Breastfeeding - expressing breastmilk

Breastmilk can be expressed by hand, or with a manual or electric breast pump. Breastmilk must be collected and stored correctly to prevent the risk of bacterial growth.

Mothers express breastmilk for a variety reasons

Mothers may need to express breastmilk for a variety of reasons. These may include:

• The baby needs extra breastmilk as a ‘top-up feed’ following a breastfeed.
• The baby may not be feeding well at the breast.
• The mother is going back to paid work.
• The mother may prefer to feed using a bottle with breastmilk.
• The mother is going to miss a feed and needs the baby to be fed by someone else.
• It helps increase the mother’s breastmilk supply.
• It helps if the mother’s breasts are feeling too full.

How breastmilk is produced

Breastmilk is produced and stored inside the breast in tiny sacs called alveoli, and travels to the nipple via milk ducts.

When the baby needs breastmilk a ‘let-down’ reflex is triggered when the nerve endings in the nipple are stimulated by either the baby sucking at the breast or by the mother expressing the breast.

Hormones play an important role in breastmilk production. When the nipple is stimulated, a signal is sent to the pituitary gland in the brain to release a hormone called oxytocin. Oxytocin causes the milk-filled alveoli to squeeze milk into the ducts where it travels down to the nipple and begins to drip out.

A baby’s suckling at the breast is the most successful trigger, but stimulating the breast by hand (combined with breast massage and breast expression) can also start the let-down.

3 ways to express breastmilk

Between 24 to 72 hours after you give birth, your breasts feel much fuller. This is referred to as your milk ‘coming in’.

By about 7 days you can expect to produce about 500 ml of breastmilk in a 24-hour period. This increases to about 600 to 700 ml over the following 2 to 3 weeks. Breastmilk can be expressed by:

• hand
• hand-held breast pump
• electric breast pump.

Expressing breastmilk by hand

Expressing breastmilk by hand is a cheap and convenient method. Once you master the skill, you can express your milk at any time. It also means you don’t have to buy or hire any special equipment, which (particularly in the case of electric pumps) can be expensive.

It may take a little practice to learn this skill, but it is worth the effort. Before preparing to hand express:

• Wash your hands thoroughly with soap and water.
• Try to relax as the let-down reflex can be delayed by anxiety. It may help to have your baby close to you. Have a photograph nearby or think about your baby.
• Massage your breasts for about a minute with the flat of your hands, working towards each nipple.
• Place a finger and your thumb either side of the nipple at the base and gently stretch and roll the nipple.
• Place your thumb above your nipple at the edges of the areola (dark area around the nipple), or about 2 cm from your nipple and your first finger below.
• Using your thumb and finger, gently press your breast tissue back towards your chest wall and squeeze. The breastmilk will move down the ducts. Drops of breastmilk should soon appear on your nipple. There is no need to move your fingers towards your nipple while squeezing, the milk will flow when you compress your breast.
• Rhythmically squeeze (about once per second). The breastmilk will soon begin to flow – sometimes even squirting out.
• Sometimes your hand may become tired so switch hands regularly.
• Once the breastmilk dwindles to a few drops, try moving to another area of your breast and continue to press and squeeze.

You can watch a video and learn more about hand expressing from the Australian Breastfeeding Association.

Expressing by hand takes time

You will need to set aside adequate time to express each breast. Repeat the above technique on each breast. If you express each breast 3 times, for 5 minutes, it will not take more than half an hour to express both breasts.

Even if you use a pump, it is a good idea to finish off the expressing session by hand as hand expressing is very effective, especially when the breast is less full.

Breast pumps

Many mothers prefer to use either a manual or electric breast pump. They find it is quicker and may help with milk production.

Breast pumps can carefully be used from birth in combination with hand expressing. Your midwife will help in this situation.

There are numerous breast pump designs on the market. Some are well designed, others are not so good. A breast pump must be:

• effective
• comfortable
• easy to use
• safe to use – that is, it should not damage the nipple or areola, or cause muscle strain
• economical.

Getting started

Suggestions for using hand-held and electric pumps are as follows:

• Stimulate the let-down reflex by hand. Once the milk has started flowing, start using the pump.
• Place the pump shield directly over your nipple (make sure your nipple is in the centre) and hold it firmly against your breast.
• Rhythmically squeeze and release the hand pump handle.
• Or with an electric pump start with low pressure and then slowly increase the pressure to your level of comfort.
• If it is painful, check that the breast shield is centred directly over your nipple and reduce the suction.
• Milk will begin to flow into the collection bottle.
• Adjust the suction strength so that it is comfortable and not causing any pain or discomfort. Excess suction will not result in the removal of extra milk, and may result in pain and nipple damage.
• Finish expressing by hand for a few moments to help with getting as much breastmilk as possible.

Electric breast pumps

Some mothers choose an electric breast pump.

Hospital-style electric breast pumps are designed for women who have a baby in Neonatal Intensive Care Unit (NICU) to establish breastfeeding and express very frequently – more than 4 times day. They cost approximately $30 to $35 per week to hire and are available from many pharmacies. However, be aware that most pharmacies will require a large refundable deposit ($200+) for the pump.

Smaller electric breast pumps can be purchased and are suitable for expressing 1 to 2 times per day.

The Australian Breastfeeding Association has breastfeeding and expressing information, and hire pumps at very reasonable rates. You can choose double pump kits that allow you to express from both breasts at the same time.

General tips for expressing breastmilk

General suggestions for expressing breastmilk include:

• Give yourself time to learn how to express breastmilk. Don’t hesitate to ask for professional help.
• Express as often as you would breastfeed in order to maintain your breastmilk supply. For example, if your baby feeds 8 times over a 24-hour period, you need to express at least 8 times.
• Express more often if you find you need to increase your breastmilk supply. You can express every 2 hours during the daytime for one to 2 days.
• If your baby cannot breastfeed and you are trying to establish your milk supply, you will need to express 8 to 10 times over a 24-hour period.
• Express at least once overnight to maintain your breastmilk supply. Babies normally breastfeed at least once overnight, and you are trying to express as though your baby is breastfeeding.
• Most women will use a bottle to give their expressed breastmilk to their baby, however some may choose to use a cup. It is best to discuss the best way to feed your expressed milk to your baby with your maternal and child health nurse.

Supplementary feeds

Avoid using supplementary bottles of formula. Your breasts operate on a system of ‘supply and demand’. If breastmilk is removed, your body will make more; if you leave it in your breasts, you will stop making breastmilk.

Storage suggestions

Breastmilk must be stored correctly to reduce the potential for bacterial growth. Suggestions include:

• Use fresh breastmilk whenever possible.
• Express into clean and sterilised containers. These may be glass, plastic (BPA-free) or sealable plastic bags.
• Label each container with the time and date the breastmilk was expressed.
• Refrigerate the breastmilk within one hour of expressing.
• Store breastmilk in the back of the fridge where it is coolest (4°C or lower), not in the fridge door, if you are going to use it within the next 3 to 5 days.
• Freeze excess breastmilk if you produce more milk than your baby requires.
• Freeze refrigerated breastmilk immediately if you are not going to use it in the next few days.
• Do not top up refrigerated or frozen breastmilk with fresh breastmilk unless it has been chilled first.
• The shelf life of frozen breast milk depends on your freezer. If your freezer is inside the fridge, storage time is 2 weeks. If your freezer is separate from the fridge with its own door, storage time is up to 3 months. Breastmilk can be stored for 6 to 12 months in a deep freezer (-18°C or lower).

Thawing and heating of breastmilk

Breastmilk must be thawed and heated correctly to reduce the potential for bacterial growth.

• Thaw frozen breastmilk by moving it from the freezer to the fridge for slow thawing over 24 hours.
• You can also run cold water over the container and gradually increase the temperature of the water. Do not overheat the milk as it will destroy some of the nutrients and may burn the baby’s mouth.
• Never use the microwave. It is a potentially dangerous practice as it can cause ‘hot spots’ in the milk that may burn your baby’s mouth.
• Frozen breastmilk that is thawed in the fridge (but not heated) will last 24 hours in the fridge and 4 hours at room temperature. It cannot be refrozen.
• If breastmilk has been thawed outside the fridge, using warm water, it will last for 4 hours in the fridge, but cannot be refrozen.

Hygiene is important

Unwashed hands and unclean pumps or bottle-feeding equipment can contaminate breastmilk. Hygiene suggestions include:

• Wash your hands thoroughly before expressing.
• Make sure all equipment, including the breast pump and bottles, are clean.
• There is no need to sterilise the equipment after each use. Wash thoroughly in hot soapy water, rinse in hot water, air dry and store in a clean covered container.
• It is advisable not to share breast pumps.

Where to get help

• Maternal and child health nurse – contact your local council for the address of your nearest child and maternal health centre
• Australian Breastfeeding Association Breastfeeding Helpline Tel. 1800 686 268
• Breastfeeding clinics – many hospitals have breastfeeding support programs
• Your GP (doctor)
• Midwives from the hospital where you gave birth
• Lactation consultant – a list of private lactation consultants practising in your area can be found at Lactation Consultants of Australia and New Zealand (LCANZ)
• Maternal and Child Health Line (24 hours) Tel. 13 22 29