Expressing means squeezing milk from your breasts, either by hand or using a breast- pump. There are a number of reasons you may find it helpful to express milk:
- To help your baby attach more easily if your breasts are very full (express just a little before you offer the breast to your baby).
- To relieve an uncomfortable breast and clear blocked areas if you feel ‘lumpy’ after your baby has fed.
- To rest a sore nipple and allow it to heal (although if the reasons for sore nipples are addressed – eg positioning , this may not be the best option – be guided by your carer).
- To stimulate your milk supply if you have low supply or if your baby isn’t sucking effectively.
- Because you have to be separated from your baby if you or your little one are unwell or your baby is premature and hospitalized.
- To leave milk for your baby to drink if you leave him with a carer, whether this is an occasional separation or you are returning to work.
Expressing breast milk can seem tedious and it can also fill you with self -doubt as you see the amount and wonder, is this enough? Please don’t worry if you don’t seem to be expressing very much. Whether you use a breast pump or hand-express, your well baby’s sucking action will be far more effective at taking milk from your breasts – he will almost always get more milk feeding directly from the breast than you will when you express.
If your baby isn’t an effective feeder yet, the quantity you express is less important than the stimulation of regular expressing to increase and/or maintain your milk supply. If you need to boost your milk supply, see our free ebook ‘Making More Mummy Milk, Naturally’ and also consult a breastfeeding counsellor or an IBCLC lactation consultant. Breast pumps are useful if you need to express longer term – a good electric breast pump will stimulate and maintain your milk supply more efficiently over time if you have a premature or sick baby or are returning to work.
However, learning to express by hand is useful for all breastfeeding women and, if you choose to express colostrum ante-natally or you need to express in the first few days after birth, you will need to express by hand (otherwise the small amount of colostrum (first milk) will be ‘lost’ as it sticks to the tubes of a breast pump).
In my lactation practice, I have found the most effective way to express breast milk, if you need to do this for an extended time, is to use ‘hands-on’ pumping with a double system electric breast pump (that pumps both breasts at once -you can hire these from some pharmacies and the Australian Breastfeeding Association). So I teach mums how to do this, with great results –it can speed up expressing time and boost your supply.
Although it’s commonly thought that an electric pump is the best way to express milk, a Stanford University study (Morton 2009) of mums expressing for premature babies, found that the suction of an electric breast pump could not reliably remove all of the milk from these mums. However, hand massaging and compressing those areas of the breast that felt firm improved milk removal. In this research, mothers were taught to use their hands to express colostrum (early milk) during the first three post partum days. Once milk volume increased, they were instructed to use a technique called ‘hands-on pumping’, using both an electric pump and hand compression as they pumped and massaged firm areas and, after the milk slowed to revert to hand-expressing.
Mothers of babies born before thirty weeks of gestation who hand expressed colostrum more than five times a day in addition to pumping, and then used hands-on pumping for eight weeks, produced an average of almost double the amount of milk than mothers who pumped only. The hands-on mothers were even able to express less frequently, and by eight weeks postpartum, could sleep longer at night. The great thing is that this method of expressing is effective for any mother who wants to express breast milk -you don’t have to have a sick or premature baby to benefit from ‘hands-on pumping. And, by emptying your breasts more effectively you will be giving your body a clear message to make more milk.
Hands-on pumping – how to do it:
- If you are separated from your baby, begin hand-expressing within six hours of birthing your baby.
- If you are exclusively pumping, use a hospital-grade breast pump with a double pump kit (so you are expressing both breasts at once) eight times or more every twenty four hours for a newborn.
- You don’t need to pump on a regular schedule; express whenever it’s convenient perhaps some shorter sessions during the day and a longer one when it’s more convenient such as at night when baby is asleep.
- Make sure the pump flanges (the part that fits over your nipple) are the appropriate size so they are not pinching or hurting.
- A specially designed pumping bra, such as the Arden Bra, will make hands-on pumping simple by holding the pump flanges firmly in place, allowing you to use your hands to massage and compress your breasts as you pump.
- Start with slow massage to stimulate let-down (milk flow). When you massage, pay special attention to the outer areas of your breast – massaging and compressing high up on your breasts (not down near your nipples).
- Apply the breast pump and use the maximum suction level that is comfortable. Not painful. Pumping should never hurt.
- Watch the sprays of milk and adjust your hand position to where milk flows more easily.
- When the sprays of milk subside, switch to single pumping so you can be more vigorous with the massage – using two hands to massage.
- When the sprays of milk subside again, turn off the the pump and hand massage into the pump flange. Some mothers can double their output this way. These later drops will be rich in hind-milk, the highest fat content milk, which is especially beneficial for a premature baby in need of calories.
- Empty your breasts so there are no lumpy areas.
- Watch the Stanford University video – Hands-on Pumping.
If you are finding expressing stressful, it may be easier to ‘power pump’ for short periods during the day then relax and do a longer session at a time when your baby (or other children) are in bed or napping. Lactation consultant Cathy Watson Jenna advises how to do this here.
Storing your breast- milk Guidelines for storing breast-milk may vary slightly depending whether you are expressing for a premature, sick or hospitalized baby or an older, healthy baby. Here is a checklist but if you have an unwell baby, please confirm with your health carers what the specific requirements are for your baby.
- Fresh milk will, of course, have the maximum immunity components – some of these are destroyed by freezing.
- Glass or hard plastic containers are best to store breast milk.
- If you are expressing for a premature baby, store each collection in a separate bottle and label each container with your baby’s name, the date and time of pumping, as well as any medications that you are taking. If you aren’t taking your milk to the hospital within 24 hours, you will need to freeze it.
- If you are expressing to leave an occasional bottle of milk for a healthy full-term or older baby, you can add breast milk to expressed milk in the fridge – but, as breast milk is obviously warm when it is expressed, it needs to be chilled before you add it to previously expressed and chilled milk.
- Do not add freshly expressed milk to milk that has already been frozen.
- Expressed milk for a healthy full-term baby can be stored in the fridge for 3 to 5 days. Keep it at the back of the fridge where it is coldest. Breastmilk can be stored up to two weeks in the freezer compartment inside the fridge, up to three months in a freezer section with a separate door, and for six to twelve months in a deep freeze (-18 degrees or lower).
- Always note the date and time on containers so that you use the oldest milk first. And, as with any other foods that may not be fresh, please remember the motto: ‘if in doubt, throw it out.’ Discard any left-over , previously frozen expressed milk after a feed.
- To thaw frozen milk, place the container in a bowl or jug of warm water, run it under warm tap water or defrost it in the refrigerator overnight. Don’t use the microwave for defrosting or warming –it kills the nutrients in breast milk . And don’t ever save partially drunk portions for later use – throw out any milk that is left in your baby’s bottle.
More info for expressing breastmilk: If you are returning to work and want to continue breastfeeding /expressing while you are separated from your baby, check out Pinky’s blog ‘Breastfeeding and Returning to Work’ for tips on combining working and breastfeeding. Also see Temeaka’s blog , The 100% Express-fed Baby. To make pumping easier, whether you want to ‘double pump’ hands free or whether you find it easier to pump one breast while your baby feeds from the other side, check out the beautiful Arden Bra – a combined nursing and pumping bra, that you don’t have to change out of to pump. If you are expressing for a baby in hospital or you are working and breastfeeding, throw some Boobie Bikkies in your bag so you have a nutritious , milk boosting snack to sustain you.