Learning how to express breast milk is an important skill for mothers because it helps you to:

  • Get your baby interested in latching when you express a few drops before breastfeeding as your baby will smell and taste your milk.
  • Keep your nipples moist and prevent soreness by gently rubbing a few drops of breast milk onto your nipples.
  • Soften your breasts near your nipples before latching your baby, if your breasts are very full.
  • Collect and store your milk to feed your baby when you cannot be with him.
  • Increase your milk supply.

Expressing Breast Milk

You can practice expressing breast milk as soon as your baby is born or even before. In the first two to three days after birth, you will get a small amount of colostrum. Colostrum is rich in antibodies and nutrients. It is an excellent food for your newborn and gives your baby’s immune system an important boost. Whether you are hand expressing or using a pump, it may take a few minutes for your milk to flow. At times, your milk will come faster, then slower, then faster again. This is normal. With practice, you will find out what works best for you.

Reasons for Expressing Breast Milk

You may need to express and store breast milk for different reasons:

  • If your baby is not able to breastfeed.
  • If your breasts are very full, hand expression before breastfeeding will soften your breast to help your baby latch.
  • If you need to give your baby extra breast milk.
  • If you are going to be away from your baby.
  • If you want to donate your extra breast milk.

Getting Ready

When you are ready to express your milk, try to relax so that your milk will flow easily. Always wash your hands before expressing milk. You can try some or all of these things to see what works best for you:

  • Massage your breasts to help the milk to come down (this is the let-down reflex). There are different ways to do this. You can massage in a circular motion with your fingers together. Or, you can support your breast with one hand, and stroke the other side of your breast firmly with your other hand. Go from the chest towards the nipple, and work all around the breast.
  • Put a warm, wet cloth around your breasts, or have a shower to start the let-down reflex that helps your milk flow.
  • Choose a place where you are comfortable. You may want a place where you have privacy.
  • Relax by thinking about your baby, looking at a picture of your baby, listening to music, or watching television
  • Lean forward and gently stroke the breast.
  • Gently roll your nipple with your thumb and finger.

Expressing by Hand

Expressing by hand is convenient and free. Try the following tips:

  • Hold your breast with one hand. The thumb and fingers of your hand should be opposite each other and about 2 ½ to 4 centimeters (1 to 1½ inches) back from the nipple. Lift your breast slightly, and gently press the breast inwards toward your chest.
  • Use a clean container with a wide opening. Put it on a surface in front of you or hold it under your breast to collect milk.
  • Lightly compress your thumb and fingers together moving them towards your nipple.
  • Relax your fingers then repeat the same motion. Do not squeeze the base of your nipple, as this will stop the flow of milk.
  • Move around your breast to express. Continue this until the flow of milk has slowed or stopped. You may want to switch hands now and again.
  • You can switch back and forth between breasts as often as you like. This can help milk flow.

Expressing with a Pump

If you decide to use a pump, you can choose a manual or an electric pump. For your safety and your baby’s safety, purchase a manual or electric breast pump, or purchase a kit that goes with a rental breast pumps. Single-user pumps should not be shared (just like a person wouldn’t share their toothbrush with a friend or relative).

Whether you decide on a manual or an electric pump:

  • Check with a lactation consultant to discuss options.
  • Check with other mothers to find out which pump worked well for them.
  • Choose one that lets you adjust the amount of suction from low to high.
  • Make sure it does not hurt to pump. If it hurts, get help.

How long and how often you need to pump depends on:

  • How often your baby is breastfeeding.
  • How well your baby is sucking and swallowing.
  • Your milk supply.

Manual pumps

There are a variety of manual pumps available in the marketplace. It is wise to talk with someone knowledgeable about breastfeeding such as an International Board Certified Lactation Consultant to help you find the breast pump that is best suited for you. Most manual breast pumps use either arm or hand action to create suction. It you have arm or hand problems you may find it easier to use an electric breast pump.

Electric breast pump

If you only need to pump for a few days or weeks you may decide to rent a hospital-grade electric breast pump. Hospital-grade electric breast pumps are also recommended if you are pumping for a baby with special needs such as a premature infant or a baby who is unable to breastfeed. You will need a kit to use with the double electric pump. Most facilities that rent or loan hospital-grade electric breast pumps have kits available to use with the pump. This pump allows you to pump both breasts at the same time. This is sometimes referred to as double pumping.

Purchased electric breast pumps are not the same as hospital-grade electric breast pumps that can be used by more than one mother. Purchasing an electric breast pump may be a good choice if you have an established milk supply and plan to be pumping for some time. Some mothers like to use a double electric breast pump when they return to work because they can express milk from both breasts at the same time.

When you are using a pump, make sure your whole nipple area is centered inside the flange. Some breast pumps have flanges available in various sizes so that you can find one that that is right for you. Adjust the pump to its lowest setting, and increase the pressure as your milk starts to flow. Use as much pressure as is needed to keep your milk flowing. None of this should hurt. It is often best to pump both breasts at the same time. Double pumping is faster than pumping one breast at a time. You can pump each breast for 10 to 15 minutes. It is helpful to combine pumping with hand expression to increase your milk supply.

If your baby was born before 34 weeks gestation, you may be eligible to receive a free hospital-grade electric rental pump while your baby is in hospital. Check with your nurse or health care provider.

Expressing Milk When Your Baby Is Not Able to Breastfeed

Begin with early and frequent hand expression and pumping. Try to start in the first hour after birth. You should express your milk eight or more times in 24 hours, until your baby is breastfeeding effectively from your breasts. To ensure that you have a steady supply of milk, express regularly during the day and at least once during the night. Your milk production is greatest during the night. Expressing during the night helps you to make more milk.

If your baby is sick or born prematurely, it may not be possible to breastfeed right away. The Bilingual Online Ontario Breastfeeding Services directory can help you connect and get help and support from professionals, experts and peers. For breastfeeding advice call also Telehealth Ontario 24/7 Breastfeeding Supports at 1-866-797-0000.

For a preterm baby refer to Breastfeeding Your Early Preterm Baby or Breastfeeding Your Late Preterm Baby.

Expressing Milk When Your Breasts Are Too Full

Hand expression is an important skill for mothers to learn. Sometimes, when your breasts are too full, babies find it difficult to latch. If your areola is so firm that your baby cannot latch, express enough to soften the area around your nipple. This will allow your baby to latch deeply and feed more efficiently. If your breasts are uncomfortable, express enough to make them comfortable. As your baby learns to latch and breastfeed, you will notice that your breasts become softer as baby drinks your milk.

Reverse Pressure Softening

This is a really effective and easy way to soften your areola. Once it’s softened you baby can more easily latch.

  1. Place your fingers on each side of your nipple.
  2. Push towards your ribs. Hold for about a minute.
  3. Rotate your fingers around the nipple and repeat.
  4. If part of your areola is still firm, repeat on that area.
  5. Reverse pressure softening may be a bit uncomfortable but should not hurt.
  6. Remember that you are pushing fluid away from the areola.

If breast fullness or engorgement continue to be a problem, be sure to talk to your health care provider.

Expressing Milk If Your Baby Needs Extra Breast Milk

Sometimes there is a reason your baby needs extra breast milk. She may be sleepy during feeds, not be gaining enough weight or born a little early. You can offer your baby your own expressed breast milk after she has breastfed. Expressing milk after each feed will also increase your supply.

Expressing Milk When You Have To Be Away From Your Baby

While you are away from your baby, be sure to express milk each time your baby would have fed. Expressing regularly will make you feel comfortable, keep up your milk supply, and prevent problems such as blocked ducts or mastitis. For more information on mastitis and blocked ducts the fact sheets Block Ducts and Breast Infection (Mastitis) complements the Breastfeeding Matters booklet.

Some mothers like to store some breast milk as a backup supply. If you want to store some extra breast milk, it may be easiest to express milk when your breasts are fullest, usually in the morning. Your milk supply will adjust and produce the extra milk for you to store.

If you have trouble getting your milk to flow, try pumping one breast while your baby breastfeeds on the other. Massaging the breast and combining hand expression with pumping can also be helpful. You may find that the amount you get depends on the time of day and whether you are tired or stressed. If you want to express more milk, take a break and then try again.

How To Feed Expressed Breast Milk To Your Baby

First, try to offer your baby your own fresh breast milk, or if not possible, your own breast milk that has been frozen and thawed. You can feed your baby your expressed breast milk by using one or more of these methods:

  • Open cup or spoon.
  • Lactation aid which uses a tube at your breast.
  • Finger feeder with a tube attached to your clean finger.
  • Bottle.
  • More specialized feeding devices.

Storing Breast Milk

Fresh breast milk is better for your baby than frozen breast milk or infant formula. Thawed, frozen breast milk is much better for your baby than infant formula. How long you can safely store breast milk depends on where you store it, and whether your baby is healthy or sick. Here are other helpful tips for storing your breast milk:

  • Use the milk according to the oldest date.
  • After your baby is finished feeding, discard the remaining milk within one to two hours.
  • If possible, try to store breast milk in the amounts you think your baby might want at one feeding. If you don’t express enough milk for a full feeding, you can mix milk from different pumping sessions.
  • Cool down the newly expressed milk before adding it to stored milk.

If you plan to freeze your breast milk, remember to:

  • Seal the container or bag only when your breast milk has frozen. This will help to prevent the bag from breaking as breast milk will expand when it freezes.
  • Leave a 1.5 centimeter (½ inch) space at the top of the container.
  • Do not add your freshly expressed warm milk to already cooled or frozen milk, to prevent rewarming of the already stored milk.
  • Place your milk on a shelf at the back of the freezer and away from the walls of self-defrosting freezers. You want to prevent your milk from warming up.

Breast Milk Storage Guidelines for Healthy Full-Term Babies at Home

Location of Storage
Temperature
Maximum Recommended Storage Duration
Room temperature16 to 29 degrees Celsius4 hours optimal
6 to 8 hours acceptable under very clean conditions
Refrigerator4 degrees Celsius4 days optimal
5 to 8 days under very clean conditions
Freezerless than -4 degrees Celsius6 months optimal
12 months acceptable
Academy of Breastfeeding Medicine (2017)

 

  • Use plastic containers that are bisphenol A (BPA) free.
  • Use clean glass or bags made for freezing breast milk that seals well. Avoid using baby bottle liners because they often break.
  • Use a new clean container each time you express milk.
  • Label containers for storage with the date of milk expression.
  • Store breast milk near the back of the refrigerator where it is coldest. Don’t store it in the fridge door where it is not as cold.
  • Throw out any milk that is older than recommended storage times.

Breast Milk Storage When Your Baby Is In Hospital

  • Use single-use, sterile containers recommended by the hospital.
  • Clearly label your breast milk containers according to hospital instructions. Be sure to include your baby’s name, date and time you expressed.
  • Fresh breast milk is best for your baby. Refrigerate breast milk right after pumping. Freeze breast milk that will not be used within 24 to 48 hours.
  • Pour your freshly expressed breast milk into a new storage container each time you pump. Do not mix breast milk from different pumping sessions.
  • Storage times may vary so ask about your hospital’s guidelines.

Sick or premature babies in the hospital need to be protected from harmful bacteria. Parents must be especially careful how they store breast milk. Refer to Breastfeeding Your Early Preterm Baby or Breastfeeding Your Late Preterm Baby to find information about pumping and storing of breast milk.

Thawed Milk

There are several ways to thaw frozen breast milk by:

  • Placing the container in the refrigerator overnight.
  • Running it under warm water.
  • Setting it in a container of warm water.
  • Using a waterless warmer.

Thawed breast milk may taste or smell different than fresh breast milk. It can also look slightly blue, yellow or brown, depending on what the mother has eaten.

Here are other helpful tips to prepare thawed milk for feeding and to avoid wasting of breast milk:

  • Slowly thaw milk in the refrigerator. This method causes less fat loss than thawing in warm water.
  • Warm thawed milk to body temperature over a period of 20 minutes in lukewarm water (at most 40°Celsius).
  • When milk is thawed, swirl it to mix in the fat.
  • Throw away any milk which has been thawed longer than 24 hours.
  • Throw away milk within one to two hours after the infant is finished feeding.
  • Store your milk in a variety of small quantities such as 15 to 60 milliliters.

Cleaning

For your baby’s safety, your breast pump, containers and feeding devices used to feed your baby should be cleaned with hot soapy water. Also, the equipment should be rinsed, air dried or dried with a paper towel before and after every use. If soap is not available, then boiling water is preferable. Clean breast pumps parts as per the pump manufacturer’s instructions.

For a healthy infant there is usually no need to sterilize. Talk to a qualified professional who has experience helping breastfeeding mothers. The Bilingual Online Ontario Breastfeeding Services directory can help you connect and get help and support from professionals, experts and peers. For breastfeeding advice you can also Telehealth Ontario 24/7 Breastfeeding Supports at 1-866-797-0000.

Source: Best Start

To Cup Feed:

  1. Sit your baby in an upright position on your lap. Use one hand to support your baby’s head by placing one hand behind their shoulders and neck.
  2. To cup feed, place the edge of the cup on your baby’s lower lip.
  3. Slowly bring the liquid to your baby’s lower lip and allow them to lap the milk like a cat. Do not pour the liquid in the baby’s mouth.

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