Your estimate of how much milk you produce is flawed. You are not just pumping your milk but breastfeeding your baby as well.
Remember that pumping is not the same as breastfeeding. The amount of milk you get from pumping is not the amount you have – it is only the amount you managed to get out by pumping. Your baby will get a lot more milk when breastfeeding directly from you than you can pump out.
Being able to express 20 mls is already very good. If you need more simply express on more occasions and add the milk together. In this respect expressing is like breastfeeding - the more you do it with more milk you will get. Thus if you express six times for 10 minutes you’ll get more milk than it you express once for an hour.
If you are really worried about the amount of milk you have try expressing after every feed for about ten minutes, or for two minutes after the milk stops. Don’t worry if your baby wakes up and asks to fed when you’ve just pumped simply put the baby to the breast, he will be able to get more milk because there is always more milk and this is the quickest way to tell your body to make more.
When you breastfeed directly three things are working together to help the milk leave your body and enter the baby’s body.
- Your hormone levels are raised, especially oxytocin. Oxytocin helps the milk ejection reflex – this is the reflex that squeezes the milk out of the aveoli, the milk producing cells, and pushes it into the ducts which take the milk to your nipple. When you pump or hand express the levels of oxytocin are much lower.
- The baby uses suction to help the milk come out – the pump tries to duplicate this but hand expression doesn’t.
- The baby’s mouth milks the breast with its tongue and jaw movements. Hand expression tries to duplicate this but the pump doesn’t.
On top of this many mothers have difficulty getting the let-down to work well when pumping. It works with no trouble when the baby is breastfeeding directly but doesn't seem to work at all when using the pump.
Many things that don’t matter when breastfeeding directly can affect the quantity when pumping. For example, how tried you feel and how much stress you are under.
You can also encourage the let-down reflex artificially, by looking at your baby, or by having a piece of his clothing next to you.
- Apply a warm wet cloth to your breasts.
- Massage the breasts in small circular motions around the perimeter of the breast.
- Gently stroke your breasts with your fingernails in a downward motion toward the nipple
- Lean forward and gently shake the breasts.
- Gently roll the nipple between your finger and thumb.
It may help to try a hand expression technique called the
Marmet Technique,
http://www.lactationinstitute.org/MANUALEX.html
This is useful because it helps the let-down and so you get more milk.
(Please note that the diagram of the breast anatomy is out of date. Recent research has discovered that the milk reservoirs under the areola (the dark coloured part of the breast near the nipple) do not exist. The method, however, still works.)
Some mothers have found that the pumps are not good at getting the let-down to happen, especially in the first couple of weeks, and so they use hand expression until the let-down and then swap to pumping. You can also use the times at the end of the Marmet Technique, including the massage, stroke and shake but instead of doing the hand expression use the pump.
Remember that your breasts being empty isn’t a problem as this is a signal to your body to make more milk. It is leaving your breasts full of milk that tells your body to stop making the milk.
Best wishes,
SARAH
GeoBaby Forum 
