Why Express?

There are many reasons why you may wish or need to express.

Here are just a few:

• To protect your milk supply if you are not able to feed your baby at the breast.
• If you are leaving your baby with a carer for an evening out, or when working or at college.
• To feed a premature or sick baby.
• To feed your baby or preserve your supply if your baby, toddler or you are hospitalised.
• For relief if your breasts are engorged or you have sore nipples.
• To increase your supply.
• To reassure yourself that you can do it, should the need arise.

Whatever your reason, expressing, like most things, is easy to do with a little practice. There may be different storage guidelines depending on why you are expressing. So if you want to store milk for a sick or premature baby or to donate to a milk bank, please ask for more information. If you want to express to relieve engorgement or you are returning to work or want to have ‘spare’ milk for your healthy term baby, then you can follow these storage guidelines. If you are expressing to preserve or increase your supply then you may need to express more frequently than if you were simply doing it to relieve engorgement or to save for use later. A counsellor will be able to discuss your particular situation with you.

How Should I Express?

You can express by hand or use a hand or electric breast pump. If you decide to use a pump – perhaps because you need to express long term – it is still a good idea to learn to express by hand. There are different actions employed when pumping or expressing. A baby will ‘suck’ and ‘milk’ when feeding, a pump can’t do both these actions, a pump sucks milk while hand expressing mimics the ‘milking’ action that a pump can’t do. So doing both is a good idea. There’s a first time for everyone when it comes to expressing and it is a skill to practice, so don’t feel upset or put off if only a few drops come out.

Begin by:

• Relaxing. Sit down with a warm drink before you start – tension may inhibit the Milk Ejection Reflex. The morning is often a good time to try for the first time.
• Warm your breasts, wrapping a warm towel around or express after a shower.
• Gently massage the breast, towards the areola, for a minute or two.
• Experiment – after all every mother is different.

If you are engorged:

If you are expressing because your breasts are very engorged, you might find that ‘nothing comes out’. Instead of using hot compresses before you express use COLD ones. Sometimes the congestion within the breast is down to the milk and blood supplies jostling for space, and each vessel is blocking the one next to it. So by putting on a cold compress for a few minutes it allows the vessels to shrink a bit (most things shrink in the cold!) and therefore allows the milk to start moving.

By Hand

• Wash your hands thoroughly (there is no need to wash breasts).
• Ensure that you have a sterilised container (a bowl will do) to express into.
• Gently massage the breast with the flat of the hand, from shoulder to nipple, underarm to nipple and under breast to nipple a few times.
• Hold your breast with your hand (same hand as side), right back near your chest wall, with your thumb and finger ‘feeling’ for your ‘spot’ (We call it the ‘B’ spot).
• Slowly and gently squeeze your breast, then move your hand a bit further forward and squeeze again, keep moving your hand down and squeezing until you find a change in texture under the skin, it could feel like ‘pea sized’ lumps or ‘hollow dents’ or simply ‘different’. It’s usually somewhere around the edge of the areola.
• Gently cup the breast and with the thumb and finger on your ‘spot’ press slightly towards the chest wall and then squeeze thumb and finger together, release the pressure, then do it again. Work around the areola so that your fingers ‘express’ all the ducts. It may take a minute or two before any drops appear, so don’t be disheartened. Once the milk starts to flow you will no doubt pick up a natural rhythm.

By Pump

Most pumps, whether hand, battery or electric, work on a similar principle of creating a vacuum when the funnel has been placed over the areola. Make sure that the funnel isn’t too small when the nipple is brought into the narrow part of the funnel, as this could damage the nipple. The newer hand pumps can be particularly efficient at expressing milk quickly. Milk will often not flow immediately. If your baby is not nearby, it can sometimes help if you think about or look at a photo of the baby. Swap breasts frequently, unless you are ‘double pumping’, e.g. pump the left breast for four minutes then the right for four minutes, pump the left breast for 3 minutes, right for 3 minutes, left for 2 minutes right for 2 minutes, left for 1 minute then right for 1 minute then stop, unless the milk is still flowing freely.

If you are expressing in order to increase supply, continue to pump for an extra minute or two after the last drip of milk. Shorter more frequent pumping sessions are more likely to increase supply than a few long sessions. The reason for switching breasts is to give the milk time to come down from the back of the breasts – rather like a baby having a swallow, deep breath, rest before sucking again (although your baby is doing this much more frequently!)

Battery and Electric Pumps

Some women, however, prefer to use a battery or electric pump instead of a hand pump. Instead of you operating the handle the motor does it for you. On most models the suction strength can be altered as well. This feature is particularly important if you have a very efficient pump! More powerful suction isn’t necessarily the best. Too strong a suction can damage nipples, so find the lowest effective suction rating to suit you. Make sure that the funnel ‘fits’, when the nipple is elongated into the narrow part of the funnel it should not be too small. Larger funnels are usually available. Once the pump is turned on and the vacuum has been created, milk will be expressed and stored in a collecting bottle attached to the pump. Many pumps have the option to be either battery or electrically-powered or may convert to a hand pump.

Double Pumping

Double pumping means pumping both breasts at the same time, it will usually increase supply more quickly and will obviously make the pumping session shorter. You could do this with two hand pumps or with a double collection set on the larger electric pumps. You might like to take a couple of breaks from pumping for a minute or two to allow the milk to drain forward, but if milk is still flowing go along with it.

Hand or Pump Expressing?

Whether you choose to express by hand or pump, it’s still a good idea to do a bit of both as a pump only ‘sucks’ the breast but hands ‘milk’ the breast. The combination will be similar to your baby feeding.

Can I hire a pump?

Only hospital-style electric pumps are available for hire, not hand pumps. They can be hired from pump agents around the country. Your midwife or health visitor may be able to give you a local contact number. If not, many breastfeeding counsellors are pump agents or can put you in touch with one in your area or can advise on where to obtain them directly. Pumps can be hired on a short-term or long-term basis depending on your needs: the counsellor or pump agent will be able to advise you. If your baby is in special care then you may be able to obtain a pump from the hospital. Some companies will only allow purchase of their electric home use pumps through agents, as they feel that you need proper instruction in their use. These pumps are generally excellent but of course aren’t available in the shops

Should I sterilise the equipment?

When storing and expressing breast milk it is imperative that everything that comes into contact with the milk is sterilised first. This includes all the parts of the breast pump (excluding the motor) as well as the storage containers. Sterilise by using a chemical or steam steriliser or by boiling the equipment for 10 minutes. If you are storing for your own, healthy baby, after first sterilising the equipment, it must be sterilised once a week (or more). In between times it can be washed with hot soapy water or put in a dishwasher according to the product's instructions (some are not dishwasher safe!). Ensure that you check your dishwasher manufacturer’s instructions about putting your particular pump parts in the machine.

How Can I Store Breast Milk?

Storage guidelines suitable for a healthy term born baby (born between 37 and 42 weeks).

• Different storage times may be needed for sick infants or donated milk.
• Room temperature: 77F/25C Up to four hours.
• Refrigerator: 3-5 days. If milk will be stored longer than this, freeze it within 48 hours.
• Previously frozen breast milk: 24 - 48 hours.
• Freezer: Up to 12 months depending on the type of freezer.
  
  (ref. Hamosh, 1996)

Refrigerate your milk in a sealed container as soon as possible.

Label it with the date and time, so that you can use it in rotation.

Store in small quantities - that way you have less waste, and it’s quicker to thaw or warm. Sterilised ice cube trays can be helpful here.

The ABM produces more detailed guidelines on storing and thawing breast milk. The guidelines can be used as a fridge magnet. Click here to order.

It is possible to collect together milk from a number of expressing sessions, but allow each ‘batch’ to cool before adding it to the sealed container

How do I defrost breast milk?

It is possible to defrost milk in a number of different ways. These include:

• Placing it in the fridge to defrost slowly.
• Placing the container in a bowl of warm water and changing the water frequently.
• Holding the container of milk under cold running water.
• Never defrost breast milk in a microwave. It can break down some properties and cause ‘hot spots’ that could burn the baby's mouth.
• Gently shake the milk before use, the fats may have separated. Don’t shake the milk vigorously – you are not trying to make butter!

Using Expressed Breast Milk (EBM):

Depending on age and health, your baby may be fed EBM in a number of different ways: by cup, spoon, feeder cup, tube, ‘supply line’ - don’t automatically think ‘bottle’. If you need help with any of these methods contact a breastfeeding counsellor for information. Many mothers do use a bottle but be aware that there are other options and a bottle could lead to breast refusal. All babies should be weaned from a bottle by the age of one year. EBM can be used straight from the fridge, but for preference most babies would like it at ‘skin’ temperature – so just take the ‘chill’ out by running a warm tap over the container.

Any other tips?

Express as often as your baby would normally feed, if possible. If you are separated from your baby while expressing, thinking about or looking at a picture of the baby may help.

Try expressing from one breast when your baby is feeding from the other. This takes advantage of the natural Milk Ejection reflex. It is possible to do, but easier if you are using an automatic pump. Most babies get used to the noise of the motor quickly – nothing stops a hungry baby feeding!

When transporting frozen EBM in a cold box, don’t use freezer blocks (these are actually ‘warmer’ than frozen EBM and will tend to start to thaw the milk.)

Some babies refuse to take milk from a bottle at first – this is not unusual. Try to spoon-feed the milk or use a small cup. Special ones are available for premature babies. Older babies will often use a beaker or feeder cup.

Always remember that your baby is the most efficient pump of all!

Breast pump agents

Ardo (pump hire) 01823 336362

Ardo Medical provides information on local pump agents, leaflets on expressing breastmilk, breastfeeding and premature babies, cup feeding. 

Download this page as a leaflet, along with others, on our leaflet download page

Should you need any further information or wish to speak to a breastfeeding counsellor, please contact us either by phoning 08444 122 949 or emailing counselling [at] abm [dot] me [dot] uk