Friday, July 7, 2017

Expressing Your Breastmilk

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/she isn't breastfeeding well. And if your milk production is low, expressing can help increase it whilst also providing extra milk to give your baby.

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/she will benefit from every drop of breastmilk you can give him/her. 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/her familiar milk when you're away.

Making more milk
(I first want to direct you to two previous post I made about increasing and boosting your milk supply. They are here and here.)You Teach your breasts to make more milk by removing the 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.

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. (Keep in mind many moms now qualify for free breast pumps. Ready this post for more information.) 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 rent and take him for use, or you could rent one from a pump manufacturer.

For occasional pumping a smaller electric or hand pump may be sufficient. WIC (program for women, infants and children) has been known to provided breast pumps for free for qualifying women. Check out WIC's website and check to see if your are provides this service to qualifying women. Or you could just hand express. For more on hand expressing click here.

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 comfortable. 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 the 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 and soapy water. 

Tips for expressing

Successful expressing has a lot to do with your emotions and how you re 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 the 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/her, listen to a sound recording or hold and smell an item of his/her clothing. Relax your shoulders and take a deep breath to calm yourself before you begin. Try not to thank about how much milk you are producing - instead, try distracting yourself by reading, listening to music or 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 ti 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. Its also perfect for the first few days after birth when the small droplets of precious colosseum 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.

  • Click here to see how 'hand expressing' can maximize milk production
  • Click here to see how to hand express
  • See more online videos listed in the Further Reading section of LLL UK's website and my post on hand expressing found here 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 releases by mimicking a baby natural sucking pattern. More on that here. 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 yelp 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 for you check out this post and this post for useful suggestions. 

Further Reading

Other Websites
Hand expressing:

Source: Written by mothers of LLLGB

Hand Expression Of Breastmilk

If you are pregnant or breastfeeding. milk expression by hand is a useful technique to learn. It's a handy way to relieve engorged breast. You can also use it to stimulate milk production and provide milk for a baby who is not breastfeeding well or needs more milk.

Why Hand Expression?

  • Skin-to-skin contact with hand expression encourages the milk ejection relax (MER) or 'let-down reflex'.
  • Mothers usually get more milk using hand expression alone or complied with pumping that using just a pump.
  • It requires no special equipment and is always available ,even in emergencies.
  • Its convenient and free.
Hand expression is particularly useful if you need to express colosseum during late pregnancy (see this article for more information) or in the first few days after birth. It makes it easy to save every drop of precious colostrum.

If You Use A Pump
Whatever pump you may use, combining pumping with hand expression can help you express more milk more effectively.
  • Breast massage and hand expression can be used at the beginning to get your milk flowing.
  • Breast massage while pumping increases the amount of  milk you can express.
  • Continuing to hand express can release milk remaining, even after the pump flow has stopped.
  • And if your pump breaks down, or there is no electricity, you alway shave your hands.
Practice Helps
Hand expression is simple to learn and gets easier with practice. You may receive information and a demonstration of hand expression from you midwife. Developing your own routine, starting with relaxation techniques and stimulating milk flow, makes it easier too.

How Breasts Work
When milk is removed more often, your breasts feel soft and comfortable and produce milk faster. When milk is removed infrequently, your breasts may feel full but produce milk more slowly. Frequent milk removal is the key to gaining milk production whether you are breastfeeding or expressing. Expressing stimulates your breasts-though not as effectively as baby- to make and release milk.

Before You Start
Wash your hands. Have a suitable clean container available to collect your milk; colostrum can be expressed into a small (5ml) container or even onto a teaspoon for immediate feeding. Once milk production has increased milk may spray in several directs so a bowl, wide mouthed container or a bottle with a funnel might be more practical. 

Relax And Get Comfortable
Milk tends to flow better when you are feeling comfortable, relaxed and arm. Tension or anxiety inhibits milk flow. Relaxation techniques can help increase the amount of milk you can express. The sound of running water may help, or you could practice in the bath or shower. 

Seek privacy; try the breathing exercises you earned for use during labor; visualize flowing milk. Have your baby nearby, or thin of him/her. Use photos or recordings of your baby and smell his/her clothing. All these will help stimulate milk flow. Take a few deep breaths, drop you shoulders and please tension with each exhalation. Bending forward with your breast suspended means gravity can help milk flow.

How To Hand Express

One Basic Approach
  1. Start by encouraging milk flow in both breast.
  2. Then hand express from each breast until milk flow slows right down. If you need to increase milk production, continue expressing for a couple of minutes after milk flow has stopped.
  3. Repeat these two steps at least twice more. You will find milk flow slows or stops sooner each time you repeat.
  4. Most mothers adapt the above approach to suit themselves, so experiment to find what works best for you.
Step by Step

Encouraging milk flow
Stimulating you r milk ejection relax (MER or 'let-down') is key to expressing. It can take a few minutes. You may see drops of colostrum or breastmilk, or even experience a tingling sensation, but many mothers don't see any milk until they start actually expressing. Experiment with the following suggestions to find out what works best for you.
  • Massage your breast starting at the top, using a firm circular pressure on one spot. After a few seconds, lift up your fingers to move to the next area on the breast. Spiral around the breast towards the areola and nipple.
  • Storke your breast from the top of the breast to the areola and nipple. Light stroking with fingers is one option, or use a soft item with a light tick-like stroke. Continue this stroking motion from the chest wall to the nipple around the whole breast. She your breast gently while leaning forward so gravity can help your ;milk flow.
Hand Position
You can use either or both hands on one breast, or express both breasts at the same time. Hold your hand in the shape of a letter 'C', with your thumb and forefinger behind the base of you ripple, feeling for the change in texture of your breast. Move your fingers closer to, or away from your nipple to find the best place for you.

To Express
Start with the pad of your thong at the top of your breast, and your finger pads below.

How Long Will Hand Expression Take?
Allow plenty of time at first: the whole process may take 20-30 minutes, but you can always stop and start again later if you need to. Frequent short sessions are usually more effective that infrequent longer expressing sessions.

Switching between breasts several times as milk flow slows can help trigger further milk ejection reflexes. The more MERs you stimulate, the more milk you will be able to express and make.

Hand Expression Shouldn't Hurt
Squeezing, pulling and sliding fingers along the skin can cause discomfort, bruising and skin burns. Pain of discomfort inhibit the MER and are signs the something needs adjusting. If your breast feels engorged or tender try warm moist heat immediately before expressing. Start expressing from the most comfortable areas.

Removing milk from areas around a blocked duct can reduce the discomfort, making it easier to express from the tender area later. 

Source: Written by Sue Upston, Karen Butler and mothers of LLLGB

Storing Breastmilk

Breastmilk's antibacterial properties help it stay fresh. The live cells and antibodies that discourage the growth of bacteria in your baby's intestines also guard against bacterial growth when your milk is stored in a container. 

The guidelines that follow apply to milk that will be give to full-term healthy babies. If your baby is premature or sick, hospital staff can give you information on stricter storage guidelines, to ensure your baby gets as much benefit from your milk as possible. 

Good hygiene is important when storing your milk. Reduce the risk of contaminating your milk by:

  • Washing hands before expressing or handling milk
  • Keeping your pump clean, using hot soapy water for all parts which come into contact with your milk. Some mothers sterilize as well
  • Keeping your fridge, freezer, cool bag and icepacks clean
  • Placing containers of milk in a clean bag or lidded box before storing
  • Keeping your milk away from meat, eggs, etc
Storage containers
Hard-sided containers, either glass or plastic, do the best job of protecting your breastmilk. Avoid containers made with the controversial chemicals bisphenol A, identified with a number 3 or 7 in the recycling symbols. A safer alternative is polypropylene, which is soft and semi-cloudy and marked with a 5 or letters PP.
  • Use containers with well-fitting tops
  • Wash containers in hot, soapy water, rinse well, and allow to air-dry before use. Or wash and dry in a dishwasher
  • Leave 2.5cm of space at the top to allow the milk to expand as it freezes. Plastic milk storage bags, designed for freezing breastmilk are convenient and take up less room in the freezer
  • Avoid bags that are not designed for freezing- they may burst or or tear. Double bagging can prevent accidents
  • Some milk storage bags can be attache directly to a breast pump, so you can collect and store milk in the same container
  • Allow 2 to 3 cm for the milk to expand when frozen and squeeze out the air at the top before sealing
  • Stand the bags in another container on the fridge shelf or in the freezer 
Remember to date the containers- it can help to put a use-by date too. Add your baby's name if he/she will receive the milk at childcare or a nursery. 

How much milk will I need?
Store milk in 60 to 120ml (2-4oz) quantities to avoid waste, at least until you know how much milk your baby takes at a feeding. Small quantities thaw quickly and can be combined if needed. You can also store smaller quantities of 30ml for when your baby is extra hungry, or wants to be fed just before you're due back.

You can combine milk pumped at different times, if you:
  • Cool fresh milk for 30 min in the fridge first
  • Add fresh milk to frozen milk only if there is less fresh milk than frozen
  • Use it within the time limit of the oldest expressed milk
Looks are deceptive!
It's perfectly normal for expressed milk to look thin, bluish, yellowish or even brownish in color and for it to separate into a milk layer and a cream (fat) layer when stored. 

Preparing to use
Thaw and heat with care
High temperatures or even moderate temperatures over a period of time affect many of the beneficial properties of breastmilk, so:
  • NEVER warm breastmilk in a pan on a stove
  • NEVER warm breastmilk in a microwave
Microwaves do not heat liquids evenly, so there may be hot spots in the container of milk, and this can be dangerous for babies.

Defrosting frozen breastmilk
Your milk can be deformed in the fridge, avoiding  unnecessary heating. Use within 24 hours. BREASTMILK CANNOT BE REFROZEN ONCE THAWED.

To defrost your milk more quickly:
  • Hold the container under cool running water and gradually increase the temperature of the water to heat the milk to feeding temperature
  • Immerse the container in a bowl of warm water, Take the milk out and reheat the water if necessary. Do not stand in a pan of water heading on the stove
Refrigerated Milk: Warm for a few minutes under a tap or in a container of water. Test for temperature on the inside of your wrist.
Avoid contamination: Dry the containers before opening, with paper towels or a clean tea towel.
Breastmilk separates naturally: Gently swirl the container to remix. (see my post on swirling vs shaking here)

Breastmilk is remarkably resilient - it stores well due to its antibacterial properties.

Temperature: Store milk in the coldest part of fridge and freezer. Self-defrosting freezers can have warm spots. Use fridge and freezer thermometers to determine where the temperature is most constant. The fresher your milk, the better.

Milk stored in the fridge will have more goodness than frozen milk. Some of the anti-infective properties are lost when milk is frozen- but it still helps protect babies from diseases and allergies and is far superior to any formula. Although you probably won't plan to keep your m ilk in the fridge for set or eight days, it's good to know you can use safely any you find hidden at the back of the fridge. When your baby gets your milk within a few days of being refrigerated, its's also reassuring to know it is well within its usable limits.

Keeping milk for the next feed
Some sources will tell you to throw away leftover frozen or heated milk, which will have lost some of its antibacterial properties. Instead, check out this post for some ideas on what to use breastmilk for that is no longer safe for consumption. It isn't known how safe it is to keep fresh breastmilk left in the bottle after a feeding. It should certainly be used within 1-2 hours. Avoid eating previous milk by offering small amounts at a feeding.

Away from home
Expressed breastmilk can be kept in a common fridge at work or at the childcare center. Label clearly. If a fridge isn't available, place it in an insulated container with deep frozen icepacks. With enough icepacks, milk will stay at fridge temperatures for us to 24 hours. Icepacks are also useful when carrying milk home from work or to childcare, especially on warm days. But breastmilk can be safely refrigerated or frozen after shortchanged periods of storage at hight temperatures.

Soapy smell? Rancid smell?
If you plan to store large amounts you could try freezing a small batch for a week before defrosting and tasting it. Some mothers notice their milk smells slightly soapy once defrosted, sue to high levels of lipase, the enzyme that breaks down fat. The milk is still safe to use but some babies refuse to drink it. Heating milk to a scald (bubbles around the edges, not boiling) then quickly cooling it before freezing can deactivate the lipase.

Freezing deactivates yeast but doesn't kill it, but there is no current evidence the milk frozen when you and your baby have thrush with reinfect you later.

There isn't yet complete agreement about storage times. But it's always preferable to store milk for as short a time as possible to ensure:
  • Minimal growth of bacteria
  • Minimal loss of antibodies and nutrients
Laboratory studies have shown that breastmilk becomes less resistant to bacteria with time, but most of the bacteria found in breastmilk are harmless skin bacteria and not illness-causing ones.

The longer you store your milk, the more care you need to take about:
  • Cleanliness while expressing, storing and handling milk
  • Storing milk at appropriate temperatures (use fridge and freezer thermometers)
  • Checking for bad taste and smell, which will show if your milk has gone off. If milk has gone bad, consider using it for other uses as mentioned in this post.
If any family members are ill, especially with scenes and diarrhea, your baby will be better off with fresh milk rather than frozen. The most recent milk from your stores will offer him/her the best protection from the illness. You may prefer not to freeze your milk until everyone is better.

Source: written by Karen Butler, Sue Upstone and mothers of the La Leche League Great Britain