Expressing your milk

This article on expressing your milk provides information on expressing,  storing your breast milk, and how to fit it in around breastfeeding.

How can I express and store breast milk?

If you are considering expressing breast milk and feeding it to baby in a bottle, the best advice would be to establish breastfeeding first — for most women it takes 3-6 weeks to feel really at ease with breast feeding. After that time you may have more success with expressing, although it varies greatly from person to person — for some mums the milk just gushes out, for others they may find it difficult to get 50-100 mls, despite breastfeeding extremely well.

Just see how it goes…

If you are expressing milk because your baby is premature, the staff in the special care baby unit will support you and help you to use their equipment, to give you baby the best possible nutrition for their start in life. No formula can provide the natural immunity and protection from allergies that your breast milk can provide for your new baby.

What equipment or gear will I need at home?

• If your baby will be mainly breastfed, but you are expressing a small amount of milk because of a temporary feeding problem, it is advisable to not introduce an artificial teat. Babies can be cup fed, or drip fed with a syringe – ask your midwife for advice.

• If you will be expressing regularly because you will be separated from the baby (for example, you are going back to work), then you may choose to use bottles and teats. Two or three bottles will get you started. Start with standard newborn teats, which have one hole, as most babies will manage just fine with these. Alternatively you could buy multiple flow teats which have three speeds, so they suit babies of different stages.

• Sterilizer- there are many options available (chemical, electric, microwave) and we have further information on these in our article Sterilizers.

• Fridge to store milk if you are expressing for later in the day (or 3-5 days ahead)

• Freezer to store milk if you are expressing for a later date (up to 3-6 months, depending upon the freezer).

• Method of warming milk to correct temperature — you can stand the bottle in a jug of hot water or use a bottle warmer. Be cautious about using a microwave as these distribute heat unevenly and can scald baby’s mouth.

• A hand pump or electric pump, if you are not going to hand express.

Hand expressing is the simplest and most comfortable method — your midwife or Plunket nurse will be able to show you this method. It requires no special equipment — simply sterilise a container such as a small plastic bowl to collect the milk and then transfer the milk into a sterilized bottle or bag if you are freezing it.

Hand expressing – a skill every new mother should be taught

• Wash your hands
• Get a clean bowl or receptacle
• Gently massage breasts, including areola and nipple
• Place index finger and thumb on opposite sides of nipple (about one inch from base of nipple, usually this will be on the edge of the areola)
• Push thumb and finger gently back towards breast wall then either squeeze gently or roll thumb and finger – without shifting their position on the breast
• It may take a minute or so for the Milk Ejection Reflex to ‘let down’ the milk, then it should flow freely for a few minutes.
• Repeat on the other breast if necessary.

Breast pumps

There are many different electric and manual hand pumps on the market- all baby shops would have a range for you to look at. Alternatively you could borrow one from a friend, or hire one to see how you get on. Organisations such as La Leche League or Parents Centre, which promote breast feeding, often own electric pumps which they hire out at reduced rates. This is a much cheaper option than buying equipment which you may hardly use.

Storage of expressed breast milk

How do I go about expressing breast milk?

Firstly have a wee, sit comfortably and have a glass of water to hand.

Sterilize all equipment that will come into contact with your milk. For options on sterilizing equipment, visit our Kiwi Families article Sterilizers.

If you are hand expressing, be sure to be shown this first by your midwife or Plunket nurse, or you could make yourself sore.

Alternatively, set up your pump if you are using one (have a practice run at putting all the bits together- don’t do this when you’re in a hurry- as all the wee bits need to fit together correctly to create the suction).

When you first express the milk you may find that the flow is very slow initially. When the ‘let down’ reflex occurs the milk will flow more steadily. This is a hormone reflex which causes the milk ducts to express milk, normally triggered by the infant sucking- it feels like a tingling sensation, similar to pins and needles. The let down can be helped along by thinking about your baby, looking at a photo if baby isn’t there and another helpful tip for expressing is to breastfeed baby on one side and to express on the other side- at the same time (if you are an octopus!) or straight afterwards, while the milk is still flowing. After a few minutes the milk flow will slow down, this is a normal part of the let down process.

When you express your milk you will notice that it appears grey/ white initially- this is fore milk which satisfies baby’s thirst. As you keep expressing on the same side the milk will become yellowier and thicker- this is hind milk which is loaded with calories and is of higher fat content. So do try to express on each side for a reasonable period of time (10 minutes or so), to ensure that the milk you collect has good calorific value.

So now you have your milk- every drop will seem very precious to you- and it either needs to go straight in to the back of the fridge, where it is coolest (4ºc) if the baby is to have it within the next 3-5 days, or into the freezer if it is for a later date. It can be safely stored in sealed bags for up to 3-6 months. (See table above). Pop the date on the bag if you are planning to build up a store of breast milk.

The safest way to defrost the milk is to transfer it into the fridge and let it defrost slowly overnight- this way it will not get too warm accidentally. The milk will separate during storage- gently invert the container to re mix it.

Many women successfully express milk when the time comes for them to return to work, or if they need to be separated for their baby for any length of time.

For other women the process can be uncomfortable and unpleasant – hand expressing is usually easier, so it’s worth giving that a go.

Giving expressed milk in a bottle…

• However you are feeding your baby, cuddle them in close and make it a special time to rest with your baby. If people are there to help you, let them run around after your toddler, while you rest and feed your baby.

• When feeding your baby, hold the bottle so that you minimise the amount of air the baby swallows; also prop your baby up slightly so that the milk does not go into their nasal or ear passages, possibly causing infection.

• Most babies will inevitably take in some air during a bottle feed, and will need winding. Pop baby upright over your shoulder, pat and rub their back soothingly after feeds. Some babies also need to be winded mid way through the feed.

What can I do?

• By taking this option you are trying to give your baby the best nutrition while you are not there yourself to feed your baby!

• Be patient- it may take a few attempts to successfully express.

• Try hand expressing as your first option. Your midwife or Plunket nurse will be able to advise you.

• Without going mad and buying every pump on the market, do look at your options and ask to borrow or hire before you buy- but remember that just because you find one particular pump awkward, it does not mean you will not be successful in the end.

• If you drip milk on the other side while you are feeding you could consider collecting this milk in breast shells, which you sterilize and wear inside your bra while you are feeding on the other side. Pop this milk straight into a sterilized ice cube tray and into the freezer. Once frozen, put into a sealed bag and collect milk this way… a few ice cubes make up a small bottle.

• Mixing the baby’s first solids with some expressed breast milk may make the food more appealing and easier digestible for your wee one.

Useful websites & articles

www.lalecheleague.org.nz

This link to La Leche League has a list of local contacts around New Zealand, who promote and support breast feeding.

Breastfeeding Knowledge shares a lot of information on breastfeeding with you, explaining the importance of exclusive breastfeeding.