There are a number of reasons you may find it helpful to express milk:
- To help your baby attach more easily if your breasts are very full (express just a little before you offer the breast to your baby).
- To relieve an uncomfortable breast and clear blocked areas if you feel ‘lumpy’ after your baby has fed.
- To rest a sore nipple and allow it to heal (although if the reasons for sore nipples are addressed – eg positioning , this may not be the best option – be guided by your carer).
- To stimulate your milk supply if you have low supply or if your baby isn’t sucking effectively.
- Because you have to be separated from your baby if you or your little one are unwell or your baby is premature and hospitalized.
- To leave milk for your baby to drink if you leave him with a carer, whether this is an occasional separation or you are returning to work.
Expressing breast milk can seem tedious and it can also fill you with self-doubt as you see the amount and wonder, is this enough? Please don’t worry if you don’t seem to be expressing very much. Whether you use a breast pump or hand-express, your well baby’s sucking action will be far more effective at taking milk from your breasts – he will almost always get more milk feeding directly from the breast than you will when you express.
Breast pumps are useful if you need to express longer term – a good electric breast pump will stimulate and maintain your milk supply more efficiently over time if you have a premature or sick baby or are returning to work. However, learning to express by hand is useful for all breastfeeding women and, if you choose to express colostrum ante-natally or you need to express in the first few days after birth, you will need to express by hand (otherwise the small amount of colostrum (first milk) will be ‘lost’ as it sticks to the tubes of a breast pump).
Hands-on pumping
In my lactation practice, I have found the most effective way to express breast milk, if you need to do this for an extended time, is to use ‘hands-on’ pumping with a double system electric breast pump (that pumps both breasts at once -you can hire these from some pharmacies and the Australian Breastfeeding Association). This technique can speed up expressing time and boost your supply.
Although it's commonly thought that an electric pump is the best way to express milk, a Stanford University study (Morton 2009) of mums expressing for premature babies, found that the suction of an electric breast pump could not reliably remove all of the milk from these mums. However, hand massaging and compressing those areas of the breast that felt firm improved milk removal.
In this research, mothers were taught to use their hands to express colostrum (early milk) during the first three post partum days. Once milk volume increased, they were instructed to use a technique called ‘hands-on pumping’, using both an electric pump and hand compression as they pumped and massaged firm areas and, after the milk slowed to revert to hand-expressing.
Mothers of babies born before thirty weeks of gestation who hand expressed colostrum more than five times a day in addition to pumping, and then used hands-on pumping for eight weeks, produced an average of almost double the amount of milk than mothers who pumped only. The hands-on mothers were even able to express less frequently, and by eight weeks postpartum, could sleep longer at night.
The great thing is that this method of expressing is effective for any mother who wants to express breast milk -you don't have to have a sick or premature baby to benefit from 'hands-on pumping. And, by emptying your breasts more effectively you will be giving your body a clear message to make more milk.
Hands-on pumping – how to do it:
- If you are separated from your baby, begin hand-expressing within six hours of birthing your baby.
- If you are exclusively pumping, use a hospital-grade breast pump with a double pump kit (so you are expressing both breasts at once) eight times or more every twenty four hours for a newborn.
- You don’t need to pump on a regular schedule; express whenever it’s convenient perhaps some shorter sessions during the day and a longer one when it's more convenient such as at night when baby is asleep.
- Make sure the pump flanges (the part that fits over your nipple) are the appropriate size so they are not pinching or hurting.
- A specially designed pumping bra will make hands-on pumping simple by holding the pump flanges firmly in place, allowing you to use your hands to massage and compress your breasts as you pump.
- Start with slow massage to stimulate let-down (milk flow). When you massage, pay special attention to the outer areas of your breast – massaging and compressing high up on your breasts (not down near your nipples).
- Apply the breast pump and use the maximum suction level that is comfortable. Not painful. Pumping should never hurt.
- Watch the sprays of milk and adjust your hand position to where milk flows more easily.
- When the sprays of milk subside, switch to single pumping so you can be more vigorous with the massage – using two hands to massage.
- When the sprays of milk subside again, turn off the the pump and hand massage into the pump flange. Some mothers can double their output this way. These later drops will be rich in hind-milk, the highest fat content milk, which is especially beneficial for a premature baby in need of calories.
- Empty your breasts so there are no lumpy areas.
- Watch the Stanford University video – Hands-on Pumping.
If pumping is stressful
If you need to express to maintain supply and you find it stessful to fit in longer pumping sessions, it may be easier to simply keep your pump handy (for a healthy full-term baby you can store your pump parts in a container in the fridge rather than washing and sterilising each time) and pump for short periods during the day then relax and do a longer session at a time when your baby (or other children) are in bed or napping.
Power Pumping
Ideally if you need to boost your milk supply, the best way is to snuggle your baby skin to skin and feed frequently. However, If you are separated from your baby (ie a premmie) or you have a baby who has difficulty latching and you need to express to increase supply another helpful technique is 'power pumping'. (Caution: if you already have a good milk supply, this could push you into 'oversupply' ). Power pumping mimics 'cluster feeding' and signals your body to increase production. It requires a time committment but you only need to do this once or twice a day (along with breastfeeds or regular pumping sessions if you are exclusively expressing and not feeding at the breast) to see results within a few days. You can also use 'hands on pumping' as you do this.
To Power Pump: Pump for 20 minutes;
Rest for 10 minutes;
Pump for 10 minutes;
Rest for 10 minutes;
Pump for 10 minutes.
A double electric pump is most effective - otherwise if you use a single pump, instead of the rest periods, switch breasts and pump the other side.
Storing Breast Milk -
For information about safely storing your expressed milk, see our blog 'Everything You Need To Know About Storing and Feeding Expressed Breast Milk'. by Pinky McKay IBCLC Lactation Consultant.
More info for expressing breastmilk:
To make pumping easier, whether you want to 'double pump' hands free or whether you find it easier to pump one breast while your baby feeds from the other side, check out these beautiful combined nursing and pumping bras, that you don't have to change out of to pump.
If you are expressing for a baby in hospital or you are working and breastfeeding, throw some Boobie Bikkies or Boobie Broth Powder (just stir into a cup of boiling water to drink) in your bag so you have nourishing snacks to support and sustain you. You could also fill a thermos or insulated drink bottle with refreshing Boobie Tea (hot or iced) to sip through the day.
