Expressing breast/human milk

Once birth parents have settled into a breastfeeding/chestfeeding routine after four to six weeks, some introduce an occasional cup or bottle of pumped or hand-expressed milk. This is a possible option if you are going to be away from your baby for longer than a few hours, need to rest sore nipples or return to work.

You can express milk:

• By hand
• With a manual hand pump (for short term or occasional use)
• With an electric pump (for long term use to save time)

• Wash your hands and get comfortable.
• Have a clean cup, bowl or jar ready to catch the milk.
• Gently massage your breast/chest tissue in a circular motion, working from shoulder to nipple.
• It may take several minutes to see any milk at the tip of the nipple. This is normal.
• Put your hand in a C-shape on your breast/chest tissue. Put fingers on the bottom and your thumb on the top at the outer edge of the areola.
• Gently push your thumb and fingers back towards your chest "wall", then squeeze them together while you move them towards the nipple, but do not pinch your nipple. Keep in mind that you are trying to mimic the feeding movements of your baby.
• Catch the milk in a clean cup, bowl or jar.
• Move your fingers around the areola in a circle to express from different parts of your breast/chest tissue. Press and release, repeat the movement on your breast/chest tissue, and switch between sides every few minutes.

Pharmacies often have a selection of pumps for purchase or rent. Call your local pharmacy to learn more.

• Wash your hands with soap before handling equipment or pumping.
• Get comfortable. Sit with your shoulders relaxed and your back and feet supported. Have everything you need within reach, including a drink.
• Relax, think of your baby and listen to music. Lean forward and massage breast tissue on both sides to help get your milk going.
• Follow the directions that came with your pump.
• Start with suction on lowest setting. Hold the nipple shield flange against your breast/chest, making sure your nipple is centred in the shield and moves freely. If your nipple rubs against the sides of the shield flange, get a larger one. Start pumping. If the pump is working correctly, you will see your nipple moving in and out.
• Quick short pulses at the start are stimulating and imitate the way a baby starts breastfeeding/chestfeeding. Once your milk is flowing, longer steady pulses are more effective.
• Once milk starts to flow, you may increase the suction if this is an option for your pump. Pumping should be done at the highest setting without being painful. Use a hand to massage and compress your breast/chest tissue while pumping to get the most milk.
• Pump until milk stops dripping, and then switch sides. Finish your pumping session with hand expression to get even more milk.

• If separated from baby: pump eight to 10 times in 24 hours.
• To increase milk supply: pump five to 10 minutes per side after each daytime feed.

The first few times are practice sessions. Don’t worry about how much you get, just give yourself time to get used to pumping. The amount of milk will vary.

Full-term newborns may take very small amounts the first 24 hours (two to 10 mls per feed). At 24-48 hours old, they will take a bit more (five to 15 mls per feed). They will gradually increase the amount of milk they take by 72-96 hours of age (30-60 mls per feed). By four weeks, babies may take as much as 90-120 mls (three to four ounces) per feed.

Birth parents often make more milk than a pump will get out, so the amount of milk you pump may not reflect how much milk you have. Pumps do not express milk as well as babies do.

After each use, take the pump apart and wash all pump parts in warm soapy water, rinse well and air dry upside down on a clean towel.

Boil the pump parts that have contact with milk for 10 minutes daily if your baby is preterm or ill. Make sure all parts are covered by water.

Your clean pump parts can be stored in a Ziploc bag in your fridge. This helps to reduce bacterial growth.

Store milk in bags designed for freezing human milk, or glass bottles. Date the bags or bottles. Fill bottles 3/4 full when freezing milk. Milk can be stored safely for:

• Up to four hours at room temperature.
• Three days in back of fridge (0 to 4°C).
• One month in freezer compartment inside a fridge.
• Up to six months in separate-door fridge freezer. Keep milk in back of the top shelf (-18° C).
• Six to 12 months in a deep freeze (-20°C).

Human milk looks different at different times. It can look clear and watery, or thicker. It can be bluish, yellow or green-tinged. What you eat can affect the colour.

There may be milk fat on the surface of refrigerated milk. Just shake it to mix it back in.

Frozen human milk will taste and smell different than fresh milk.

Cup feeding with your human milk can provide a short term alternative to breastfeeding/chestfeeding. Your baby must be wide awake, alert and showing feeding cues.

• Wrap your baby securely and place a bib under the chin (cup feeding often has spillage).
• Hold your baby sitting upright on your lap.
• With a small cup half full of milk, tip the cup so the milk touches your baby's lips.
• The cup rests lightly on the lower lip, and the edges of the cup touch the outer part of the upper lip.
• Your baby will lap or sip the milk. Do not pour it into the mouth. Leave the cup in position, unless taking a specific break.
• When your baby has had enough, they will stop the sipping or lapping motions or may fall asleep.

Spoon feeding works well in the days just after baby is born. If birth parent and baby are having trouble latching, express drops of colostrum (first milk that appears sticky and yellowish) onto a clean spoon with rounded, smooth edges. The parent or someone else can tilt the spoon so the milk just touches baby’s lower lip. The infant may lap or sip the milk. Allow time for the infant to swallow and/or rest, while the parent expresses more colostrum. Baby may wish to try breastfeeding/chestfeeding after this.

Dropper feeding is a short-term supplementation method. It is most often used to give a breast/chestfed infant complementary feeds. It is an inexpensive way to provide small amounts of supplement at the breast/chest to infants who are latching and sucking. Dropper feeding allows partner or a support person to help feed baby with birth parent's own expressed milk, donor milk or a non-human milk. Insert the dropper slightly in the inside of the baby's mouth, inside the lower lip, or between cheek and gums.

Tube feeding works well for a baby who latches and sucks well but who has lost enough weight that supplementing is necessary. Tube feeding also works well for a parent who may have a low milk supply. Keeping baby at the breast/chest signals to your body to make more milk, avoids nipple confusion, and affords baby all the neurological and emotional benefits of being skin-to-skin with you. Insert the tube slightly in the inside of the baby's mouth between cheek and gums and very slowly allow milk to flow through the tube as baby sucks.

• Video: Hand expressing milk
  Healthy Families B.C.
• Expressing your milk by hand video
  Offered in English, French, Mandarin, Urdu, Vietnamese, Spanish and Punjabi. Note: These videos are from the Peel Public Health in Ontario.