All about Expressing
When direct breastfeeding isn't possible, expressing milk is a great alternative to ensure babies still receive the vital nutrients and immune support that breastmilk offers. Breastmilk is uniquely designed for human infants. It contains water, fat, carbohydrates, proteins, vitamins, and minerals in proportions ideal for a baby’s growth. It also includes valuable components not found in formula, such as enzymes, antibodies, hormones, growth factors, and essential fatty acids. As your baby grows and develops, your milk naturally adjusts to meet their changing nutritional needs.
If your baby is not ready to breastfeed immediately after birth (perhaps due to prematurity or medical treatment) you can begin expressing your milk to be fed in another way, such as through a supplemental nursing system (SNS). Start expressing within six hours after birth if possible. Early milk, called colostrum, is rich in nutrients and antibodies. Hand expressing is especially effective at this stage, as it allows you to collect every drop of colostrum using sterile syringes or small containers. Even if you're only producing a few drops at first, that's completely normal; frequent expressing will gradually increase your supply.
Expressing breastmilk relies heavily on the hormone oxytocin, which triggers the let-down reflex. When a parent feels calm, connected to their baby, or even thinks about them, oxytocin causes the tiny muscles around the milk producing glands to contract, pushing milk into the ducts so it can be expressed more easily. Pain or anxiety can reduce oxytocin release, making milk flow harder, while relaxation and bonding cues help improve milk expression.
To establish a good milk supply, aim to express 8 to 10 times over a 24-hour period, including at least once during the night. Avoid going more than 3 to 4 hours between sessions. This frequent stimulation follows the principle of supply and demand, the more you express, the more milk your body will produce. By day 3 or 4, you may notice your milk becoming thinner, whiter, and increasing in volume. This indicates the transition to mature milk. By two weeks, most mothers that are exclusively expressing, are reaching volumes of around 500 to 700ml over 24 hours. If you're expressing less than 350ml by the end of the first week, it can be important to seek additional support.
Understanding your baby’s stomach capacity can help set expectations for milk needs.
Successful expressing relies on 3 key factors: support with initiation, frequent sessions, and effective technique. Before and whilst expressing, stimulate milk flow with breast massage. You can do this by applying a warm cloth and using gentle, circular movements over the breast, rolling your knuckles downwards from the top toward the nipple, and gently stimulating the nipple area. Be gentle, massage should feel comfortable, not painful. Expressing both breasts at the same time (double pumping) is a time saving method that often increases milk output. Continue expressing for 2 to 5 minutes after the milk flow stops to help boost future supply. Aim to leave your breasts feeling soft after each session, as full or hard breasts reduce milk production.
When using a breast pump, ensure you have the appropriate flange size, as this can maximise output. Some pumps have a special “initiate” mode designed for mothers who are dependent on pumping in the early days; this helps stimulate milk production and replicate the fluttery stimulating sucks a baby does at the breast at the beginning of a breastfeed.
If you are expressing outside of the hospital setting, you may need to rent or purchase your own breast pump. Hospital grade pumps are available for rent from suppliers and there is 3 suitable options currently available: the Medela Symphony, Spectra S1/S2 and the Ardo Carum.
Once expressed, breastmilk should be stored safely. At room temperature, it can be left out for up to six hours. In the refrigerator below 4°C, 6 days, and in a home freezer, milk can be stored for up to six months. Always label bottles clearly with the date of expression and use the oldest milk first. If expressing milk at home to bring into hospital or another care setting, use a cool bag with ice packs to keep the milk at a safe temperature during transport.
For babies unable to feed by mouth due to illness, surgery, or prematurity, non-nutritive sucking can help them practise the action of sucking and provide comfort. This involves letting the baby suck on a dummy while being tube-fed or allowing the baby to “dry breastfeed” at the breast. This helps them associate sucking with feeling full and can support their transition to oral feeding. Once your baby begins coordinating sucking, swallowing, and breathing, you may try feeding from a partially expressed breast to make milk easier to access, and eventually move to full breastfeeding without expressing first.
If you ever feel unsure or concerned about your milk supply or the expressing process, seek support. There are many resources available to help you successfully provide breastmilk to your baby.
For more information see:
https://kellymom.com/bf/pumpingmoms/pumping/milkcalc/
https://globalhealthmedia.org/video/expressing-and-storing-breastmilk/
