Expressing and storing breast milk safely
Expressing breast milk can give you flexibility and some respite from frequent breastfeeding. Whether you decide to express by hand or with a pump, here’s what you need to know about expressing milk and how to store and use it.
Why should I express milk?
Not every mum feels the need to express breast milk but doing so comes with a number of benefits.
It gives you a break. Expressing milk allows other people, such as your partner, the opportunity to feed your baby using a bottle. This is known as mixed feeding, where you combine breastfeeding and bottle feeding without your baby missing out on the benefits of breast milk. It gives you some respite – and even means you could get someone else to take on a night feed. And you know what that means… that’s right, sleep.
It gives you flexibility. If you are planning a big night out, giving your baby milk that you’ve expressed beforehand will eliminate any chances of alcohol entering his system through your breast milk, should you have a glass or four of wine.
It boosts your milk supply. Milk production works on a supply-and-demand basis. When your breasts are empty, it sends a signal to your milk ducts to produce more. Expressing milk between feeds keeps your body in milk-production mode.
It can help a premature baby. If your baby is born very early, he may have to spend some time in a neonatal unit, making it difficult for you to feed him on demand, and many prem babies haven’t yet developed the suckling reflex or are too young to digest formula. You may be encouraged to express milk so that it can be fed to your baby. Very premature babies are usually fed intravenously through a tube – if their digestive system is developed enough, breast milk can be fed through this tube. As he gets older, neonatal nurses will bottle feed your baby with the expressed milk and you may even be able to get breastfeeding started once he’s big enough to be able to suckle, if you’ve kept up your supply by expressing.
It relieves engorgement. If your baby is not emptying the breast at a feed or you have an oversupply of milk, it can leave your breasts feeling full and engorged. Engorged breasts that are not relieved through frequent feeding or additional expressing can develop into blocked ducts and mastitis.
It allows you to return to work. If you want to continue to give your baby breast milk at this point., expressed milk can be fed to your baby by his carer while you’re at work. You may need to continue to express milk during the day at work in order to prevent engorgement. Although there is no legal requirement for an employer to give you breaks at work in order to express, most do show some flexibility. If you are returning to work, speak to your HR department or your manager to explain your commitment to breastfeeding and your need to slip away and express milk.
When should I start expressing breast milk?
Although there are no steadfast guidelines about when to begin expressing breast milk, it is advisable to wait until your breastfeeding routine is established. Try to spend the first four to six weeks focussing on your routine with your baby and getting technique and latch right before introducing yet another new practice to master.
If you are feeding your baby on demand and also expressing milk, you could risk sending your milk supply into overdrive. If you do need to express milk in order to relieve a feeling of fullness in your breasts, then pumping occasionally and for a short period of time shouldn’t cause any upset to your routine or your milk supply – just don’t overdo it.
How do I express milk?
You can express milk either by hand or with a manual or electric pump. Here are some tips on the how much, when and where:
I used to express for my twins first thing in the morning (about one hour after their first feed) to use for night feeds. I found I would get twice as much in the morning than in the evenings.
Pick the right time and place. Choose somewhere that you are comfortable and won’t be disturbed when you are expressing for the first time. You’ll also find it easier to express at certain times of the day. If your breasts are feeling full, it will be easier to release milk.
Lower your expectations. Most women don’t fill a whole container on their first attempt so don’t be hard on yourself if you only get a couple of ounces. It has nothing to do with your milk supply and everything to do with practice. The more you express, the easier it becomes.
Have your baby nearby. Skin-to-skin contact is the best way to trigger the release of milk. If it’s not possible to have your baby nearby, then you could try keeping a photo of her or a piece of her clothing nearby to help stimulate that mother-child bond and get the oxytocin (happy hormones) flowing.
Leave some time between feeds before expressing. If you’ve just emptied your breasts during a feed, you’ll find it hard to produce anything when you express. Similarly, if you express right before a feed, there’ll be nothing left for your baby. Try to space it out.
Expressing milk by hand
Expressing milk by hand is definitely the cheaper and most convenient option. You can do it anywhere without having to lug a breast pump around with you.
Although it can take a bit of getting used to, some mothers prefer to express by hand, particularly in the first few weeks when nipples may be tender from breastfeeding. The skin-to-skin contact that comes with hand expression also helps to stimulate the let down (the release of milk).
Here’s what you need to know about expressing by hand:
- Always wash your hands before starting.
- It can help to apply some warmth to your breast beforehand or massage them.
- Hold a sterilised milk container, bottle or breast milk storage bag beneath your breast with one hand, ready to catch the milk.
- Cup your breast with the other hand and with the forefinger and thumb, form a c-shape and press on the milk ducts. Keep your fingers on the outer edges of the areola as the milk ducts sit behind there. It won’t help to squeeze your nipple and will probably just make it sore.
- As you apply pressure, drops of milk will appear and eventually milk will start to ‘spurt’ as you squeeze.
- Release the pressure, go again and steadily build up a rhythm.
- Once the milk is flowing, work around the breast, so you’re emptying all the milk ducts. If you’ve ever milked a cow or goat it will probably all come flooding back to you at this point.
- Swap breasts and repeat the above steps.
Expressing milk with a breast pump
Breast pumps can be easier to use than doing it by hand. They’ll do the stimulation for you and often more effectively, helping to maintain a good milk supply.
You can get a manual pump or an electric one and it really boils down to preference – different pumps suit different women. Before purchasing your pump, read Mumsnetters' reviews of what’s on the market. Electric pumps require little effort – you put the suction cup over your breast and let it do the work. Manual pumps require you to squeeze a handle to extract the milk and can make the process longer but they do offer more control.
Both come with a bottle attached. Make sure your breast and nipple fit the suction cup adequately. You can get different cups and funnel sizes for different sized breasts and nipples. You can also hire a breast pump if you don’t want to invest in one.
Before using a pump, here’s what you you need to know:
- Make sure your breast pump and its parts are sterilised and clean before use each time.
- Make yourself comfortable. As with hand-expressing, you’ll have more success if you’re relaxed. It can also take a while. If you’re pumping from both breasts, it can take up to an hour.
- Again, be patient. Just because you’re using a pump, doesn’t mean you’ll be filling multiple bottles straight away. It can take a few attempts to get it right.
- Support your breast and place it into the suction cup, ensuring that your nipple fits into the funnel.
- Try to maintain a seal between the funnel and your skin without causing pain. Pumping shouldn’t hurt. If it does, take it off and reposition.
- Pump until the milk flow slows down and then switch breasts.
“The more you express, the more you'll produce. Babies are so much more efficient than pumps. The majority of mums find it scary and hard at first but it’s gets easier.”
How should I store breast milk?
The antibodies in breast milk mean it can be successfully stored without risk of spoiling. Even at room temperature, freshly expressed breast milk will keep for four hours. When storing expressed milk, keep in mind the following:
- Make sure to store it in sterilised containers or specially designed breast milk storage bags.
- Make sure you label and date your milk to make it easier to track its expiration.
- Store it in small quantities to prevent waste.
- When refrigerating, keep it at the back of the fridge where the temperature is coldest, never in the door.
- Breast milk can be stored for up to five days in a fridge that is 4°C or lower. If your fridge is warmer than 4°C or you are unsure of its temperature, then only store for three days.
- Breast milk can be stored for up to two weeks in the freezer compartment of a fridge or for up to six months in a standalone freezer. A standalone model, such as a chest freezer, maintains a consistently lower temperature that of the freezer compartment in your fridge.
- If you are heading out for the day or on a long trip, then it’s good to know that breast milk that’s been chilled in a fridge will keep for up to 24 hours when carried with ice packs.
- Frozen breast milk should be defrosted slowly in the fridge but if you’re in a hurry you can run it under warm water. Do not use a microwave to defrost breast milk – it will defrost unevenly and can kill off antibodies in the milk.
- Never refreeze defrosted milk.
- If you want to warm breast milk to body temperature do so by running a bottle under a warm tap or sitting it in some warm water. Again, avoid using a microwave as it won’t heat evenly and hot spots may burn your baby’s mouth.
- Once your baby has drunk from a bottle of expressed milk, it should be used up within an hour.
How should I feed my baby expressed milk?
The most common way to feed your baby expressed milk is in a bottle. If you want to continue breastfeeding, it’s advisable to only introduce bottles once your breastfeeding routine has been established, usually four to six weeks in. Some midwives advise that the use of an artificial teat too early on could cause ‘nipple confusion’ and latching on problems.
Bottlefeeding also requires a different suckling action than breastfeeding so it may take your baby a little while to get used to it. If you have a specific reason for giving her expressed milk, such as returning to work, then you may want to introduce the bottle in advance to allow her time to get used to it.
If your baby was born prematurely, then she is likely to be fed either through a tube or with a syringe to begin with. A syringe or dropper can also be used to feed a full-term baby who is having trouble taking a bottle, or even breastfeeding.
If your baby has refused to take a bottle despite your own perseverance then you could also try giving her milk using a sippy cup. Sippy cups are usually introduced at around 12 months but some babies are able to use them as young as six months. She may need a bit of support to hold it while she feeds at first.
I can’t express breast milk. What should I do?I think that expressing is something of a learned skill, just like breastfeeding. You'll get used to what time of day is best and how to get more milk.
Every woman is different and while some take easily to expressing milk, others find it a challenge.
Let’s be honest, there are times when it can feel just plain undignified to have a mechanical contraption attached to one of your most intimate parts. If you’re pumping at work, then it’s likely to feel even more uncomfortable.
Very often the difficulty can be that your baby is not there. After all, it is the skin-to-skin contact with your little one that stimulates your body to produce milk in the first place.
If you are struggling to express, consider the following:
- Is it your breast pump? Some mothers find it harder to express with a manual pump than with an electrical one. Even if you are using an electrical pump, you may find it helpful to upgrade to a double-breast electric pump, which is more powerful.
- You’ll be more successful if you have an established milk supply. Staying hydrated and feeding or pumping frequently will help your milk supply.
- If you can master it, you could try feeding your baby on one side and expressing on the other. It’s a bit like rubbing your head and patting your tummy at the same time but it does help to trigger milk release. It can cause a distraction for some babies so this technique won’t be suitable for everyone.
If expressing milk is important to your feeding routine, it may be worth going to see a lactation consultant or visiting your local breastfeeding support group for advice. There are also plenty of tried-and-tested tips to be shared on Mumsnet Talk.