Expressing your milk
You may have been asked to hand express some colostrum before the birth of your baby for a number of reasons. There may be a medical condition that your baby has that will require them to be cared for in the neonatal unit. If that’s the case, your baby may not be able to feed directly from you in those early days and may need to be fed through a feeding tube or via syringe. Being able to give your baby your milk will be of great benefit to them. Babies that are born to mothers with diabetes may have some difficulties in keeping their blood glucose at the correct level. By expressing some colostrum antenatally, it can help them to stabilise their blood glucose straight after birth and for a short time after. Some people will choose to express purely to stimulate their milk production or to relieve engorgement.
Once you are 37 weeks pregnant you can start off by hand expressing twice a day and when you are ready to increase you can work up to four times a day. Very occasionally expressing can stimulate mild contractions. If these occur each time you express then you need to stop expressing and contact your midwife for further information.
Colostrum is the thick and sticky milk that you begin to produce during pregnancy and the first few days after birth. Its colour can change from a watery looking colour to yellow. Colostrum contains everything your baby needs in the first few days including proteins, fats and infection-fighting antibodies, and it will help stabilise your baby’s sugar levels. Colostrum is only produced in small amounts at a time, but as a baby’s tummy is only as big as a small marble when they are born they’ll only need a small amount to be full.
Expressing by hand is recommended in pregnancy and in those first few days, as it a gentle way to express colostrum. By hand expressing it can allow you to encourage the milk flow from a particular part of the breast. This can be helpful if you find that one of your milk ducts becomes blocked. You will need to hold a sterilised syringe, spoon, bottle or container below your breast to catch any milk that flows. It may be best to have someone help you!
- Before you start, wash your hands with soap and warm water
- Have something sterilised ready to collect the milk in
- Gently massage your breasts for a couple of minutes - the most effective technique is a gentle ‘dragging’ from the outer parts of your breast towards the nipple using your fingers together – imagine you are moving the milk towards the nipple.
- Cup your breast with one hand (easiest to use the arm on the same side)
- With your other hand, form a "C" shape with your forefinger and thumb
- Place your fingers either side of your nipple and then open them wider so that they rest outside of the areola (the pigmented area around your nipple)
- Squeeze very gently whilst pushing ‘inwards’ towards your breastbone, keeping your finger and thumb a few centimetres away from your nipple. This will gently compress your milk ducts. Do not squeeze the nipple itself as you don’t want to make it sore. This process should not hurt or leave any marks on your skin.
- Release the pressure to allow the milk ducts to refill, then repeat, building up a rhythm. Try not to slide your fingers over the skin as this can lead to skin irritation.
- When drops start to appear, you can start collecting the milk
- If no drops appear, don’t be disheartened. Try moving your finger and thumb around to a different area (imagine around your nipple is a clock, move your fingers from 6 to 12 to 3 to 9 position)
- When the flow slows down, move your fingers round to a different section of your breast, and repeat
- When the flow from one breast has slowed or 20 minutes has elapsed, swap to the other breast.
Breast pumps can either be manual or electric. Manual pumps (otherwise known as hand pumps) are often cheaper. They are generally gentler on your breasts than electric pumps as you can control the speed and suction by hand. They may take a little longer to collect your milk, but are a fantastic option for expressing on the go.
Electric pumps are great for when you have an established milk supply. They will come with controls to alter the speed and suction, and often come with different sized attachments so you can get a perfect fit for your breast shape. A pump should never cause any bruising or soreness, so if it does, you may have it on too high a setting. Some electric pumps are portable (you can place them in your bra) which allows you to move around – this may be practical if you have other young children to care for whilst you’re expressing.
When using a pump of any kind, you need to make ensure that the pump and container are both sterilised before every use. You may also be able to hire some hand or electric pumps in your local area. Talk to your midwife or local breastfeeding supporter for details of hire services available.
When storing your colostrum/breast milk, place the sterilised container (syringe, bottle or breast milk storage bag):
- in the fridge for up to 8 days at 4C or lower (you can buy fridge thermometers online) – if you are not sure of the temperature of your fridge, or it is higher than 4C, use it within 3 days
- for 2 weeks in the ice compartment of a fridge
- for up to 6 months in a freezer, if it is -18C or lower
Store it in the middle of the fridge to ensure the temperature stays as constant as possible. Avoid storing milk in the fridge doors as these are often not as cold.
If you have cooled the breast milk in the fridge, it can be carried in a cool bag with ice packs for up to 24 hours. It can be beneficial to store your milk in smaller quantities to avoid any waste. Always remember if you are freezing it, to ensure that you label it with the date and time you expressed.
When transporting milk in the hospital, place the frozen colostrum/milk into a cool bag with ice packs - this will help to maintain the cold temperature. Once you arrive at the hospital your milk can be put in a fridge or freezer. Please make sure you have labelled each individual container of milk with your full name, date of birth and the date and time you expressed.
The best way to defrost frozen breast milk, is slowly in the fridge. If you do need to use it quickly, place it in a jug of warm water or hold it under a tap of warm running water. You may need to give the defrosted milk a little shake if it has separated. Use straight away and ensure that you do not re-freeze any milk that has been defrosted. If your baby is taking your milk from a bottle, it should be used within 1 hour and any left over should be disposed of after the feed.
Some babies are happy to drink milk straight from the fridge or if your baby prefers, you can warm the milk to body temperature. You can do this by putting the container of milk into a jug of warm water or run it under a warm tap. Never use a microwave to defrost or warm breast milk as this can cause hot spots, which could burn your baby’s mouth and damages the quality of the milk.
Make sure you’re relaxed and you don’t need to rush – avoid distractions in the background as you will need your love and relaxation hormones flowing!
Having a warm shower or bath may help to relax you and stimulate your milk supply
Have your baby, a photo of baby or some of your baby’s clothes/blanket near to you when you’re expressing! If you are pregnant, try expressing whilst thinking about your baby and how lovely it will be when you can finally cuddle them. These loving relaxed thoughts will help your hormones, and your milk flow!