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Breastfeeding—expressing breast milk

When will I need to express milk for my baby?

There may be times when you need to express breast milk for your baby, e.g. if you are going out or returning to work; or if your baby is preterm or unwell and unable to suck at the breast.

Mothers who give birth to premature babies produce breast milk that differs from full-term milk in the amounts of some nutrients, making it especially important for the preterm baby.

The principle behind expressing breast milk is to copy as closely as possible what occurs with normal breast feeding. Frequent and thorough removal of milk from the breasts is very important for milk production. Expressing by hand or using an electric pump needs to commence as soon as possible after the birth of your baby.

How do I express?

You can either express by hand, or use a breast pump:

  • Always wash your hands well before handling your breasts.
  • A warm face washer on the breasts may help the milk to let-down. Gentle massage of the breast towards the nipple is also helpful.
  • Use a clean container to collect the breast milk. In the first few days colostrum may be hand expressed and the droplets drawn into a syringe. This may require some assistance from your midwife.
  • If possible, it is best to feed your baby before expressing. Therefore, you can express at the end of a feed taking advantage of the milk flow your baby has started. Remember not to aim to express large amounts at once unless your baby is not breastfeeding at all).
  • Your midwife can assist you to work out how much breast milk you will need to express for your baby.

Hand expressing

  • Position your thumb and first two fingers about 2.5–4 cm behind the nipple. Place your thumb pad above the nipple and the finger pads below the nipple forming the letter "C" with the hand as shown below.
  • Push straight into chest wall.
  • Press thumb and fingers together gently (to meet) and then release. Repeat step two and three to establish milk flow.
  • Repeat rhythmically to drain the breast. Position, push, roll, position, push, roll…
  • Rotate your thumb and finger position to milk the other ducts.
  • Any handling of your breast should be gentle and non-painful. If discomfort occurs, move your fingers further behind the areola which should increase comfort as well as milk flow. Ask your midwife to assist you if difficulties occur.

Avoid:

  • squeezing the breast—this may cause bruising
  • pulling out the nipple—this can cause tissue damage
  • sliding on the breast—this can cause skin burns.

How often do I need to express

We recommend that you commence expressing within the first hour after your baby is born. You should express at least 8 to 10 times per day or more, with a maximum break of five hours (usually at night); especially in the first two weeks. You do not need to express at set intervals and you may express after one, two or three hours, as long as you can do this eight times per day. This is the most crucial time for establishing a good milk supply. Expressing frequently during this time, will assist you to build and maintain a good supply.

Many mothers need to continue to express eight times each day, with one or more sessions during the night time in order to maintain their milk volume although some mothers may be able to reduce the number of expressions to six times per day when their milk volume reaches greater than 750 ml per day.

The nursery staff can provide you with Mater Mothers’ Hospitals Expressing record so that you can record your progress. This is included in your information pack.

Using a breast pump in the first few days

The yellow hospital grade pump, which is available for use on the wards and in the nursery, can be used from day one to aid with the stimulation of your milk production.

Stimulation phase. In the first few days, before your milk has come in, only use the stimulation phase which has low suction combined with a rapid pumping speed. This is ideal for stimulating milk flow. Use the pump (on stimulation phase) for two minutes on the first breast and then hand express for up to five minutes on the same breast. Repeat on the other breast, and then again on each side.

Pumping phase. Once you are able to express approximately 5 ml of breast milk by hand you can allow the pump to proceed to the next phase of expressing—the pumping phase. Signs of increasing milk production include warming, tingling and firming of the breast tissue.

Note: the suction should be set at the highest level that you are comfortable with.

When you are expressing with an electric pump you may use a single kit and alternate between each breast every five minutes for a total of 20 to 30 minutes, or double pump using two kits to express both breasts simultaneously for 10 to 15 minutes. If you are expressing for twins or will need to express for a number of weeks, double pumping may be the preferred option.

Remember

  • While your baby is in the Neonatal Critical Care Unit, try to express beside your baby, as looking at your baby can assist your milk to let-down.
  • If you are having any problems hand expressing your breast milk, please speak to the midwife or nurse caring for you or your baby, or the lactation consultant.
  • Milk needs to be used within 72 hours of expressing while your baby is in hospital, or frozen within 24 hours for future use. Fresh milk should be transported to the nursery in a cold Esky. You may need to freeze some of your milk at home.
  • The aim of expressing is to build up a daily volume of approximately 750 ml to 1000 ml over the two to three weeks following your baby’s birth.
  • Prior to discharge from hospital, think about how you will maintain your milk supply at home.

Milk volume

Milk volume will vary from mother to mother and vary over the day. All mothers’ breasts have a different capacity to hold milk and this is not determined by breast size, but by the amount of glandular and ductal tissue in your breasts.

Some things that may affect or enhance your supply:

  • Stress, pain, anxiety and illness which may decrease your supply.
  • Having a photo of your baby with you can assist your milk let-down.
  • Warm compresses and massage of your breasts prior to expressing will help you express.
  • Relaxation exercise, aromatherapy and gentle music at home may help decrease anxiety levels.

As a general guide, optimal amounts to express would be:

  • By day 5: 200 to 300 ml per 24 hours
  • By day 8: 400 to 500 ml per 24 hours
  • By day 14: 750 ml per 24 hours
  • Thereafter: 750 ml to 1000 ml per 24 hours

If you feel there are ongoing concerns with expressing your breast milk, please talk to the nurse or midwife caring for your baby, or the lactation consultants.

Over time some mothers may find their milk volume has dropped. Often your supply can be improved by planning an intensive expressing campaign at home for a few days. You may need assistance at home so that you can rest and concentrate on expressing. You will get a smaller volume each time you express for the first 48 hours but the extra stimulation will increase the overall production noticeably within two to three days. You can use your ‘log book’ to track these changes.

If there are ongoing concerns regarding milk volumes, despite frequent expressing, some medications have been proven to be effective in supporting supply. Speak to the lactation consultant about these medications. Prescription medications will need to be prescribed by your obstetrician or your G.P.

All milk given to your baby is valuable and all your efforts appreciated, so remember that every drop counts. No matter how small each expression is, ALWAYS save the milk for your baby.

Transporting your breast milk to hospital

Breast milk expressing bags are available in the Neonatal Critical Care Unit for expressing, storing and transporting your breast milk. Each bag of expressed breast milk (EBM) should be clearly labelled with your baby’s identification label. Please write the following information on the label:

  • EBM.
  • Date.
  • Time (am or pm).

Up to three consecutive expressions can be added to each bag as long as it is labelled with the time of the first expression. All milk needs to be at the same temperature prior to adding together, i.e. after you have used the expressing bag the first time, you would need to express using a clean bottle, cool the milk in the refrigerator and then add the milk to the bag.

We will store approximately 400 to 600 ml for each baby in the freezer at the hospital for use when there is no fresh breast milk available for your baby. Unfortunately, we are unable to store large volumes. If you live in Brisbane we would like you to bring in enough milk each day for your baby’s needs, plus a little extra to allow for changes to feed volumes—ask the midwife or nurse caring for your baby to calculate the required volumes.

Expressed breast milk should be transported to the hospital in an insulated container containing reusable ice bricks to keep it cool.

Storing expressed breast milk safely

Breast milk Room temperature Refrigerator Freezer

Freshly expressed into closed container.

Six to eight hours at less than 26 degrees Celsius.

If refrigeration is available, store milk in the back of the refrigerator where it is the coldest.

Three to five days at 4 degrees Celsius.

Store in back of refrigerator where it is coldest.

For the hospitalised baby—three days.

Two weeks in freezer compartment inside a refrigerator

(-15 degrees Celsius).

Three months in freezer section of refrigerator with separate door (-18 degrees Celsius).

Six to 12 months in deep freeze

(-20 degrees Celsius).

Previously frozen and thawed in refrigerator but not warmed.

Four hours or less i.e. next feed.

Store in refrigerator 24 hours—if milk has not been warmed.

 Do not refreeze.

Thawed outside refrigerator in warm water.

For completion of feed.

Hold for four hours or until next feeding.

Do not re-freeze.

Infant has begun feeding.

Only for completion of feed, then discard

Discard.

Do not refreeze.

Never heat breast milk in a microwave as the milk heats unevenly and hot spots in the milk can burn your baby's mouth. Microwaving also destroys some of breast milk's important properties.

Cleaning expressing equipment

It is important to wash your hands before handling clean expressing or feeding equipment.

General cleaning

  • Wash your hands.
  • Rinse all equipment in cold water immediately after use.
  • Wash all equipment in hot soapy water, using a soft bottle brush to remove all milky residue.
  • Rinse all equipment with clean hot water so that no soap remains.
  • Drain any water from the equipment and air dry on clean paper towel.
  • Assemble and seal bottles and store in a clean container in the fridge for 24 hours. It is important that equipment is dry before sealing bottles and storing in the container.
  • If not used in 24 hours repeat cleaning, including the storage container.

If someone who lives in your home is unwell, general cleaning must be followed by boiling or steam disinfection.

Boiling

  • Put all equipment into a large saucepan and cover with water making sure that all air bubbles are removed from the equipment.
  • Place a lid on the saucepan and bring to the boil—continue to boil for five minutes.
  • Allow the equipment to cool in the saucepan, with the lid on, until it is just hand-hot before removing it.
  • Drain any water from the equipment and air dry on clean paper towel.
  • Assemble and seal bottles.
  • Store in a clean container in the fridge for 24 hours.
  • If not used within 24 hours repeat cleaning, including storage container.

Steam

Units using steam to disinfect are automatic and raise the temperature quickly to the range which kills germs. Follow manufacturer’s instructions carefully. Then follow steps for drying and storing as above.

Dishwasher

Bottles, storage containers and other equipment may also be placed in the dishwasher for heat disinfection, after general cleaning, if the dishwasher has a final high temperature rinse program. Then follow the steps for drying and storing as above.

Reference

Parker LA, Sullivan S, Krueger C, Kelechi T, Mueller M, 2012. 'Effect of early breast milk expression on milk volume and timing of lactogenesis stage II among mothers of very low birth weight infants: a pilot study', Journal of Perinatology; 32, 205–209

Mater acknowledges consumer consultation in the development of this patient information.
Last modified 04/8/2016.
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