Expressing Breastmilk

There are many reasons why you may wish or need to express. Here are just a few:
expressing breastmilk
ABM > Specific need/experience > 10 Expressing breastmilk

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Why express?

– If you are leaving your baby with a carer for an evening out, when working or at college.

– To feed a premature baby and to preserve your milk supply.

– If your baby, toddler or yourself are in hospital.

– For relief if your breasts are engorged or you have sore nipples.

– To increase your supply.

Whatever the reason, expressing, like most things, is easy to do with a little practice. Because expressing happens for different reasons, the details may vary. A counsellor will be able to discuss your particular situation with you.

How should I express?

You can express by hand or use a manual or electric breast pump. There’s a first time for everyone when it comes to expressing and it is a skill to practice, so don’t feel upset or put off if only a few drops come out. Experiment – every mother is different. Whether you choose to express by hand or pump, it’s still a good idea to do a bit of both as a pump only ’sucks’ the breast but hands ’milk’ the breast. The combination will be similar to your baby feeding.

  • Begin by relaxing. Tension may inhibit themilk ejection reflex (also know as the ’letdown’ reflex). The morning is often a good time to try for the first time. Have a warm drink, listen to music, relax your breathing.
  • Warm your breasts, wrapping a warm towel around or express after a shower or bath.
  • Gently massage the breast, towards the areola, for a minute or two.

By Hand:

Stimulate hormone release: Massage your breast in a circular manner. Roll the nipple to optimise oxytocin release.

Identify where you need to put your fingers in order to express your milk: Cup the breast with the palm of your hand. Walk your thumb down your breast (or up from nipple). Stop where you identify a change in texture. Place middle/index finger opposite thumb. Make a ’C’ shape.

Express the milk: Compress the breast tissue over the magic spot. It may help to think: “press back, bring together, press forward”. Release and repeat until milk flow subsides. Rotate the fingers around the areola to express all areas.

By Pump:

Most pumps, whether manual, battery or electric, work on a similar principle of creating a vacuum when the funnel has been placed over the areola. Make sure that the funnel isn’t too small when the nipple is brought into the narrow part of the funnel, as this could damage the nipple. Milk will often not flow immediately. If your baby is not nearby, it can sometimes help if you think about or look at a photo of your baby. Swap breasts frequently unless you are  double pumping. Try only a few minutes on one side and then swap. Experiment with  different lengths of time.

If you are expressing in order to increase supply, shorter, more frequent, pumping sessions are more likely to increase supply than a few long sessions.

Battery and Electric Pumps:

Some women prefer to use a battery or electric pump instead of a manual pump. Instead of you operating the handle the motor does it for you. On most models the suction strength  can be altered as too strong a suction can damage nipples, so find the lowest effective suction rating to suit you. Make sure that the funnel ‘fits’. When the nipple is elongated into the narrow part of the funnel, the funnel should not be too small or too large. Some manufacturers can provide alternative sizes. Once the pump is turned on and the vacuum has been created, milk will be expressed and stored in a collecting bottle attached to the pump. Electric pumps can lose effectiveness over time and may need servicing after heavy use.

Double Pumping:

Double pumping means pumping both breasts at the same time. It will usually increase supply more quickly and will make the pumping session shorter. You could do this with two manual pumps or with a double collection set on the larger electric pumps.

Can I hire a pump?

Only hospital-style electric pumps are available for hire, not manual pumps. They can be hired from pump agents around the country and can be dispatched quickly. Your midwife or health visitor may be able to give you a local contact number. Many breastfeeding counsellors are pump agents or can put you in touch with one in your area or can advise on where to obtain them directly. Pumps can be hired on a short-term or long-term basis depending on your needs: the counsellor or pump agent will be able to advise you. If your baby is in special care then you may be able to obtain a pump from the hospital.

Should I sterilise the equipment?

When storing and expressing breast milk it’s vital that everything that comes into contact with the milk is sterilised on first use. If you are storing for your own, healthy baby, after first sterilising the equipment, it must be sterilised once a week (or more). In between times it can be washed with hot soapy water or put in a dishwasher according to the product instructions. Check your dishwasher manual about putting your particular pump parts in the machine.

How can I store breast milk?

These storage guidelines suitable for a healthy term born baby. Different storage times may be needed for sick infants or donated milk.

  • Room temperature (77ºF/25ºC) for up to 6 hours.
  • In main part of fridge (below 4ºC) up to 5 days.
  • Warmer fridge (5ºC – 10ºC) for 3 days. Fridge thermometers can be bought from kitchen shops.
  • Freezer (approx -18ºC) 6 months.
  • Previously frozen/thawed 12-24 hours in fridge

Refrigerate your milk in a sealed container as soon as possible. Store in small quantities so there is less waste and it’s quicker to thaw or warm. The ABM produces a card with more detailed guidelines on storing and thawing breast milk. Click here to order. It is possible to collect together milk from a number of expressing sessions, but allow each ‘batch’ to cool before adding it to the sealed container.

How do I defrost breast milk?

It is possible to defrost milk in a number of different ways. These include:

  • Placing it in the fridge to defrost slowly.
  • Placing the container in a bowl of warm water and changing the water frequently.
  • Holding the container of milk under cold running water.

Never defrost breast milk in a microwave. It can break down some properties and cause ‘hot spots’ that could burn the baby’s mouth.

Gently shake the milk before use, the fats may have separated.

Using Expressed Breast Milk (EBM)

Depending on age and health, your baby may be fed EBM in a number of different ways: by cup, spoon, beaker, tube, supply line – don’t automatically think ‘bottle’. If you need help with any of these methods contact a breastfeeding counsellor for help. Many mothers do use a bottle but be aware that there are other options and a bottle could lead to breast refusal or confusion with latching at the breast (beakers can be used from around six months). Many babies like EBM to be warmer than fridge temperature. Just take the chill out by running a warm tap over the container.

Any other tips?

  • Express as often as your baby would normally feed, if possible. If you are separated from your baby while expressing, thinking about or looking at a picture of the baby may help.
  • Try expressing from one breast when your baby is feeding from the other. This takes advantage of the natural milk ejection reflex. It’s easier if you are using an automatic pump. Most babies get used to the noise of the motor quickly – nothing stops a hungry baby feeding!
  • When transporting frozen EBM in a cold box be aware that cool blocks can be warmer than your milk so check they are newly frozen and refrozen regularly.
  • Some babies refuse to take milk from a bottle at first. This isn’t unusual. Try to spoon-feed the milk or use a small cup – special ones are available for premature babies. Older babies will often use a beaker or feeder cup.
  • Remember, your baby is the most efficient pump of all! Don’t use your pumping output as a reliable judge for what is going on with your milk supply. Pumping is a skill and, even when mastered, it is not the same process as a baby feeding.

Breast pump agents:

Ardo (pump hire) 01823 336362 — www.ardomedical.co.uk

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