Expressing Breast Milk

Understandably, giving birth to a premature or sick newborn may be a stressful time, but it is very important to start expressing milk as soon as possible.

At first, the milk you express is called colostrum. You will only produce very small amounts, but it is extremely concentrated, rich in nutrients and antibodies. This “liquid gold” is priceless, so keep every drop! Due to the thick, sometimes sticky consistency, you may find it easier to hand express and use a syringe to collect as much colostrum as you can.

Regular expressing acts as breast stimulation to assist the breasts as they build milk volume over the next few days. Once your mature milk comes in, you will need to express frequently (eight to ten times a day) to establish and maintain your milk supply. After a few weeks or months, when your supply is established, you may be able to reduce the number of times you express.

Expressing breast milk is a skill that takes time to learn and in the first few days after giving birth, you may only collect drops of milk. Please don’t get discouraged; remember that each drop is like a medicine for your baby and it is helping get them off to a healthier start.

The requirements for collecting breast milk for sick or premature babies in hospital are more stringent than those applying to collecting milk for healthy babies at home. Midwives, lactation consultants, early childhood nurses and Australian Breastfeeding Association counsellors are available to provide advice about expressing, both in hospital and at home.

There are three methods of expressing: hand expressing, hand pump expressing, and electric pump expressing. Your choice will depend on your reason for expressing and your personal preference. The following general hints apply, regardless of the method you choose:

• Express in a comfortable, private place
• Disable the telephone
• Have a glass of water nearby
• Have all expressing equipment ready
• Relax! Music may help

Hand Expressing

Every mother should be shown how to hand express her milk, regardless of whether she chooses other methods to use in the longer term. This method has many advantages – it is convenient and the skin-to-skin contact stimulates milk production. Many women find that hand expressing becomes easier with practice.

Steps for expressing breast milk by hand:

• Wash hands with soap and warm water (cold hands can cause the process to take longer than warm hands)
• Hands must be thoroughly dried with a clean towel, single-use towel or hand dryer
• Gently massage the breast – start from the top of the breast and stroke towards the nipple, massage the underside too and repeat several times to ensure that the whole breast is massaged
• Hold a clean plastic dish under the breast to collect the milk – this may be difficult for some mothers to manage when they are learning and, instead, a wide bowl can be held between the legs or placed on a low table, leaving both hands free, a towel may be needed to catch any spills
• Place thumb and finger diagonally opposite each other on the edge of the areola
• Gently press inward towards the centre of the breast, squeezing the finger and thumb together
• Repeat with a rhythmic rolling movement, feeling for the milk sinuses – the fingers should not slide over or pinch the skin
• Once the milk flow has stopped, move the fingers around the nipple and press again – this helps express more milk and empty all sectors of the breast
• Repeat the process on the other breast
• •If more milk is required, the mother can change from breast to breast until she has the amount of milk needed or she can wait and try again later
• Pour the collected milk into a storage container and put it in the refrigerator

Hand Pumps

Hand pumps are portable and relatively inexpensive. many types are available and should be used according to the manufacturers’ instructions.

Steps for expressing breast milk using a hand pump:

• Wash hands with soap and warm water
• Have a clean, sterilised pump ready
• Gently massage the breast – start from the top of the breast and stroke towards the nipple, massage the underside too and repeat several times to ensure that the whole breast is massaged
• Place the flat rim of the breast cup on the breast, centring the nipple
• Gently work the pump with a smooth action, pulling the piston and releasing the suction rhythmically – by releasing the suction, the blood circulation to the areola and the nipple will be maintained
• Continue working the pump until the breast is soft and about half the required amount of milk has been expressed
• Change to the other breast and repeat the process, starting with the gentle massage
• If more milk is required the mother can change from breast to breast until she has the amount needed or she can wait and try again later
• Pour the collected milk into a storage container and put it in the refrigerator

Electric Pumps

Electric breast pumps may be preferable for longer-term use. Electric breast pumps can be purchased or hired from many pharmacies or from the ABA.

Steps for expressing breast milk using an electric pump:

• Wash hands with soap and warm water
• Have the sterilised pump equipment ready
• Gently massage the breast – start from the top of the breast and stroke towards the nipple, massage the underside too and repeat several times to ensure that the whole breast is massaged
• Hand expressing for a few minutes before and after pumping can optimise milk output
• Place the breast cup on the areola, centring on the nipple
• Ensure that the flange is the correct size – women with larger nipples may need a larger flange
• Turn the suction strength to low, start the pump, and relax
• Gradually increase the suction strength – as long as there is no discomfort. The strength should not be increased above the recommended level for the type of pump being used. High levels of suction do not increase milk production
• Continue until the breast is soft and about half the required amount of milk is collected
• Change the cup to the other breast, turning the suction to low, and repeat the process, beginning with the gentle breast massage
• If more milk is required, the mother can change from breast to breast until she has the required amount or she can wait and try again later
• Pumping both breasts at the same time (double pumping) may increase milk yield and saves time
• Pour the collected milk into a storage container and put it in the refrigerator

Expressing and Storing Breast Milk gratefully reproduced by permission. National Health and medical Research council (2012) Infant Feeding Guidelines. Canberra: National Health and Medical Research Council.