With that in mind, Sharon Trotter, midwife, breastfeeding consultant and neonatal skincare advisor gives us her advice on how to express breast milk effectively.
When should I start expressing?
Unless your baby was premature or is ill it’s best to wait until your milk supply is established before starting to express. This is usually at around the six to eight weeks point.
‘Express often – after the first feed of the day is a good time,’ says midwife Sharon Trotter. ‘If you’re separated from your baby, use a photo, piece of clothing or even a video of your baby to stimulate your let-down.’
How to express milk:
When it comes to expressing breast milk, you have three options:
Breast pumps create a suction to stimulate milk flow whereas expressing by hand is more like milking. However, both styles work effectively as they closely mimic your baby feeding. When expressing milk, it is important you relax as it takes practice and can be a difficult skill to master.
Expressing milk by hand:
Expressing milk by hand is particularly effective with a newborn, during the first days and weeks of being a new mum. Hand expressing means you can stimulate milk flow from a particular part of the breast so if one of your milk ducts becomes blocked, this style of expressing can be particularly useful.
Before you start expressing, place a sterilised bottle or container underneath the breast to catch the milk. The NHS gives steps on how to express by hand:
"Wash your hands thoroughly with soap and warm water.
Some mothers find gently massaging their breasts before expressing helps their milk to let down.
Cup your breast with one hand then, with your other hand, form a "C" shape with your forefinger and thumb.
Squeeze gently, keeping your finger and thumb near the darker area around your nipple (areola) but not on it (don't squeeze the nipple itself as you could make it sore). This shouldn't hurt.
Release the pressure, then repeat, building up a rhythm. Try not to slide your fingers over the skin.
Drops should start to appear, and then your milk usually starts to flow.
If no drops appear, try moving your finger and thumb slightly, still avoiding the darker area.
When the flow slows down, move your fingers round to a different section of your breast, and repeat.
When the flow from one breast has slowed, swap to the other breast. Keep changing breasts until your milk drips very slowly or stops altogether."
Expressing milk with a manual breast pump:
A manual breast pump relies on you squeezing the handle to create suction to express the milk. The advantages of a manual breast pump are that they do not require an electricity supply, they are often smaller, cheaper, quieter and good if you pump infrequently or want to take it on holiday. With a manual pump, make sure the funnel isn’t too small when your nipple is brought into the narrow part, as this could be painful. Operate the handle as instructed on the packaging and swap breasts frequently.
Watch our video for more advice:
Expressing milk with an electric breast pump:
If you prefer an electric pump, the motor will operate the pumping action for you. The advantages of electric breast pumps are that they are often faster, better at producing larger volumes of milk and they allow you to adjust both speed and suction. It is important to build up slowly as setting the strength too high could be painful initially.
Advances in breast pump technology mean that electric breast pumps are becoming quieter and more discreet than previous models which often required mums to be plugged into an electricity supply. There are now hands-free wearable breast pumps that can sit in your nursing bra.
If you want to try an electric breast pump, the NHS notes the option of hiring a pump "Your midwife, health visitor or a local breastfeeding supporter can give you details of pump hire services near you."
7 tips to know when expressing milk:
Angela Cartwright, a lactation consultant, midwife and mum of three, reveals her top tricks and tips which will speed you straight up the expressing learning curve and change your relationship with that pesky pump!
You’ll find it much, much easier to express your milk if you can see, hear or smell your baby. The reason for this is a hormone called oxytocin. Known as the love hormone, it is the same hormone which will have caused your uterus to contact and push your baby out if you had a vaginal birth.
‘Most mums think their babies suck milk out of their breast,’ says lactation consultant Angela Cartwright. ‘But actually when your baby suckles, your body produces oxytocin, which makes your breast push milk out to your baby.’
And this is a very physical process: the nerve cells in your nipple send a message to your brain to produce the hormone, which cause the muscles around your glands to contract, squeezing milk into the milk ducts.
This is called the let-down reflex and you may feel a tingling sensation when it happens.
If you’re feeling stressed or under pressure, your body can’t produce the oxytocin it needs to let loads of milk go. So another good way to get your brain releasing oxytocin is to feel relaxed, happy and comfortable. You might think that the best place to express is by yourself, in your bedroom – but maybe not.
‘Try expressing while somebody you love gives you a shoulder or foot massage,’ suggests Angela. ‘Laughter also stimulates the production of oxytocin, so pump while you’re catching up with a good friend or watching something funny on TV.’
The first time you express, you may find you don’t manage to collect much milk. And the second time… and the third time! This isn’t a sign that your body isn’t producing enough, it just means you need a bit more practice.
So, if you’re returning to work or planning a night away from your baby, don’t leave it until the last minute to try expressing for the first time. Get in lots of pumping sessions beforehand.
‘Just like any new skill, expressing takes practice,’ says Angela. ‘If you’re going back to work when your baby is six months, start expressing at three months so you can learn which technique works best for you.’
4) Take the pressure off
Unless your work/life plans alongside your wish to breastfeed dictate that expressing is going to be a necessity, there’s no need to buy an all-singing, all-dancing pump from the get-go.
Spending upwards of £100 can mean you put pressure on yourself to produce lots of milk and somehow justify the cost. But start small, and see how you get on. ‘In the early days, hand expressing is really useful – you don’t need to buy anything or sterilise any equipment, you just squeeze the area around the nipple to get milk out,’ says Angela.
Sore nipples make expressing seem much more difficult but being careful while you pump and you can easily avoid this common problem.
‘Pop a smear of nipple cream or petroleum jelly inside the funnel, so it doesn’t rub,’ suggests Angela. ‘And make sure your nipple goes straight into the middle of the funnel and isn’t slightly skewiff, which can cause a blister.’
If you’re using an electric pump, begin on its lowest setting while you check to see if you’ve positioned it comfortably. Then turn it up to whatever level works for you, and gets your milk flowing. ‘But if you start to feel at all sore, turn it straight back down again,’ says Angela.
6) Collect leaks
When you express or feed your baby from one boob, you may notice milk leaking out of your nipple. This is normal, and a result of your let-down reflex.
‘Use a breast shell to collect any milk that leaks from your other breast so it doesn’t go to waste,’ suggests Angela. ‘These leaks are milk that’s stored in your breast between feeds, and tends to be low in fat and low in protein, as well as quite high in sugar.
It stops the more valuable, higher-protein milk from coming out. It’s fine to use this for an occasional feed, but if you’re weaning, then mix this in with food.’
Keep pumping until your breast feels soft. ‘Your breast is never completely empty, but try to express until it feels well drained,’ says Angela. ‘This is important to avoid blocked ducts, which can lead to engorgement and mastitis. And it will help to preserve your milk supply. If you don’t drain your breast thoroughly, it’ll send a message to your brain that you don’t need to produce as much milk.’
How long can you store breast milk?
Don’t worry if you’re out and about as your expressed breast milk is fine to stay at room temperature for about six hours. However, any longer and it needs to be in a fridge.
Your milk can be stored in the fridge for up to five days at 4C or lower or for two weeks in the ice compartment of a fridge. You can buy a fridge thermometer from a kitchen shop if you are unsure of the temperature.
If you want to keep the milk for longer, you can freeze it for up to six months and use it up to 24 hours after defrosting. Refrigerate or freeze your milk in a sealed and sterilised container or specially designed milk storage bags. Always label and date expressed milk and ideally store it in small quantities to avoid waste and so it can warm or thaw quickly.
How to feed your baby expressed breast milk:
Your milk is best served fresh, as it’s perfect on the day it’s expressed. But, if you’re giving it to your baby after having been in the fridge or freezer, there are some things to watch out for.
Defrost your milk by placing it in the fridge to defrost slowly or try holding the container under cold running water. The NHS says: 'You can feed expressed milk straight from the fridge if your baby is happy to drink it cold. Or you can warm the milk to body temperature by putting the bottle in a jug of warm water'.
However, ‘Don’t microwave expressed breast milk,’ Sharon advises. ‘It will create dangerous hot spots that will burn your baby’s mouth and you also run the risk of milk break-down.’ Don’t shake the milk vigorously if it’s separated. Instead, gently swirl it.
If your baby refuses to take expressed breast milk from you, don't be disheartened. This is because they are so used to feeding on your breast. ‘Try offering it to them from a spoon, cup or bottle,’ Sharon suggests. ‘They might also accept it from their dad or another close carer.’
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