Expressing - the how, when and where
Most mothers will express their breastmilk for their baby at some time and it is common for mums-to-be to have a breast pump on their baby shower wishlist.
While expression of breastmilk most frequently occurs after baby is born, in certain circumstances such as when a mother has diabetes, hand expression and collection of colostrum before baby is born may also be recommended.
Antenatally expressed colostrum given to the newborn in addition to breastfeeds provides a valuable means of maintaining optimal blood glucose levels in these babies’ early days of life. Mothers expecting twins may also choose to have a little bank of antenatally expressed colostrum ready to ensure both babies receive adequate amounts of this precious resource while the mother’s milk supply is establishing in the early, busy days.
Hand expression is most appropriate in the early days after your baby is born because the quantities of colostrum produced are small. This is nature’s design. Babies have very tiny stomachs and only need to take small quantities of colostrum at each breastfeed. The colostrum is easily digested so feeds need to be frequent and given whenever baby cues to breastfeed. If a pump is used to collect small volumes of colostrum (less than 10mls) most of the precious liquid sticks to the inside of the flange and is difficult to retrieve to give to the baby. Hand expression and collection with a small syringe is the most efficient means of collecting and storing colostrum, however it does take some practice and patience to successfully obtain and deliver it to your grateful newborn.
Some reasons a mother may need to express colostrum and breastmilk include:
- The baby is born premature or unwell, and is unable to breastfeed
- The mother has sore or injured nipples which need a rest from latching baby to feed
- The mother has uncomfortably full or engorged breasts which need to be drained to assist baby to latch and to avoid blocked ducts and mastitis
- The baby needs to stay in hospital but mother has been discharged
- The baby has problems latching or refuses to breastfeed
- The mother needs to leave the baby with a caregiver
How to express
Good hand hygiene is essential when handling the breasts, feeding and expressing equipment.
Your hands are always available so here is how to hand express:
- The Marmet Technique prepares the breast for expression and stimulates the milk ‘letdown’. Massage each breast in a circular motion all the way around – this takes a few seconds. Stroke the breast lightly, passing the fingers gently over the nipple and areola – this just takes a couple more seconds. Gently hold the breast and give it a little shake. That’s it! Your breast is ready to begin hand expression.
Position your index finger and thumb opposite each other on the breast just past the outer edge of the areola as shown in the first diagram. Press directly backwards towards the chest wall as shown in the middle diagram, then close the index finger and thumb towards each other (third diagram), and release. Repeat this action in the same location several times and watch for tiny beads of colostrum to appear from the nipple pores. Collect each drop with a small syringe, drawing it into the barrel of the syringe and it will fall into the chamber if gently tapped. Repeat the collection process for each drop that appears, and continue until all the milk has been expressed from that location of your breast.
Rotate the fingers around the ‘dial’ of the areola to access a number of areas on each breast. Imagine it is like a clock so your finger and thumb are placed at 6 o’clock/12 o’clock; nine o’clock/3 o’clock and so on. Hand expression will be comfortable if the nipple is not rolled or pulled or extended during this expressing motion. Your fingers should not slide over the skin or stretch it during hand expression.
Use the Marmet Technique again before expressing the opposite breast. The Marmet Technique will also be helpful to stimulate letdown if you are expressing using a pump.
Expressing using a breast pump
There are many types of breast pumps available and the choice can be rather daunting – especially if it is dad who has been sent shopping to buy one when an unexpected ‘situation’ has arisen which requires mechanical help. You will need to decide whether to hire or to buy, whether to get a manual pump or an electric pump, single or double, and which brand to choose.
How it is best to pump really depends on why the pump is needed. Is it only needed for occasional use such as collecting breastmilk a few times over a couple of days because you are planning a night out without your baby? If so a manual hand breast pump will probably be adequate for the job.
Are you expressing for a premature baby who will be in hospital for a number of weeks? In this case a good quality electric pump is ideal. Whether to hire a hospital grade electric pump for this purpose or buy a good quality pump will involve some arithmetic to compare the costs and expected timeframe that regular expression of breastmilk will be necessary.
Whichever way the decision process goes, it is essential that the breast pump flange size matches the mother’s nipple, areola and breast size. Many women require a larger size flange than is supplied with the breast pump, so seeking advice from a midwife or lactation consultant about your specific requirements will save money and potentially pain and injury as well.
When to express
Most women find their supply is most plentiful in the first half of the day so collection of ‘surplus’ milk will probably be easiest between the hours of about 5am and midday. I suggest expressing after baby has been breastfed and settled. Mum has a drink and something to eat, then sits down to express. If baby has fed from one breast only, express the opposite breast. If baby has fed from both breasts express from both breasts. How long to express? Continue until the milk flow slows down. Massage the breasts again, and continue pumping or switch to hand expression. Remember frequency of breast drainagewill enhance the volumes of milk produced, rather than the length of time between expressions or how long pumping is continued.
Expressing following a breastfeed will result in collection of rich hindmilk. If you are wanting to collect milk to give to baby as a ‘top up’ to enhance your baby’s ability to settle to sleep, or if your baby has been ‘windy’ and passing explosive greenish poo, increasing the amount of hindmilk baby receives will help slow baby’s gut function and aid settling.
Expressing in the early weeks after your baby is born will not lead to over-fullness or oversupply. Early lactation is driven by the hormonal changes after the birth rather than ‘supply and demand’. Supply and demand (or actually it is the other way around – baby demands – supply increases) dominates the lactation process from a few weeks after the birth and is regulated in response to baby’s changing needs as he grows.
It should also be understood that it is not only the breastmilk volumes which change as baby grows, but also the constituents of the breastmilk produced which constantly change as the baby matures.
Where to express
Hand expression can take place anywhere, anytime that it is needed. If the milk does not need to be collected, hand expressing in the shower or into a hand basin is an easy and effective way of relieving the discomfort of over-full breasts if your baby is not available or ready to breastfeed.
Many workplaces now provide facilities for breastfeeding employees to express in privacy and comfort. The Australian Breastfeeding Association has developed guidelines to assist employers to support mothers to return to work and continue breastfeeding. “Creating a supportive breastfeeding environment can deliver significant cost savings by improving retention rates, encouraging earlier return to work, reducing the need for sick leave & carer’s leave, and reducing recruitment and re-training costs".
Breast milk can be stored in a clean container – in a refrigerator for up to five days at 4°C or lower, and in a freezer for up to six months.
Defrosting/thawing frozen breast milk is best done slowly while refrigerated. If the milk is needed quickly, sit the container in warm water and swirl it frequently as it is thawing. Thawed breastmilk should be used the same day, and any breastmilk left in a bottle which has been fed to the baby should be discarded. Never re-freeze thawed breastmilk.
Warming breast milk – place the bottle in a container of warm water and bring it to lukewarm temperature. Never microwave breastmilk or formula to heat it as this method can heat unevenly and possibly lead to burning your baby’s mouth. Also nutrients may be destroyed if heated above 60 degrees celsius.
Cleaning expressing equipment after each use is important. Parts need to be squeaky clean but do not need to be sterilised/disinfected for a healthy term baby. All parts which have been in contact with milk or skin need to be rinsed using cold water, then washed thoroughly with detergent and hot water and then rinsed with hot water. Store all washed equipment in a clean container with a lid. If the breast pump flange needs to be used more than once while away from home it can be rinsed thoroughly with cold water and placed in a clean snaplock bag or clean plastic tub with a lid until the next use, and washed later when those facilities are available.
Always refrigerate expressed breastmilk as soon as possible, and use a thermal travel pack with frozen blocks when transporting breastmilk. Label all stored breastmilk with the date and time it was collected. Breastmilk storage bags are space-savers in the freezer and easy to thaw ready for baby. Successful expression of colostrum and breastmilk will prove to be a valuable and satisfying skill for you to acquire which can support and enhance your breastfeeding journey.
Note: The views and advice expressed on this blog post are those of the author and are not representative of the Pregnancy Babies & Children's Expo.