Early Days
Expressing Breast Milk
Qualified NCT Breastfeeding Counsellor, Jenny Hemsley discusses expressing and exposes some of the myths surrounding it.
In antenatal sessions, expectant parents almost always ask about expressing; more often than not this is in the context of “allowing the dad to give the baby a bottle of breastmilk; to help them bond and give the mum a break from feeding”. These are completely valid reasons to want to express breastmilk, although there are plenty of other ways dad can bond with his baby, and expressing isn’t something you have to do if you are breastfeeding. To express breastmilk or not is a decision for you to make depending upon your circumstances, but there are a number of other reasons why you might decide to express breastmilk.
1. Your baby is born prematurely and is unable to feed at the breast – babies are normally able to coordinate breathing, sucking and swallowing by around 35 weeks. If your baby is born early, they may not be able to breastfeed for all their feeds until they become more developed. If you want your baby to receive breastmilk and if you want to try to establish a full milk supply for when your baby is older, then you will be recommended to start expressing at least 8 times a day from birth. The milk you express can be either fed directly to your baby or stored for later.
2. Your baby is born at full term, but is unable to feed at the breast for any reason – again, if you want your baby to receive breastmilk and if you want to try to establish a full milk supply for when your baby is older, then you will be recommended to start expressing at least eight times a day from birth.
3. You experience engorgement – at around days three to five you might experience engorgement in your breasts as your mature milk starts to come in. Engorged breasts feel heavy, tender and hard and it is not unusual for your baby to find them difficult to latch onto, even if feeding has been going well. Feeding your baby is often the best relief but you may find gently expressing breastmilk (just enough to soften and make comfortable) can help at this time. Later on, you may also experience engorgement if your baby suddenly starts sleeping for longer periods of time, or if they’ve boosted your milk supply (by frequent feeding) for a growth spurt and then gone back to a less demanding pattern of feeding.
4. You want to try to build your milk supply – if you are anxious about whether you are making enough milk for your baby, it can be helpful to discuss your feelings with a breastfeeding counsellor. If there are concerns about supply, the first thing to try is feeding your baby more often. You can also try breast stimulation through breast massage and compression and by expressing milk after feeding and between feeds as many times as possible during the day.
If you decide you want to express breastmilk, there are a number of options on how to do it:
Hand expressing – a gentle way of expressing , requiring no equipment so can be done at anytime and anywhere. This is particularly relevant if you need to express colostrum (the first milk your breasts produce) as this does not express well into a breastpump due to the consistency and low volumes produced. Hand expressing is a useful skill to learn, but you may need some help at first and a bit of practice to find the best method for your breasts. UNICEF has a good video.
Breast-pump – once your mature milk has started to come in after days three to five, then you could start expressing using a breast pump. An effective breast pump attempts to mimic the sucking action of a baby, combining the suck, release cycle with the sucking strength required to effectively draw out the breastmilk. There are a number of options:
• Rental/ hospital grade pump – as they are very expensive, you can hire the pump unit (which is a closed system, meaning the working parts do not come into contact with the breastmilk) and buy the tubing, flanges, valves and storage containers. These pumps usually have multiple cycles and speeds, allow you to express from both breasts at the same time and