When your baby is too small or unwell to feed from the breast you must remove the milk by hand or with a breast pump, this is called milk expressing. When a baby feeds at the breast, hormones are released to produce the milk and to push it along the milk ducts. If your baby is unable to feed you will have to mimic this action to trick the brain into releasing the hormones and continuing with milk production. This can be done by massaging the breasts and expressing milk.
The first milk expression should take place as soon as possible following birth, preferably within the first six hours. Well babies will normally feed about 8 -10 times in 24 hours, including at night. It is essential to express in the same way, 8 -10 times in a 24-hour period including at least once overnight. Do not get too caught up with strict times, it is the frequency that is important. Never leave more than 5 – 6 hours between expressing overnight.
For the first day or two after birth you can collect your milk using hand expression or an electric pump. The amount of colostrum you express is usually quite small and you may feel that when using the electric pump, the colostrum collects in the equipment rather than in the bottle. For this reason some mothers choose to hand express their milk into a small syringe. Your midwife will give you an early expressing pack containing syringes, labels and caps. If you want to use the electric pump, your midwife will given the pump expression pack.
As explained above it is a good idea to massage the breasts before starting to express, it is thought that this in some way helps stimulate the let down reflex which normally occurs when your baby goes to the breast
For more detailed information and pictures on preparing for and expressing milk, click Expressing breast milk by hand – Start for Life – NHS (www.nhs.uk)
Expressing milk is quite a time consuming activity and you have to allow yourself the time to do it properly. You will not be able to carry on all the things you did prior to giving birth. Spending time with your baby and carrying out frequent milk expression is the best way to achieve a good milk supply. Being kind to yourself by ensuring you have time to rest properly and eat well, will also help.
When your baby’s condition is stable, the nursing staff will suggest you start holding your baby on your chest in close skin to skin contact, this is known as kangaroo care. Mothers who hold their baby in kangaroo care release oxytocin and prolactin (the hormones needed to produce milk) and often find they can express more than usual after a kangaroo cuddle.
Step by step to milk expression
When you first begin to express milk you may only collect a few drops; don’t be disheartened, this amount should increase gradually over the next few days. Sometimes having a baby in the neonatal unit can delay a mother’s milk production a little due to the stress and worry of the situation and because of the separation of mother and baby. This is normal so try not to worry about this too much.
To begin with you should always wash your hands with soap and warm water and then dry them thoroughly; then gather all your expressing equipment, this could be the hand expression pack or electric pump pack; if using the electric pump you will also need a sterile bottle. These things are available in each nursery, ask a member of staff if you can’t find them. When opening up the packs or touching the equipment be sure not to touch the areas that will come into contact with your milk.
Choose somewhere quiet and comfortable to express – expressing room, cot side, in your own home. Expressing by the cot side can often help increase your milk supply because you are close to your baby. Screens are available in each nursery for privacy if you wish.
Make yourself comfortable, find the right chair, pillow, collect a drink etc.
It is thought that carrying out a simple breast massage before each expression stimulates the let down reflex which in turn helps make the milk expression easier and quicker. We suggest each massage should be done in two parts.
- Massage – make gentle circles with your fingers over your breast in the direction of the nipple. This should only take a minute or two.
- Stroking – stroke the breasts with your finger tips. It should be a feather light touch inwards towards the nipple. Continue around the whole breast.
Start with hand expressing. Cup your breast with your hand and fingers in a C shape about 2-3cms back from the base of the nipple.
- Press your thumb and fingers gently together.
- Hold for a few seconds and then release; continue this action in a slow rhythm. It may take a couple of minutes before your milk begins to drip. If no milk appears after a few minutes move the fingers slightly forward or back to find the right spot.
- When the flow slows down move your thumb and fingers to a different position around the nipple but keep the same basic shape.
The time taken to express each breast is variable and depends on the milk flow. When you have expressed all areas of the breast move on to the other breast and repeat the process. Avoid any sliding of the fingers as this can cause damage to the breast tissue. Collect any milk in a syringe.
Next use the electric pump for about 10 – 15 minutes. In the beginning it is unlikely that you will collect any additional milk but this pumping stimulates the hormones needed for milk production. You can borrow a pump to use in the hospital.
Once your milk volumes start to increase, usually around day 3 of baby’s life, you can choose to just use the breast pump or continue with a combination of both hand expressing and the pump.
Before hand expressing or using the pump for the first time, a nurse or midwife should show you how to hand express and how to use the pump properly. You should also be given any equipment needed plus a hand converter for the expressing sets, which allows you to continue expressing at home.
When using the pump it should not hurt. One of the ways to prevent any trauma or pain is to make sure that the funnel is the correct size for you. To do this place your nipple into the centre of the funnel and turn the pump on. The suction pressure should be increased to a setting that is comfortable to you. Now watch what happens to your nipple. If the nipple rubs against the side of the funnel then the funnel may be too small for you and if the nipple and areola are drawn into the funnel then the funnel may be too large for you. If you are uncertain or need a different size funnel to the one you have been given, please speak with your baby’s nurse. More information on selecting funnel size can be found at: Breastfeeding & pumping products (medela.com) or the the Ameda website
Initially each expression session should last about 10-15 minutes so that there is time for your prolactin to be released. Remember in the first few days you will be getting small amounts of milk. Once your milk has ‘come in’ it is important to keep expressing while milk is flowing and for a couple of minutes after it has stopped. More information about expressing your milk can be found here
Once you have finished expressing, label each syringe or bottle with, baby’s name, date of birth, and date and time of expression.
Place in nursery fridge or your home fridge until needed.
