Breastfeeding - expressing breastmilk

Breastmilk can be expressed by hand or with a manual or electric breast pump. However it is collected, it must be stored correctly to prevent the risk of bacterial growth.

Why mothers express breastmilk#

There are many reasons a mother may choose to express milk, including:

• The baby needs extra breastmilk as a top-up feed after a breastfeed.
• The baby is not feeding well at the breast.
• The mother is returning to paid work and needs the baby to be fed by someone else.
• The mother prefers to give a bottle of breastmilk, or is going to miss a feed.
• Expressing can help increase the mother’s milk supply.
• Expressing can relieve breasts that feel uncomfortably full.

How breastmilk is produced#

Breastmilk is produced and stored inside the breast in tiny sacs called alveoli, and travels to the nipple through milk ducts.

When the baby needs to feed, a let-down reflex is triggered as the nerve endings in the nipple are stimulated, either by the baby sucking or by the mother expressing.

The role of hormones#

When the nipple is stimulated, a signal is sent to the pituitary gland in the brain to release a hormone called oxytocin. Oxytocin causes the milk-filled alveoli to squeeze milk into the ducts, where it travels to the nipple and begins to drip out.

A baby suckling at the breast is the most reliable trigger, but stimulating the breast by hand, combined with breast massage, can also start the let-down.

Between 24 and 72 hours after birth, the breasts feel much fuller. This is known as the milk coming in. By about 7 days, you can expect to produce around 500 ml of breastmilk in a 24-hour period. This increases to about 600 to 700 ml over the following 2 to 3 weeks.

Expressing by hand#

Expressing breastmilk by hand is a cheap and convenient method. Once you master the skill, you can express at any time without buying or hiring special equipment, which (particularly electric pumps) can be expensive. It may take a little practice, but it is worth the effort.

Getting ready#

• Wash your hands thoroughly with soap and water.
• Try to relax, as anxiety can delay the let-down reflex.
• It may help to have your baby close to you, or to keep a photograph nearby and think about your baby.
• Massage your breasts for about a minute with the flat of your hands, working towards each nipple.
• Place a finger and thumb on either side of the nipple at the base, and gently stretch and roll the nipple.

The technique#

Place your thumb above your nipple at the edge of the areola (the darker area around the nipple), about 2 cm from the nipple, with your first finger below. Gently press your breast tissue back towards your chest wall and squeeze.

Drops of breastmilk should soon appear on your nipple. There is no need to slide your fingers towards the nipple while squeezing; the milk will flow when you compress the breast. Squeeze rhythmically, about once per second. The milk will soon begin to flow, sometimes even squirting out.

If your hand becomes tired, switch hands regularly. Once the flow dwindles to a few drops, move to another area of the breast and continue to press and squeeze.

Repeat the technique on each breast. If you express each breast 3 times for 5 minutes, it should take no more than half an hour to express both breasts. Even if you use a pump, it is a good idea to finish the session by hand, as hand expressing is very effective, especially when the breast is less full.

Using a breast pump#

Many mothers prefer a manual or electric breast pump. They find it quicker, and it may help with milk production. Breast pumps can be used from birth in combination with hand expressing. If you are unsure, your midwife or a breastfeeding support worker can help.

A good breast pump should be effective, comfortable, easy to use, economical, and safe, so that it does not damage the nipple or areola or cause muscle strain.

Suggestions for using hand-held and electric pumps:

• Stimulate the let-down reflex by hand first.
• Once the milk is flowing, start using the pump.
• Place the pump shield directly over your nipple, with the nipple centred, and hold it firmly against your breast.
• With a hand pump, rhythmically squeeze and release the handle. With an electric pump, start with low pressure and slowly increase to a comfortable level.
• If it is painful, check that the shield is centred over your nipple and reduce the suction.
• Adjust the suction so that it is comfortable. Excessive suction does not remove extra milk and can cause pain and nipple damage.
• Finish by hand for a few moments to remove as much milk as possible.

Electric pumps#

Hospital-grade electric breast pumps are designed for women whose baby is in a neonatal intensive care unit (NICU), to establish breastfeeding and express very frequently (more than 4 times a day). These can often be hired, and some suppliers ask for a refundable deposit. Smaller electric pumps can be purchased and are suitable for expressing 1 to 2 times a day. Double pump kits allow you to express from both breasts at the same time.

General tips for expressing#

• Give yourself time to learn how to express.
• Do not hesitate to ask for professional help.
• Express as often as you would breastfeed in order to maintain your supply. For example, if your baby feeds 8 times in 24 hours, you need to express at least 8 times.
• Express more often if you need to increase your supply. You can express every 2 hours during the daytime for one or two days.
• If your baby cannot breastfeed and you are trying to establish your supply, express 8 to 10 times over a 24-hour period.
• Express at least once overnight to maintain your supply, as babies normally feed at least once overnight.

Most women use a bottle to give expressed breastmilk, though some choose a cup. Discuss the best feeding method with your child health nurse or doctor.

Avoid supplementary bottles of formula#

Your breasts work on a system of supply and demand. If breastmilk is removed, your body makes more; if milk is left in the breasts, milk production slows.

Storing breastmilk#

Breastmilk must be stored correctly to reduce the chance of bacterial growth:

• Use fresh breastmilk whenever possible.
• Express into clean, sterilised containers. These may be glass, BPA-free plastic, or sealable plastic bags.
• Label each container with the time and date it was expressed.
• Refrigerate the milk within one hour of expressing.
• Store milk at the back of the fridge where it is coolest (4°C (39.2°F) or lower), not in the door, if you will use it within 3 to 5 days.
• Freeze any excess milk if you produce more than your baby needs. Freeze refrigerated milk promptly if you will not use it within a few days.
• Do not top up refrigerated or frozen milk with fresh milk unless the fresh milk has been chilled first.

The shelf life of frozen breastmilk depends on your freezer. If the freezer is inside the fridge, storage time is about 2 weeks. If it is a separate freezer with its own door, storage time is up to 3 months. In a deep freezer (-18°C (-0.4°F) or lower), breastmilk can be stored for 6 to 12 months.

Thawing and heating breastmilk#

Thaw frozen breastmilk by moving it from the freezer to the fridge to thaw slowly over 24 hours. You can also run cold water over the container and gradually increase the water temperature. Do not overheat the milk, as this destroys some nutrients and may burn the baby’s mouth.

Never use the microwave#

Microwaving is a potentially dangerous practice, as it can create hot spots in the milk that may burn your baby’s mouth.

Frozen breastmilk thawed in the fridge (but not heated) lasts 24 hours in the fridge and 4 hours at room temperature, and cannot be refrozen. Breastmilk thawed outside the fridge using warm water lasts 4 hours in the fridge and cannot be refrozen.

Hygiene#

Unwashed hands and unclean pumps or feeding equipment can contaminate breastmilk:

• Wash your hands thoroughly before expressing.
• Make sure all equipment, including the pump and bottles, is clean.
• There is no need to sterilise equipment after every use. Wash thoroughly in hot soapy water, rinse in hot water, air dry, and store in a clean covered container.
• It is best not to share breast pumps.

Key points#

• Breastmilk must be collected and stored correctly to prevent the risk of bacterial growth.
• Hormones play an important role in breastmilk production.
• Express as often as you would breastfeed in order to maintain your supply.
• Express at least once overnight to maintain your supply.
• Never microwave breastmilk, as it can cause hot spots that may burn your baby’s mouth.

Where to get help#