relate to animals.

But I thought that was interesting. There was so many uses of animals to educate children on breastfeeding beyond humans. 

[00:43:02] Emma Pickett: And was anybody expressing or putting breast milk in a bottle? 

[00:43:06] Dr Kelsey Bianca: There was a couple of instances. It seemed very intentional by the authors to give a wide range of feeding illustrations and discussion.

Um, but it was predominantly directly breastfeeding was what was depicted. 

[00:43:21] Emma Pickett: Okay. So thinking about next steps, if obviously you're, you've got your busy teaching schedule, but if I was gonna wave a magic wand and give you a big chunk of time to do more research in this area, where do you think the gaps are when it comes to our understanding of exclusive pumping?

[00:43:37] Dr Kelsey Bianca: One gap is, a lot of research suggests if people are exclusively pumping, they're not likely to ask like a pediatrician or even a lactation professional. They're more likely to go online and use social media. So we know that tends to be the case, but there's not a lot of research on what happens in those spaces, what happens in social media.

So I just finished data collection and analysis on a study looking at Reddit posts in exclusively pumping threads. Um, to look at, you know, what's being discussed, what are people's questions. Um, so I looked at that, but I think we still need more to know. I think if we know what people are talking about in those spaces, we can better educate and inform lactation professionals so they can come armed with the knowledge of what people are asking questions about or need.

In terms of pumping. 

[00:44:24] Emma Pickett: Yeah. One of the people I spoke to in the podcast previously was a mom based in France, who, who found a, a French specialist in, um, in, in, you know, obviously all her resources are in French. What are some of the resources that you found that people really liked? Where do people go to get their information about exclusive pumping?

[00:44:42] Dr Kelsey Bianca: I think all the social media, um, like Facebook, Instagram, Reddit, um, and I know a lot of it seems to have a general theme is that you can get an answer immediately and you can get an answer from multiple people who, like, if you have a question about a certain pump, like, Hey, I turned on my pump and it made this weird noise.

You can ask and get answers from 30 different people pretty quickly that have had something similar and they've, you know, figured out what was going on. I think people are asking in maybe different social media platforms, but the reason they're asking is probably this underlying kind of immediacy and also kind of crowdsourcing people's experiences, which makes sense that that is so useful.

Um, if it's like 3:00 AM and you're trying to get a pump session going and you can't figure out why your pump's not working, it makes sense that that would be helpful. 

[00:45:27] Emma Pickett: Yeah. So if somebody was to reach out to you and say, Hey, Dr. Bianca, I'm thinking about exclusively pumping. Um, I, I heard you were talking about a podcast.

I've come across your research. Where do I begin? Where do I start? What would you want that person to know? 

[00:45:42] Dr Kelsey Bianca: I would say do some research and choose a pump that works. I don't think there's one right pump for everyone. I know some people value the suction level. Some people value the amounts, like some pumps only hold, um, a certain amount.

Like my sister's pregnant and she was looking at the willow and I said, well, it only holds a certain amount and you'd have to empty it. Um, some, so pumps have different pros and cons, and I would look at what do you want to make it work in your life? And it might change, right? It might be something that you might have to buy a new pump after six months 'cause something has changed.

You know, your child has become more mobile and you need to be able to get around more. But I would say choose a pump that seems to align with what you need, knowing there's no right answer. And also knowing things you know, might change. Um, and I would recommend people use social media groups with the caveat that not everything people post is accurate or true and one person's story is not representative.

But I do think those can be helpful, especially for troubleshooting, pumping issues. Um, I think that would be a big recommendation. Um, and also support, like it's helpful to have people on your side that can even do small things like washing bottles. Um, or like we talked about, my grandmother watched my son and she was very pro giving, pumped milk.

Um, so I think having those people on your side can be helpful too, um, for the actual logistics of doing it, but also to have that kind of emotional support. To keep you going. 

[00:47:04] Emma Pickett: Yeah, for sure. Where do you stand on the research around the need to sterilize? So, at the moment in the UK we're sort of saying that things seems to have been shifting slightly.

And actually you don't need to sterilize a pump every day or, um, you know, if someone's in a working environment and you might even just use the same pump again in the next session, in the next day. What, what do you say about cleaning and washing and sterilizing? 

[00:47:26] Dr Kelsey Bianca: I think sterilizing with like high temperature heat isn't always needed.

I think the recommendation in the US is to clean parts and bottles the same way you would clean anything. You'd eat food off of, um, hot soapy water, making sure you're scrubbing it. There is a biofilm that can accumulate on pump parts and bottle. Um, so I know a lot of people will like, throw things in their dishwasher, like they'll throw the bottles in the dishwasher.

Um, but you do actually need to scrub things to get off that biofilm that can sometimes not be taken off by just hot water. 

[00:47:58] Emma Pickett: Okay. 

[00:47:58] Dr Kelsey Bianca: So that would be the recommendation. I know some people use some methods that, um, are not recommended. Like there's, for some exclusive pumpers, people are using the pitcher method like a pitcher.

Where they're, like, for example, throughout the day, they're doing their pumping sessions and they're just adding what they pump to one big container, sometimes open within a refrigerator or sometimes, you know, it's got a closed top that technically is not within milk guidelines, at least in the US because every time you add body temperature milk, you're changing the temperature in that container.

Yeah. So throughout the day it's continually fluctuating, which is not great for mm-hmm. 

[00:48:36] Emma Pickett: Bacterial growth. Yeah. Yeah. So we, we would talk about keeping the, the warm milk cooler separately until it's finally cooled down and, and yeah. Putting it in one big container. Yeah. It's also a risk. 'cause if something was to happen, you've lost all that milk.

[00:48:50] Dr Kelsey Bianca: Yeah. If you drop that picture. 

[00:48:52] Emma Pickett: Yeah. There's a reason why we might keep things in smaller quantities. Uh, yeah. We don't tend to talk about that very much in the states. That's interest, sorry. In the uk. So that, that's interesting. And, and what about the idea about someone's in an office environment and they're not washing the pump in between pumping sessions, they're maybe putting the pump parts in a Ziploc bag, putting in the, in the fridge, putting it in their freezer bag.

Um, is that something that you think that the research supports? 

[00:49:16] Dr Kelsey Bianca: The guidelines right now say that we shouldn't be doing that again. What we say we shouldn't be doing and what we're doing are two different things. Um, but the guidelines are milk shouldn't be changing temperatures. And if you're putting your pump parts in.

You know, you're throwing 'em in a Ziploc bag, you're throwing 'em in a refrigerator and you're gonna use 'em for your next session. It is easier, right? You're not cleaning 'em. But technically, any little bits of milk in those pump parts are going from body temperature to whatever the refrigerator is, and then they're gonna change temperature again when you use them to pump.

So that fluctuation of temperature, again, is concerning. I'm saying that though, as someone who did that method, I would sometimes throw things in a Ziploc bag, throw 'em in the refrigerator, just because I was at work. It's hard to clean things at work. Um, it's just easier sometimes. So I know the guidelines say one thing and I didn't even always follow those guidelines, so, 

[00:50:04] Emma Pickett: yeah, 

[00:50:05] Dr Kelsey Bianca: yeah, 

[00:50:05] Emma Pickett: yeah.

It's, it's tricky, isn't it? 'cause the guidelines, guidelines also say room, you know, milk is fine at room temperature for six hours. It's, you know, if the room is below 21 Celsius, it's fine to sit on the counter for, for six hours. So people are saying, well, my working day, I'm not, you know, it's going in the fridge for some of that time and surely it's okay for six hours if some of that time's in the fridge.

So it feels logical to apply what we know about room temperature, milk to, you know, this, this pumping scenario. But you are saying we can't necessarily extrapolate information from one place to another. 

[00:50:37] Dr Kelsey Bianca: Yeah. And the guidelines are for like a perfect world and in the US at least, it's not a, like, in a perfect world, we wouldn't be going back to work at four weeks.

We wouldn't be, a lot of people are pumping 'cause they just have to, um, because they're going back to work. So yeah, in an ideal world, we could follow the guidelines, but we're not in an ideal world and people are kind of just trying to make it work, um, which is understandable that they wouldn't be following those guidelines.

You know, it's really hard to follow those guidelines if you're pumping in a car on your way to work. 

[00:51:02] Emma Pickett: And if you're pumping eight to 12 times in 24 hours, that's pretty, pretty impossible. I mean, you've gotta be working in a fairly unusual office environment to wash a pump all, you know, four times in a working day, or five times in a working day.

[00:51:13] Dr Kelsey Bianca: Mm-hmm. 

[00:51:13] Emma Pickett: Um, yeah, it's pretty intense. Um. I'm guessing this wasn't the case in your research study, but do you find people who exclusively pumped for a big chunk of time and then maybe return back to breastfeeding later on? Or, I don't want to suggest that, that that should be a goal or that should be something they're aspiring to doing, but is that something that you come across?

[00:51:32] Dr Kelsey Bianca: I haven't seen a lot of research on people who've exclusively pumped and then transitioned into directly breastfeeding. Um, some of the participants in my dissertation study had temporary illnesses. Um, so one of my participants had. I think it was mastitis and thought, okay, I'm just gonna pump 'cause you know, it's too hard and I have too much pain.

I'm just gonna pump for this period of time. And once we get through the mastitis, we'll go back to directly nursing. And then she got mastitis again. She had back to back and. Her time period went from just a couple days to a couple weeks to, it was like a month and a half, and that's when she decided it's been too long.

And she was like, I'm just gonna stick with pumping because that's where we are. And, um, but feeding changes, right? I mean, directly breastfeeding after pumping for a period of time is definitely an option. People who have babies in the NICU often can get to directly nursing after essentially they're exclusively pumping, right?

They're pumping and feeding their baby that milk. So it's definitely possible. Um, there's not a lot of research on it though, unfortunately, for a lot of this pumping stuff. 

[00:52:31] Emma Pickett: What would you say to anyone listening to this who's in the sort of breastfeeding support world, um, about exclusive pumping? What do you think it's important that, that breastfeeding support professionals understand?

[00:52:41] Dr Kelsey Bianca: I think part of what I would advocate for is listening to what people are saying and what they need. Um, I know there's a lot of bad advice. Even when I was in my, you know, journey of breastfeeding somebody, while my pediatrician was saying, yeah, you can exclusively pump, that's a viable option. Somebody else told me, oh, you can't, eventually your milk will dry up if you try and do that.

Um, so I think staying up to date with the research and also listening to people's input. Like I said, choosing a pump really depends on someone's. You know, what their day typically looks like and what their goals are. So I think listening, um, would be a big part of that. 

[00:53:14] Emma Pickett: Yeah. What you're saying about you'll eventually dry up.

I still hear that today in 2026, people saying, oh, exclusive pumping is not a thing. It really works for so few people. Only the lucky for you make it work. Um, that information is definitely still thrown around, I think. 

[00:53:27] Dr Kelsey Bianca: And unfortunately, more people would make it work. If we had more research and more support, it would be, we'd probably hear more about it.

[00:53:34] Emma Pickett: Yeah, I, we need to understand more about the pumps themselves. I mean mm-hmm. It's amazing how often mom says online, oh my god, my pumping output's massively decreased. And someone says, oh, well that's what happens. Your body gets used to it. And actually they just needed a new valve. They just needed, yeah.

You know, the, the motor to be repaired. And it's just because we don't really know pumps very well. I think sometimes that's what lets parents down as well. 

[00:53:54] Dr Kelsey Bianca: Mm-hmm. 

[00:53:55] Emma Pickett: Um, yeah. Not easy. Thank you so much for your time today, Kelsey. I'm incredibly grateful. Is there anything we haven't talked about that you felt we needed to cover?

[00:54:03] Dr Kelsey Bianca: No, it's been wonderful talking with you. Thank you so much. 

[00:54:06] Emma Pickett: Oh no. Great pleasure. Well, very best of luck with the rest of your work in this field and I'd love to hear about your next research study and, uh, what comes next. 'cause what you're doing is incredibly important. This is a group of people that, that really need our support and need all the information we can get.

So thank you very much for all the work you're doing in this area. Really appreciate it. 

[00:54:24] Dr Kelsey Bianca: Thank you.

[00:54:29] Emma Pickett: Thank you for joining me today. You can find me on Instagram at Emma Pickett Ibclc and on Twitter at Makes milk. It would be lovely if you subscribed because that helps other people to know I exist and leaving a review would be great as well. Get in touch if you would like to join me to share your feeding or weaning journey, or if you have any ideas for topics to include in the podcast.

This podcast is produced by the lovely Emily Crosby Media.