Expressing milk

Pumping or manually extracting breast milk lets your baby enjoy your milk when you’re not there to feed her, or if she is premature or sick. Expressing milk not only allows you to maintain your milk supply, but also helps relieve the effects of engorged breasts.

Tips to keep your milk flowing

Your baby’s nursing stimulates the let-down reflex, which increases milk flow. It’s sometimes harder to stimulate this reflex when you’re expressing milk by hand or with a breast pump, especially on your first attempts. With a little practice, you’ll become good at it.

Depending on what you prefer, you can use any of the following methods to stimulate the let-down reflex:

  • Self relaxation
  • Breast massage
  • Warm compresses
  • Visualization of your baby nursing
  • Thinking about your baby
  • Distracting yourself with another activity (for instance, watching television)

Choosing a method for expressing milk

Breast milk can be expressed in a number of ways. Your choice of method will depend on:

  • the situation;
  • how frequently you express milk;
  • how you are feeding your baby—that is, breast-feeding or not;
  • and of course, your own preference.

Regardless of the method you choose, it’s important to handle your breasts gently and to wash your hands before expressing milk.

Photos: Jean-Claude Mercier

 

Massaging your breasts

To relax your breasts before expressing milk, try a technique borrowed from massage. The idea is to use the knuckles to gently stimulate the breast.

  • Make a fist and keep it closed throughout the massage.
  • Place the knuckle of your index finger at the top of your chest and roll your knuckles down toward the nipple.
  • To massage the underside of the breast, place the knuckle of your little finger against your ribs and roll your knuckles up toward the nipple.
  • Move your fist to the other breast and repeat the rolling motion.
  • Work your way around the breast once or twice, then start expressing milk.

Massage shouldn’t be painful. You can repeat this massage once or twice while you’re expressing milk.

Expressing milk manually

Photos: Jean-Claude Mercier

Manual expression is a technique every mother should know. It’s the most effective way to express colostrum, you can use it any time, anywhere to relieve an engorged breast, and it’s free.

This technique is easier than it sounds. Ask hospital staff, your midwife, or a CLSC nurse to teach it to you.

  • Wash your hands.
  • Use a large, clean container.
  • To prompt the let-down reflex, massage your breast gently.
  • Lean forward slightly so the milk can flow into the container.
  • Make a “C” with your thumb and index finger. The tip of each should line up like a pair of pliers (see photo no. 1).
  • Place your thumb and index finger on either side of the nipple, 2 to 5 cm (1 to 2 inches) away. With practice, you’ll find the best distance (see photo no. 2).
  • Press your fingers into your breast, pushing horizontally toward the ribs (see photo no. 3).
  • While maintaining pressure on your fingers, pinch your thumb and index finger together as if they were a pair of pliers. You don’t need to press hard. This motion shouldn’t leave any mark on your breast or cause any pain.
  • Repeat this pinching motion several times, reproducing the same rhythmic movements your baby uses when nursing.
  • Be careful not to slide your fingers along your breast. Maintain firm pressure on your breast without stretching the nipple, which is painful and not very effective.
  • Work your way around the breast with your fingers until it’s emptied.

Your milk will flow drop by drop at first, then begin to spurt. With practice, you’ll be able to work more efficiently and quickly.

Choosing a breast pump

It is not always necessary to buy a breast pump. Many women prefer to use one, however, especially if they have to express their milk on a regular basis. To find a breast pump that suits your needs, contact a community breast‑feeding support group or a person trained in breast-feeding.

A number of models are available on the market:

  • Manual breast pumps
  • Various types of electric breast pumps, including some that allow you to express milk from both breasts at the same time.

You should also consider the following factors:

Essential information to rememberA good breast pump should:

  • be leakproof and maintain proper suction;
  • fit your nipples properly;
  • protect your nipples by avoiding suction that is too strong or prolonged;
  • electric breast pump: create and release suction at 60 to 70 cycles per minute;
  • manual breast pump: be comfortable and not tire your hand.

Quality – A poor quality breast pump may hurt you or reduce your milk production.

The number of sucking movements per minute – Choose a breast pump that allows for 60 to 70 sucking movements or cycles per minute so that it imitates as closely as possible the rhythm and strength of your baby’s sucking.

Suction – A breast pump with insufficient suction reduces the quantity of the milk expressed, whereas suction that is too strong and prolonged irritates the nipples.

Size and shape of the cup – The breast pump’s cup, which fits on the nipple and areola, must be properly adjusted to your nipples to avoid injuring them. Some companies offer a number of models and sizes.

You can rent hospital-grade electric breast pumps from community breast-feeding support groups and some drugstores. These sturdy, good-quality pumps are intended for use by many people, so they are designed in such a way that the pump motor never comes into contact with the milk. In fact, it is the motor you rent: each woman must buy a new set of tubes, which includes all parts that come in contact with the milk.

Regardless of the type of breast pump you choose, it’s important to clean it properly. Read Cleaning bottles, nipples and breast pumps.

Second-hand breast pumps

A breast pump is a personal item, like a tooth brush or piece of underwear. Breast milk can transmit diseases like HIV and hepatitis, or less serious infections like thrush. If you decide to use a second-hand breast pump, the only way of making sure that it’s safe is to sterilize it in an autoclave, like they do in the hospital. Boiling a used breast pump does not make it safe, even if it does reduce the risk of disease transmission. If you do decide to use a second-hand breast pump, take the following precautions first:

  • Take the breast pump apart.
  • Put all the parts in a large pot.
  • Cover the parts completely with water. Make sure there is enough water so the parts remain covered until the boiling is complete to avoid burning them.
  • Boil for 5 to 10 minutes.

If you buy a used breast pump that is not hospital grade, keep in mind that there may be milk remaining in the motor. Since there is no way to check this or to clean the motor, there is a risk of contamination, even though the risk is low. For this reason, it is recommended that you not buy a used breast pump. If you decide to do so, be sure to buy a new set of tubes.

Expressing milk occasionally or regularly

If you breast-feed, your milk production has adjusted to your baby’s demand. So it is normal to express only a few drops on your first few attempts. Be patient.

There is no ideal time to express your milk. The ideal moment is the one that suits you the best! Try these suggestions:

  • When your baby has fed at only one breast
  • In the morning
  • When your breasts are engorged
  • Between feedings
  • While your baby is feeding at your other breast
  • When you skip a feeding

If you express milk between feedings, you will probably get only a small amount of milk. You will get more if you express the milk from a breast that your baby has not fed from for some time.

Expressing milk without breast-feeding

Information to comfort you and boost your confidenceIt is normal to get only a few drops the first few times you express your milk. The more you stimulate your breasts, the more milk they will produce.

Some women express milk for a baby who won’t breast-feed. Others simply prefer this method. Depending on your situation, you can express your milk for several days, weeks, months, or throughout the entire period you feed your baby breast milk.

During the first month, many babies who did not breast-feed at birth succeed in doing so if your milk production is high. Don’t hesitate to ask for help if you want to try breast-feeding again.

Remember that premature babies are smaller and their intestines are not yet fully developed. In the first few days, or even weeks, they only drink a little if at all and they do not suck as effectively. However, to get your milk production off to a good start, it’s better to express your milk as if your baby were full term.

The way you express your milk when not breast-feeding will change as your milk production gets going and adapts to your baby’s individual needs.

Feeding your baby with your milk without breast-feeding

Before Your Milk Comes In

Frequency

  • If possible, start stimulating your breasts within 6 hours after the birth.
  • Express your milk 6 to 8 times a day.
  • Use the breast pump at least once every 6 hours, even at night.

Duration

After expressing the colostrum by hand, use the breast pump for 5 to 10 minutes.

Quantity

  • You will produce from a few drops to several milliliters. The colostrum (first milk) is thicker.
  • Expressing milk by hand seems to produce more milk than the breast pump during the first 24 to 48 hours. As your milk changes, it will become easier to express with the breast pump.
  • The quantity of milk usually increases from 48 to 72 hours after the birth.

When Your Milk Comes In

Frequency

  • Express your milk as often as necessary for comfort’s sake, but at least 8 times a day.
  • Use the breast pump at least once every 4 hours, even at night.

Duration

Express your milk until your breasts are soft and comfortable.

Quantity

  • The quantity of milk increases rapidly. Take advantage of this period to get your milk production off to a good start, even if your baby drinks much less that you express. Stock up.
  • Mothers who express at least 500 ml of milk per 24 hours after the first week seem to produce more milk afterwards.

1 to 6 Weeks

Frequency

  • Express your milk 6 to 8 times a day.
  • Use the breast pump at least once every 6 hours, even at night.

Duration

Express your milk until the milk has stopped flowing for about 2 minutes.

Quantity

  • Try to express a little more milk than your baby drinks. That way you will always stay ahead of her needs, which will increase rapidly.
  • It’s normal that the quantity of milk you express varies each time.
  • Mothers who express at least 750 ml per 24 hours after two weeks seem to produce more milk afterwards.

After 6 Weeks

Frequency

  • Depending on how much milk you produce, you can adapt to your baby’s needs.
  • Some women can stop expressing milk at night, and others not.

Duration

Express your milk until you have have the quantity of milk your baby needs.

Quantity

  • Adjust the quantity of milk you express according to your baby’s needs.
  • Ideally, try to express a little more milk than your baby drinks in order to stay ahead.