As originally published in Bump & Baby: Issue 17
Registered Nurse, Lactation Consultant and Owner of The Mama Coach – Lindsay Mullen shares her expertise!
If you are planning on breastfeeding your new little bundle you are likely thinking: “Do I need a breast pump?” The answer to this question is actually…Maybe? The truth is there are many ways to express your breastmilk and this guide will take you through all the why, when, and how of breast milk expression. So let’s start at the beginning of your breastfeeding journey. Did you know you can begin expressing colostrum for your baby once you have hit 37 weeks in your pregnancy?
GET A HEAD START
We start producing colostrum at about 20 weeks gestation. New research is currently showing many advantages for mums who perform what is known as antenatal hand expression. Those expressed drops of colostrum at 37 weeks can help encourage babies to latch in those first few days, can be a real game changer in dealing with low blood sugars if the baby is hypoglycemic, and can really help stimulate your milk production. It also helps you get comfortable with your breasts and hand expression before the baby comes, giving you a head start in your breastfeeding journey.
How to Hand Express
Before we delve into the process, ensure you’ve received clearance from your healthcare provider to proceed. Most pregnant women can safely practice antenatal hand expression, but exceptions apply. If you have placental previa, a cervical suture, or are at risk of preterm labor, postpone expression until after childbirth. In most women, it is safe to start expressing after 37 weeks of gestation.
Equipment You’ll Need:
- 2 medicine cups
- 14 x 1 mL syringes with caps
- 5 x 3 mL syringes with caps
- 3 x 5 mL syringes with caps
- Freezer bags
- Labels
The Process:
- Hygiene First: Wash your hands thoroughly with soap.
- Posture Matters: Sit up straight and lean slightly forward.
- Breast Massage: Start with a gentle breast massage, moving from the base towards the nipple, as if using a clock’s hand.
- Hand Placement: With one hand, cup your breast, forming a “C” shape with your thumb on top and fingers underneath, positioning them 5 cm back from your areola.
- Expressing Motion: Gently press your thumb and index finger towards your chest wall, then compress them towards the nipple, holding briefly before releasing.
- Collect that Liquid Gold: Keep a medicine cup ready to collect drops of colostrum as they emerge.
- Repeat: Continue this motion for 5-10 minutes per breast, twice a day (morning and evening). Remember the mantra: “Press, Compress, Release, Repeat.”
- Watch for Contractions: If you experience contractions during hand expression, stop immediately and consult your healthcare provider.
- Syringe Collection: After expression, draw up the colostrum from the medicine cup into a clean syringe. Don’t be discouraged if only a few drops are visible; the quantity does not determine breastfeeding success.
- Labeling: Label the syringe with your name, date, and time. This ensures proper identification for healthcare providers after delivery.
- Storage: Store the syringe in the fridge. You can combine the day’s collection together and place it in the freezer at the end of the day. Colostrum can stay in the fridge freezer for up to 3 months and in a deep freezer for 6-12 months.
This tool is so useful in so many scenarios as a breastfeeding mum! Whether you are out and forgot a pump or are just feeling slightly full in the shower, or you don’t let down as well for a pump, your hands are always with you! Now let’s be honest, hand expressing is great, but it requires 2 hands and time, both things that we are short on as mums!
Let’s Talk About Breast Pumps!
While not everyone will need a breast pump, having one is never a bad idea! Breastmilk is a supply and demand neurohormone feedback system, and delay in breast stimulation may cause a reduction in breastmilk supply. Having access to a breast pump will allow you to maintain your supply if you encounter issues such as, pain with breastfeeding, damaged nipples, latching issues, or in case you need to increase your milk supply to provide supplemental nutrition for your newborn. There are so many pumps on the market these days it can be difficult to choose the right one for you. As a Lactation Consultant, I can tell you I do not recommend the same pump for every mum. To find one that’s suited to you, look for something that’s designed to help you feel comfortable, and think about your overall lifestyle. There are two main types of breast pumps to consider…
The Manual Pump
Manual breast pumps — such as a single hand pump or a silicone pump are great for occasional expressers; those looking to express off small amounts of breastmilk, or collect letdown from the other breast while they breastfeed. This allows you to build a small supply and occasionally bottle feed your infant. These options are portable and easy to use and allow you to express anywhere without a power source. They are also available at a much lower price point than other pumps. Manual pumps use suction by having mum use her hands to manually “express” and create that suction. Silicone breast pumps create a steady suction and are meant to be used on the non breastfeeding breast while breastfeeding on the other. They can be a great tool to manage engorgement in those first few weeks postpartum.
The Electric Pump
These come in single, double, and hospital grade variations. They are an efficient way to empty the breast, but can be a bit of a financial investment. Most are designed to mimic an infant’s natural sucking pattern. When considering an electric pump, make decisions based on your needs: Are you looking for something portable or will you be expressing at home? Are you looking for a time-effective expressing session or to occasionally bottle feed your baby? Hospital grade pumps are ideal for exclusive expressers and parents of multiples or preemies. Those wanting to combination feed (breast and bottle), returning to work while continuing to provide breast milk, or those looking for a more effective expressing session may be happy with a double electric pump. A single electric pump may be perfect for the special occasion expresser.
How You Can Get the Most Out of Your Pumping Session
Skin-to-Skin Connection: Hold your baby skin-to-skin before or during expressing to boost oxytocin levels and stimulate milk letdown.
Heat: Apply warmth, such as a warm shower or heating pad, before expression to increase milk volumes.
Hygiene: Always wash your hands before pumping with soap to prevent bacterial contamination.
Create a Pumping Station: Ensure everything you need is within reach.Don’t forget water and a treat for yourself mama!
Lubrication: Apply breast milk, lanolin, or a drop of coconut/olive oil to the circular edge of your breast shield for added comfort.
Proper Fit: Ensure your breast shield isn’t too tight, which can cause narrowing of the ducts and reduce milk expression.
Pump Settings: Familiarize yourself with the pump settings, especially those mimicking infant suckling.
Hands-On Expressing: Combining hand expression with pumping can increase milk expression by up to 45%.
How to Store Your Milk
After expressing, breastmilk should be frozen if it is not going to be used within two days (it may be stored in the fridge for no more than 48 hours). Be sure to freeze in approved storage bags for breastmilk. Freezing milk in 60-90 mL quantities per bag will help ensure little of your hard work is wasted. Lay milk flat in the freezer to allow for more storage room. Don’t forget to label it with date and amount and make sure you use the older milk first!
But my Baby Won’t Take a Bottle?
Is your little one putting up a fight whenever you attempt to introduce the bottle? Does their face turn away from it, lips tightly sealed? Or perhaps they take a few sips only to arch their back in discomfort or burst into tears? You’re likely facing the challenge of bottle refusal—a hurdle many parents navigate. Babies can have various reasons for resisting bottles, but worry not! Lindsay- The Mama Coach has got a handful of invaluable tips to help your baby embrace the bottle-feeding experience
Opt for the Right Teat
The choice of teat matters significantly. Aim for a teat with a gradual slope and a broader base. This design supports your baby’s oral motor skills. Avoid teats that are short and suddenly widen at the base, as they might hinder effective sucking.
Determine the Right Flow Rate
Pay attention to the flow rate of the bottle. If your baby struggles to extract milk or the teat collapses, a faster flow might be necessary. Conversely, if they’re spilling, gulping, or coughing during feeding, consider opting for a slower flow rate. Keep in mind that different bottle brands have varying flow rates, so a bit of trial and error may be needed to find the perfect fit.
Experiment with Side Lying Feeding
If you’re transitioning between breast and bottle, try a side lying position similar to the rugby hold in breastfeeding. Ensure your baby’s upper body is slightly elevated. This position enables the baby to better control the flow of milk from the bottle, creating a positive feeding experience for your baby.
Let Your Baby Set the Pace
Approach bottle feeding with patience. Gently touch the bottle teat to your baby’s lips, allowing the collar to rest against their chin. Wait for them to open their mouth wide before inserting the teat. Avoid forcing the teat into their mouth. Let them suck a few times before slightly tilting the bottle up. Keep the bottle horizontal while your baby drinks, ensuring the teat is about half full. Allowing your baby to control the pace can make feedings more comfortable.
Observe Baby’s Cues
Stay attuned to your baby’s signals. Look for signs of stress or fullness, like a worried expression, turning away, arching, leakage, gulping, or distraction. If you notice any of these cues, stop the feed.
Breast Before Bottle
Ease the transition by offering the bottle after a short breastfeed. Just like adults, babies don’t learn well when they’re hangry. Letting them eat from what they know first will allow them to be more willing to learn something new, the bottle.
Practice Makes Perfect
Remember, bottle feeding is a learned skill. It might take time for your baby to adjust. Continue offering the bottle 2 or 3 times a day. When it is not time for a feed, let them explore the bottle teat by sucking on it and consider adding a drop of breast milk to the tip using a syringe.
Seek Professional Help
Sometimes, bottle refusal might stem from underlying physical issues such as oral restrictions, reflux, tension in the body, allergies, intolerances, or high lipase in expressed milk. If you’re unsure how to proceed, don’t hesitate to reach out to a lactation consultant. Book a free chat with me here. Our expertise can guide you through a comprehensive assessment and provide tailored solutions for you and your baby.
Navigating bottle refusal can be challenging, but with patience, understanding, and these expert-backed strategies, you’re well-equipped to overcome this phase and establish an easy happy feeding routine for you and your baby.