Breastfeeding is the biologically normal way to feed a baby and there are significant risks associated with reduced breastfeeding for both mother and baby. For instance, substituting breast milk with any of the range of available alternatives increases a mother’s risk of developing breast and ovarian cancer, and increases a baby’s risk of suffering from SIDS, gastrointestinal infections, respiratory infections, ear infections, cavities, obesity and a reduced IQ (https://www.breastfeeding.asn.au/bfinfo/health-outcomes-associated-infant-feeding). As a result of this, many mothers aim to either exclusively breastfeed their babies or maximize the amount of breastfeeding they can accomplish.
Exclusively or even mostly breastfeeding a baby doesn’t necessarily mean that mothers have to direct-latch breastfeed all the time, however. sometimes direct-latch breastfeeding isn’t possible or there may be another reason why direct-latch breastfeeding isn’t ideal in a particular circumstance. That’s why being able to express breast milk can be such a valuable skill for many mothers.
Unfortunately, just as breastfeeding can be really hard sometimes, so too can expressing. That’s why we’ve put together this article on how to express breast milk. We believe all mothers should be able to take advantage of this skill if they want to.
If you’re not sure where to start with expressing breast milk or you’ve had some trouble, don’t be perturbed. The below information will give you a really good grounding to get you started in the right direction.
Why mothers express breast milk
The reasons why you want to express breast milk can have an impact on how you go about pumping that precious liquid. So, before we dive into tips and techniques, let’s examine some of the most common reasons for wanting to express breast milk.
Separation - One of the most common reasons why a mother might choose to express breast milk is because she is going to be separated from her baby. This might be an occasional separation, such as when a relative offers to babysit, or it might be a regular separation, such as when she returns to work and Bub attends some form of child care.
Bonding with other caregivers - A mother might choose to express breast milk even when she isn’t being separated from her baby so that her partner or another caregiver can bond with Bub through feeding. While there are many ways for carers to bond with a baby, feeding is often a particularly cherished method so expressing under these circumstances can be a real gift to another special person in Bub’s life.
To give the mother more time to sleep - Having a baby can mean many sleepless nights. In some households, a mother will choose to express breast milk so that her partner can feed their baby when he or she wakes for at least one of the night-time feeds and allow the mother to get a bit more sleep.
Top-up feeding - Sometimes a medical professional will recommend that mothers express breast milk in order to provide a top-up feed. This is fairly common in some areas when a baby isn’t gaining weight at the expected rate.
Direct-latch breastfeeding difficulties - Sometimes direct-latch breastfeeding may be difficult for a mother and baby. This could be as a result of a physiological impediment to direct-latch breastfeeding, such as a baby’stongue-tie, or it might be a psychological impediment, such as an association between breastfeeding and a trauma. Some babies, likeRebecca’s Bub, develop an aversion to breastfeeding, and premature babies sometimes have difficulty breastfeeding initially. All of these situations are examples of when a mother might choose to express breast milk so that her baby gets the benefits of breast milk without having to direct-latch breastfeed.
Maintain or increase milk supply - When a mother wants or needs to increase her milk supply she might regularly express some breast milk. Usually, she’ll do this immediately after her baby has direct-latch breastfed or she may even express from one breast while Bub feeds from the other. Alternatively, if a mother has to temporarily stop breastfeeding for any reason, say she needs to take some medication that is known to cross into breast milk (and which is known to be harmful to babies), she can help ensure her milk supply remains at the same level by expressing (and discarding) her breast milk when her baby would usually be feeding.
Personal choice - Sometimes a mother may not want to direct-latch breastfeed for whatever reason but she may still want her baby to benefit from her breast-milk. This is yet another example of a situation in which being able to express is of great benefit to a mother and her baby.
Milk donation - Some very special mothers choose to express milk in order to donate it to babies in need. This is an amazing gift to give a family member, friend or complete stranger.
3 Ways to express breast milk
There are three ways to express breast milk:
Hand - Expressing by hand is the cheapest method of expressing breast milk as you don’t need any equipment (other than something to collect the milk in of course). Some mothers have great difficulty expressing by hand, however. It can also be tiring and time-consuming. This is a great option if you only need to express occasionally or for a short period of time. It is also a great option if you need to express colostrum during pregnancy or postpartum but before your milk comes in as it is recommended that youdon’t use any kind of pump until your breast milk has come in.
Manual pump - Using a manual pump to express breast milk can save time and simplify the process. Manual pumps are usually cheaper than electric versions.
Electric pump - Electric breast pumps make expressing breast milk easier for many mothers as they pretty much automate the process. Electric pumps are the most expensive option, so do your research to find one that you think will be best for your short-term needs as well as your longer-term goals for supporting your continued breastfeeding. Perhaps the best thing about electric pumps, for those mothers who are not expressing from one breast while feeding from another, is that you can choose to use a double pump setup that will enable you to express from both breasts at the same time. This can obviously save a lot of time.
How to express breast milk
Whether you’re breastfeeding, expressing by hand or expressing using a breast pump, there are a few aspects of extracting breast milk that are universally relevant. This is the process:
- Your nipples contain a large number of nerve endings, making them quite sensitive. When suction is applied to your nipple, either by your baby sucking or a pump applying suction (and when you massage your breast if you’re expressing by hand), the nerves detect that sensation and signal your breasts to produce a variety of hormones that flow into your bloodstream and trigger some important responses.
- Prolactin, one of these hormones, stimulates your breasts to produce more milk.
- Oxytocin, another of these hormones, stimulates the ‘let-down’ reflex, which releases the milk your breasts have already produced and stored. (Sometimes other cues also cause oxytocin to be released, such as a baby crying - that’s why some women’s breast leak when they hear a baby crying.) Anxiety can slow this process down so, when expressing, try to remain calm and relaxed. If you’re anxious, your let-down will still occur, it will just take longer. If you’re expressing when your baby is around, it may help to have your baby nearby. If Bub isn’t around, some women find it helpful to think about their baby or look at a photo of Bub.
- Your milk can then either be drunk by Bub or collected.
- The milk that your breasts release early during a feed or when expressing, is lower in fat. This milk is good for quenching your baby’s thirst.
- As a feed or expressing session continues, the fat content of your milk increases. This milk, also called the ‘hindmilk’, is good for satisfying your baby’s hunger. It is important that you collect the early milk and the hindmilk when expressing so that all your baby’s milk needs are met.
The aspects of expressing breast milk that vary between methods are detailed below.
When expressing by hand, you can’t apply suction to your breast. So instead, you start the process by massaging your breasts with the flat of your hands. When doing this, start close to your chest and work out towards each nipple.
Next, gently roll and stretch your nipple between your thumb and index finger. Then position your hand with those fingers at the edge of your areola (the darker area around your nipple); put your thumb above your nipple and your first finger below it.
Once in this position, gently press your fingers towards your chest (this moves your fingers towards the back of the milk ducts) and then squeeze your breast, moving your fingers back towards their starting position (this pushes the milk down the ducts towards your nipple).
Do this pumping action a few times until you start to see drops of milk appearing on your nipple. Rub these first drops into your nipple in order to further stimulate your let-down and help your milk flow better. Once you’ve done that, continue pumping and begin collecting your milk in your chosen vessel.
As the flow of your milk reduces to just a few drops, move your fingers onto another area around the edge of your areola so that you can gather milk from other ducts. It’s a good idea to switch hands regularly, perhaps every time you need to reposition your hand, so that your hand doesn’t get too tired and sore.
Depending on your circumstances, you might continue pumping until you cannot extract any more milk from your breast. If you’re going to express from both breasts, you may wish to have a break in between breasts to give your hands a rest, especially if you’re not used to expressing by hand. With practice, many women find they can express both breasts in about half an hour.
Expressing with a manual breast pump
If you want to express breast milk using a manual breast pump, start by assembling the pump according to the manufacturer’s instructions. Once you’re all set up, you can then begin expressing in the same way as you would if you were expressing by hand as you’ll need to stimulate your let-down reflex by hand before the pump can extract any milk (see the instructions for hand expressing above).
Once your milk is flowing well, you can then position the pump. To do this, position the flange of the pump over your nipple and press it gently but firmly against your breast.
Once it’s in position, you simply squeeze and release the pump handle rhythmically. Your milk should soon begin to flow into the bottle attached to your pump.
If you experience any pain or discomfort, you might need to adjust the suction level, reducing it until expressing becomes comfortable.
Many mothers like to finish expressing by hand as they find it helps them remove extra drops of the rich hindmilk.
Expressing with an electric pump
If you choose to express using an electric pump, start by assembling your pump according to the manufacturer’s instructions. You can then position the flange over your nipple and press it gently but firmly against your breast.
Once it’s in position, follow the manufacturer’s directions for safe use. Usually, there will be a button to press that starts a suction cycle designed to stimulate your let-down reflex and then another button that starts a suction cycle designed to express your milk.
If you experience any pain or discomfort, you might need to adjust the suction level, reducing it until expressing becomes comfortable.
Even when using an electric pump, many mothers like to finish expressing by hand to remove extra drops of the rich hindmilk.
To ensure your baby’s safety, always wash your hands thoroughly before expressing breast milk. You must also make sure all your feeding equipment, including the breast pump components and your baby bottles, are completely clean and, ideally, sterilized (for components that can be sterilized).
What to look for in a breast pump
Regardless of whether you’re interested in buying a manual or electric breast pump, there are a few characteristics you’ll want to look out for. A good pump should be:
- safe to use - no pump should risk damaging your nipples or areolas, nor should a pump cause muscle strain
- effective - if you find lots of reviews of a specific pump that claim that the pump isn’t actually very good at extracting milk, then that model is unlikely to be worth your while
- easy to use - if a pump is too hard to use you’ll just end up looking for another one, switching to expressing by hand or giving up on expressing entirely, so make sure the model you choose has good, easy-to-follow instructions
- economical - this doesn’t necessarily mean it needs to be the cheapest model that will do the job but the price of the model you choose should make sense in the context of how much you’ll be using it
If you’re interested in buying or hiring an electric breast pump, it’s also a good idea to choose a model that has adjustable suction. If the suction is too high, it won’t extract any extra milk and expressing may be painful and cause damage to your breast.
Top tips for expressing breast milk
Learning to express breast milk can be hard but the potential reward can be huge. For the greatest chance of success, here are some tips that you might find helpful:
- be patient - give yourself time to learn the skill and don’t just give up if you don’t succeed the first time you try
- aim to either direct-latch breastfeed or express every 3-4 hours during the day and every 5-6 hours during the night (at least once overnight) to avoid engorged breasts as engorged breasts can be uncomfortable and both difficult to express from and hard to latch on to (for Bub)
- if your baby would feed more often than the above guidelines, express as often as your baby would feed as this will help you maintain the level of milk your baby needs
- if your baby isn’t getting enough expressed milk this way, express even more often (perhaps as often as every 2 hours) as expressing doesn’t always extract as much milk as a baby can
- express at least once between midnight and 4am as prolactin is highest at that time and expressing when prolactin is highest will help build a better milk supply
Where to get help with expressing breast milk
If you need additional help to enable you to successfully and consistently express your breast milk, there are a number of places you can turn to for help:
- the midwives from the hospital where you gave birth (if you gave birth in a hospital)
- a maternal and child health nurse
- a lactation consultant - this is a professional who specializes in helping mothers with breastfeeding
- your GP or obstetrician
- a breastfeeding or lactation association in your area if there is one.