The Art of Expressing Breastmilk

Oct 22 2007

Well the time has come for you to have to go out somewhere other than remaining within the confines of your home and possibly without your baby this will feel either completely daunting, an absolute relief or a strange mixture of both.

So, its time to express this might seem easier said than done.
Don't feel alone in your absolute ignorance of not knowing where to start. You are only just getting the hang of breastfeeding and you've never done this before.
Many women come in to clinics or phone their midwives at various times in the first year trying to learn the ropes of expressing. So here are a few tips to help you unravel the mysteries of expressing. We hope you find them helpful, and pass them on to friends and relations, why struggle when others have gone through the struggle and can pass the info on to you.

First thing would be to find a breast pump, but which one?

Well Some of the favorites would have to be the Medela double, the Medela swing electric or the Avent hand pump. Shop around, ask other women what they would recommend and then decide. You do have the option of buying one or renting.

Note please, these will not feel like your most glamorous moments, but keep reminding yourself that exclusive breast milk is the best food for babies up until 6 months and that might help you through those feel like a dairy cow moments which you might experience, just before getting all dressed up to go out.
Exclusive breastfeeding is best for the first 6 months and there are some ways to exclusively breastfeed your baby and to be able to go out and about:

  1. you can take her with you her with you and feed when ever she needs to, this is probably easiest in the first 6 months,
  2. feed and depart immediately after feed and return when you estimate the next feed will be due-ish
    express and
  3. leave a bottle for the babysitter or grandmother or your partner to feed if a hungry moment suddenly occurred. You will probably still need to express when you get home. Often women end up doing a mixture of all three.

When to express:

You can start expressing when your baby is about a month old, it is possible to do so earlier, but it can sometimes interfere with breasts working out how much they need to produce, which they are always doing but it is particularly noticeable in the first month.

If you are wanting to have the option of bottlefeeding your baby using expressed breastmilk, it is a good idea to offer a bottle within the first 6 weeks, (so between 4-6 weeks is the ideal time) and then to offer a weekly reminder just to help your baby remember that milk can come out of something other than a breast.

Generally it is best to express immediately after a feed. Let the baby have the usual feed and then express the excess off both breasts. Some feeds are better than others, so preferably do this after a feed when the breasts still feel a little full, mornings are often good times.
It is best to express staight after a feed as that gives the breasts time to fill up before the next feed.
When you express, sit down, get comfy and relax. There's no point in trying to hurry, the quicker you relax, the quicker the let down reflex will work and the quicker the milk will be expressed.

How much should I express:

This is not generally something that you can decide, or have much control over. Different women produce different amounts, you will have to wait and see. Some feel concerned at not being able to express large volumes and worry that they are not making enough milk. This is often because some breasts don't make too much extra other than exactly what the baby needs, this might mean that building up a stash of breast milk might take a bit of time, but generally it is still possible.

What if the baby refuses to take the bottle:

It is best to do a trial run yourselves, before leaving the baby with someone else and no back-up if things go pear-shaped.

There are a few ways of marketing the bottle to the baby.
Preferably let someone else do the feeding not yourself (many fathers love feeding babies)
Serve the milk slightly warm or at room temperature, but not too hot
Some little babies feed better when they are still half-asleepy, as long as they are hungry. This might be a good way to persuade a reluctant feeder.
The most important thing if the baby refuses the bottle is not to make an issue of it. Don't keep trying. Give it a break for a few days and try again.
It might be worth trying out another type of bottle to see in the baby prefers that. (Generally Avent or Dr Brown are good brands to start with.)

Expressing Breastmilk and Storage of Breastmilk (Expressed Breast Milk EBM):

  • Ensure that you wash your hands before expressing.
  • The pump must be sterilized before expressing and the milk must be stored in a sterilized container. E.g. plastic bottles, containers or sterile freezer bags designed for storing breast milk.
  • Use fresh breast milk wherever possible. Fresh EBM contains live macrophages / cells which help protect your baby from infections.
  • EBM can be safely kept at room temperature (19-25 degrees) for 6 hours before refrigeration.
  • EBM can be kept in the fridge for 3 days
  • EBM can be frozen for 3 months.
  • Label each container of EBM with the date and time and the volume of milk in each container before storing.
  • In the case of defrosted EBM, it can be kept in the fridge and used within 24 hours.
  • Thawed milk should never be re-frozen.
  • When warming EBM submerge the bottle in running hot water or in a container of hot water or a bottle warmer. Shake well before testing the temperature. Do not boil EBM
  • EBM often separates on standing, the fat and water contents separating to form layers. Merely shake the bottle to mix the contents again.
  • You can mix fresh and frozen breast milk together to make up a bottle for a feed.
  • It is fine for EBM to be offered to your baby at room temperature.
  • Do not use a microwave to thaw or warm EBM as it destroys the protective properties of the milk and heating continues even after the milk is removed from the microwave.
  • To work out how much EBM to offer your baby for a feed is to take baby's present weight, multiply by 150 and divide the amount by the number of feeds baby has in a 24 hour period. E.g. 4kg x 150 = 600 / 6=100ml / bottle.

Good luck.

Karen Clark, 22 October 2007