Expressing Your Milk - La Leche League GB

Expressing your milk by hand or with a pump helps you establish and maintain your milk production if you’re separated from your baby or if he isn’t breastfeeding well. And if your milk production is low, expressing can help increase it whilst also providing extra milk to give to your baby.

When a baby can’t breastfeed
Return to work or separation
Making more milk
Storing breastmilk
Pumps
Tips for expressing
Expressing when out and about
Feeding your baby your milk

When a baby can’t breastfeed

Breastmilk is especially important for babies who are unwell. And if your baby can’t breastfeed because of prematurity he will benefit from every drop of breastmilk you can give him. Some babies have conditions which mean they can’t feed at the breast, they can still have your milk. If your full term baby is taking a while to learn to breastfeed, expressing protects your milk production and gives you both time to practice.

The prospect of expressing might
seem daunting at first but giving
your milk is something you can
do that will make a real difference
to your baby’s
short and long term health.

Return to work or separation

When you can’t be with your baby, expressing maintains your milk production and helps you avoid engorged breasts during the separation. It also means your baby can continue to have his familiar milk when you’re away.

Making more milk

You teach your breasts to make more milk by removing milk. Full breasts signal to your body to slow down milk production, so don’t wait for your breasts to ‘fill up’ before expressing, as this will mean a lower milk supply over time. The more thoroughly and frequently you remove milk from your breasts, especially in the early days and weeks, the more milk you will make and the greater the benefit for your long term supply. If you’re expressing to establish milk production, making extra milk in the early days can make it easier to produce more milk later on to keep up with your baby’s needs. Milk can always be frozen and used later. If you are expressing to increase milk production remember a well-attached baby is far more effective than any pump, so do seek help to improve positioning and attachment so your baby can feed more effectively when at the breast.

Storing breastmilk

Breastmilk’s antibacterial properties help it stay fresh so it can be safely stored at room temperature for up to 4 hours and in the fridge for up to a week. If away from home you could use a cool bag with ice packs. Our page Storing Your Milk has comprehensive details on safe periods for storing expressed milk for healthy babies. If your baby is unwell or premature then follow hospital guidelines. Your baby will benefit more from fresh than frozen breastmilk because its living properties will help him fight off possible infections.

Pumps

You can simply use your hands to express, or you can buy or rent a pump. Your choice of pump will depend on your reasons for expressing and your circumstances. If your baby can’t yet feed directly from the breast, or if you need to greatly increase your milk production then consider a hospital-grade double electric pump. Such a pump lets you adjust the suction and pumping speed (cycling) and is designed for long-term use. Many hospitals have these pumps available for use on the ward. Some have pumps that you can hire and take home for use during the night, or you could rent from a pump manufacturer.

Even if you rent a hospital-grade pump you may also find a smaller, portable pump useful for when you are out and about. For expressing while out at work mini electric pumps are a popular choice. These usually come in a carry case for portability.

For occasional pumping a smaller electric or hand pump may be sufficient. Or you could just hand express.

Double pump set: hire pumps and some mini electric pumps come with two pump sets. Double pumping (expressing from both breasts at once) improves milk flow and saves time.

Check fit: check that your pump flange and nipple tunnel fits you comfortably. If too much of your areola is pulled into the tunnel during pumping it can cause rubbing and soreness. If the tunnel is too tight it can inhibit milk flow. Size varies between different makes and models, with some available in a choice of sizes. You may need a different size for each breast.

Suction and cycling controls: look for a pump with separate controls for suction and cycling (speed) so you can vary these to suit yourself.

Cleaning the equipment: always wash your hands before expressing milk. If you’re expressing for a premature or sick baby who is still in hospital then you’ll need to follow the hospital procedures for cleaning and sterilizing the pump parts. If your baby is healthy, pump manufacturers generally recommend washing with hot soapy water. Just like your milk, pumping equipment can safely be left at room temperature for short periods and refrigerated in a clean container or bag for longer periods, giving you more time for your baby.

Tips for Expressing

Relax!
Successful expressing has a lot to do with your emotions and how you are feeling. The hormone oxytocin causes the milk in your breasts to be released (let-down). Oxytocin is released when you feel happy and relaxed. It can be difficult to relax if your baby is very ill and in hospital, or if you feel rushed or under pressure. Make a conscious effort to put your mind at ease and use your senses to help trigger milk release. Hold or sit near your baby, or look at a picture or video of him, listen to a sound recording or hold and smell an item of his clothing. Relax your shoulders and take a deep breath to calm yourself before you begin. Try not to think about how much milk you are producing—instead, try distracting yourself by reading, listening to music or a relaxation CD, watching TV or even chatting on the phone. Some mothers who express long term build up a pre-expressing ritual that ‘prompts’ their breasts to release milk.

Use your hands
When hand expressing, the skin-to-skin contact helps stimulate the let-down reflex. And your hands can remove milk from parts of your breast which the pump can’t. It’s also perfect for the first few days after birth when the small droplets of precious colostrum you make can be collected on a clean teaspoon. Combine hand expression with pumping This can help you remove milk more thoroughly than with pumping alone. Each time you express start with hand expression to stimulate a let-down. Then alternate pumping (double pumping if possible) and massage/hand expression until the flow slows. Finish by hand expressing into the pump flange, or single pumping with intensive breast compressions, switching between breasts until you feel that no more milk can be removed.

This link shows how ‘hands on expressing’ can maximise milk production: http://med.stanford.edu/newborns/professional-education/breastfeeding/maximizing-milk-production.html
This link shows how to hand express: http://med.stanford.edu/newborns/professional-education/breastfeeding/hand-expressing-milk.html
See more online video links listed in the Further Reading section and our page Hand Expression of Breastmilk and experiment until you find the rhythm and technique that works best for you

Suction and cycling speed
When using a pump, set its suction strength so it feels comfortable. Aim for the lowest suction strength which effectively produces milk for you; higher settings can hurt and won’t necessarily produce more milk. Encourage multiple milk releases by mimicking a baby’s natural sucking pattern. Increase the cycling speed when milk flow slows and use a slower speed as flow increases again. Aim for at least 3–5 milk releases during the session. If single pumping, switching between breasts several times can help trigger milk releases.

How often?

If you need to establish milk production without breastfeeding your newborn baby, aim to express 8–12 times per 24 hours including at least once during the night to mimic a baby’s natural breastfeeding pattern. It might help to plan when to express during the day (e.g. on waking, after breakfast, mid-morning, after lunch, mid afternoon, early evening, twice during the evening and once at night).

Once your milk supply is well established, you may find that you can maintain your milk production with fewer expressing sessions.
You don’t need to express at evenly spaced intervals—little and often can be more effective than long sessions.
Express until milk flow stops, then have a short break and come back to it—even a few extra drops of milk or expressing for a few minutes here and there make a difference.
Expressing several times (cluster pumping) during the evening can help you increase the number of times you remove milk per day, so increasing your milk production.
If you’re expressing to increase milk production, or because your baby isn’t yet feeding well at the breast, do it after or between feeds to ensure your breasts stay well drained. This will stimulate them to make milk faster.
If you are expressing at work or for a short term separation from your baby see our page Workday Practicalities for useful suggestions.

Expressing when out and about

You can breastfeed your baby very discreetly but you may feel much more exposed when expressing. In a public place you can use a lockable baby change facility or ask to use a changing room in a clothes shop. A battery or hand pump can be useful in these situations. Some mothers express in the car, creating privacy with shades on the windows and/ or with a cardigan or scarf. When visiting people you may feel more comfortable and relaxed in a separate room. At home it helps if you can get used to expressing with family around, as retreating to a separate room may reduce how often you do it. But some women just find it easier in a private place. Support and encouragement Expressing milk is sometimes challenging but it’s always worthwhile, whether you are establishing breastfeeding, producing milk for a baby who is unable to breastfeed, increasing your milk or returning to work. Seek support from people who understand and value what you are doing and ignore comments from those who don’t. Your local LLL Leader and Group will be able to give you encouragement and support. To find them take a look at our website.

Feeding your baby your milk

See Further Reading and resources below for information on ways to feed your baby your expressed milk.

Written by mothers of LLLGB. Photos courtesy of Lois Rowlands and Rae Vacher Lowe.