Breastfeeding is a natural way of providing nutrition to your baby, but sometimes you may not always be able to breastfeed your baby directly. At certain stages of your breastfeeding journey, you may need to express and store your breast milk.
Expressing breastmilk
Expressing your breastmilk is when you remove the milk from your breast by hand or pump. You can express breastmilk for a number of reasons including feeding your baby, relieving a full breast before a feed or helping boost a low milk supply. Your breastmilk can be given to your baby with the use of a syringe, a cup or a baby bottle.
Expressing breastmilk is not something that every mum will need to do, particularly if breastfeeding is going well, but knowing when and how to express it is important so that your milk supply and breastfeeding success is not affected in any way.
Hand express colostrum
It is worth noting that expressing colostrum during pregnancy is not routinely advised unless there is a risk of separation from your baby after birth due to specific conditions such as gestational diabetes or other known reasons for feeding difficulties i.e., cleft palate, prematurity
If you do want to hand express colostrum in your pregnancy, it is safe to do so from around 36 weeks but don’t be alarmed if you only get a few droplets of colostrum. This does not indicate that you will not produce milk. It just means that your hormones are geared toward pregnancy, not breastfeeding.
When to express milk
Expressing your breastmilk may be necessary for a variety of reasons, including:
You are separated from your baby after birth due to prematurity, difficulty breathing, and other suspected illnesses;
Your baby is not latching well to the breast and isn’t able to be satisfied from the breast;
Painful and damaged nipples that need some time to heal (poor latch);
When your breasts feel full and engorged - expressing helps to soften the areola and nipple to aid a better latch;
When your breasts are uncomfortably full even after breastfeeding your baby - expressing for comfort only helps ease the discomfort without overstimulating your milk supply;
To help treat blocked milk ducts and mastitis;
To help increase your milk supply when your supply is low;
When you are leaving your baby with a carer for several hours ie when going to a wedding or event or when you are returning to work.
How to hand express breastmilk
Hand expressing is particularly useful to express colostrum as it is quite thick and in small quantities in the first few days after birth. It’s also a helpful skill to have to use at any time during your breastfeeding journey. The process for hand-expressing breastmilk is as follows:
Wash your hands
Sit comfortably and support your breast with your non-dominant hand
Place your thumb and forefinger on either side of your areola (a little way back from the tip of your nipple)
Gently squeeze your fingers back towards your chest and towards each other (try not to drag your fingers along your breast or nipple.) Then release.
Squeeze and release your fingers in a slow and steady rhythm
You may feel some lumpiness under your fingers. These are your milk ducts, and you will start to see milk droplets form on the nipple.
It can take a couple of squeezes before you notice milk droplets form on your nipple.
Hand expressing breastmilk can be quite tiring, too and you may find your hand starts to cramp up. You can swap hands as many times as you need to and move your fingers around to another angle.
You can catch the colostrum or milk you’re expressing in a cup or draw up the droplets into a syringe. It is very important to understand that hand-expressing breastmilk should not be painful.
Expressing breastmilk with a breast pump
Breast pumps can be either manual or electric. If you are needing to express long-term for a preterm or ill baby, are trying to increase your milk supply or are returning to work it may be worthwhile investing in a handbag-sized electric breast pump.
It’s important to be aware that the volume of breast milk you can get with a pump is no indication of how much milk is actually in your breast. Your baby is the best pump available and can draw more milk than your breast pump can get.
It is important to note that pumping breastmilk should feel comfortable at all times
Expressing breastmilk with a manual breast pump
Expressing breast milk with a hand breast pump can be a convenient and efficient way to obtain milk for your baby when you are away from them or need to relieve engorgement. To express breastmilk with a manual pump:
Centre your nipple in the breast shield. Make sure the nipple space fits comfortably around the base of your nipple. It should not rub or feel irritated on the pump.
Start with a low suction level and increase until it feels strong but comfortable
It can take a few moments before your milk starts to flow
Express for 10-15 mins or until the flow of milk starts to slow down
You can swap breasts multiple times within 10- 15 mins if you find that works better.
Try double pumping - this can save many hours of your day if expressing every feed.
If using an electric pump, remember that you can hire a hospital-grade electric pump from your hospital or the Australian Breastfeeding Association!
Expressing breastmilk tips
Here are some helpful tips to keep in mind when expressing breast milk:
A warm face-washer around your breast and gentle circular massage for about a minute before expressing can help you to let down more freely;
Take slow deep breaths and relax your shoulders ;
Visualise a stunning waterfall of milk! (Sounds ridiculous but is surprisingly effective!)
DON’T look at the pump! Look at your beautiful baby (or a photo of your baby) to encourage your hormones naturally and lessen the stress of disappointment if only a little milk is flowing;
Limit expressing to 10-15 mins at a time. Expressing for longer does not make more milk; it just wastes your precious time!
Try to express breastmilk late at night to maximise your body’s naturally elevated hormonal period (around 10 pm)
When trying to boost your supply it’s important to express at the same time each day. Expressing at different times, randomly, will not stimulate an increase in your hormones and milk supply.
NOTE that the amount of breastmilk you express with the pump is no indication of how much milk is available in your breast.
When should you avoid expressing breastmilk?
Did you know that expressing breastmilk can create significant feeding challenges and a huge workload for you if done unnecessarily? Here are a few situations when expressing is not helpful:
When your milk supply is already adequate for your baby - expressing can create too much milk;
To check that you have enough milk in your breasts - there is always more milk in your breast than you can express, so this is not an accurate measure of how much milk is in the breast.
Try to give your baby more milk to help them into a feed /sleep routine. Your baby will always feed to his appetite each feed. Frequent feeds are normal and expected in the early weeks and he will find his own feed/sleep rhythm that meets his needs.
To have a bottle of milk so that your partner or family member can share in the feeding - consider the extra work involved for you in creating that bottle of milk! If your baby has a bottle of breast milk, you should be expressing at that time to support your milk supply, so is it really helpful?
To create a stash of breast milk in the freezer ‘just in case’. Expressing more milk than your baby needs can overstimulate your hormones and milk supply. An oversupply of milk is a very challenging situation for both mum and baby, including blocked ducts and mastitis.
Storing Expressed breastmilk (EBM)
Freshly expressed breast milk (EBM) can be stored in a clean container such as a bottle, cup, breast milk storage bag or even in a clean ice-cube tray with a lid. Mark the date and time you express. This is especially important if you are transporting milk to the hospital or to daycare. If it’s not labelled, it will be thrown out!!
EBM can safely be stored:
At room temperature (<26 degrees celsius) on the kitchen bench for up to 8 hours;
At the back of the fridge for up to 3 days;
In the freezer under the fridge for 3 months;
In a deep freezer for up to 12 months.
If you want to mix your milk from more than one express together into one container, you can either:
Keep all milk expressed within 8 hours at room temperature, then combine into one container and place in fridge or freezer;
Cool all EBM in the fridge first, then combine it together
It’s not advised to express fresh warm milk into fridge-cooled milk and never microwave breast milk as this destroys the nutrients as well as creates hot spots in the milk.
Defrost frozen EBM by either placing overnight in the fridge or warming the container in a tub of warm water. Cool milk can be warmed by setting the container in some warm water. Some babies will happily drink cool milk, so you may not need to heat it!
Thawed EBM can be used either immediately, kept at the back of the fridge for 24 hours or at room temperature for 4 hours.
Do not refreeze thawed milk.
Transporting Expressed Breast Milk
EBM can easily be transported either fresh or frozen in a cooler bag with an ice pack. The above-time guidelines for use remain the same.
Cleaning your expressing equipment
Breast milk is full of beneficial bacteria so there is NO need to sterilise any of your expressing equipment.
Rinse the breast shield in warm water between expresses
Your breast shield needs only to be cleaned in hot soapy water ONCE a day!
All bottles, cups, and containers that only come into contact with breast milk can be cared for in the same way.
Rowena Gray is the Parents You've Got This lactation expert. She is a mother to 3 daughters, nurse, midwife and International Board Certified Lactation Consultant (IBCLC) and has been both a consumer and giver of copious amounts of breastfeeding advice! She is the author of ‘Born to Breastfeed - the first six weeks and beyond’. Rowena has a private Lactation Consultant practice in Melbourne. www.rowenagray.com.au
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