‘Never express before 6 weeks!’
You may have been told that you should never express before your baby is 6 weeks old. It true that expressing large amounts of milk during this time, so that someone can feed your baby from a bottle instead for example, has the potential to cause problems. A baby who is latching and feeding well will be better at stimulating your breasts and drawing milk out than your hands or a breast pump. It is important that your baby is feeding regularly and effectively during this time in order to establish a good supply. You can read more about how this works here. Replacing breastfeeds with bottle feeds, even when you are using bottles of expressed milk, can mean that you may struggle to establish a good supply. Expressing lots of milk alongside breastfeeding can lead to you developing an oversupply, which can put you at a higher risk of developing blocked ducts and mastitis. During these early weeks, you and your baby are both learning how to breastfeed, so introducing a bottle during this time may lead to your baby developing nipple confusion or a bottle preference.However, there are many situations in which it would be very beneficial to express before 6 weeks:
- If your baby is born prematurely or is poorly and unable to breastfeed
- If your breasts are engorged and your baby is struggling to latch on
- If you have developed a blocked duct or mastitis
- If your baby is not yet latching and feeding effectively
- To increase your supply
Some women do still choose to express before 6 weeks. One of the main reasons for this is to allow their partner to bond with their baby. There are, however, many ways in which your partner can bond with your baby without disrupting breastfeeding. Information on that can be found here. For some women who have had a very difficult start to their breastfeeding journey, being able to express for the occasional bottle feed may make the difference between stopping breastfeeding and carrying on. If you are wanting to do this, it may be helpful to speak to a breastfeeding peer supporter, breastfeeding counsellor, or IBCLC. If you’re not sure where to go for support, some resources can be found here.
All mothers should be taught how to hand express. It sometimes takes a little practice but it is a very useful skill to have, particularly in the early days. Some Mums find that hand expressing works much better for them than using a breast pump. This method is great because your hands are always available and it’s free! It also doesn’t use any suction, so if your breasts are engorged or your nipples are damaged, hand expression might be the most comfortable option.
Using a breast pump
Unlike hand expression, breast pumps use suction to express milk. They come in two forms: manual, or electric. Electric pumps tend to be quicker but are a bit more expensive. It is important to make sure that the flange or shield on your pump isn’t too small for your breast, as a too-small shield can minimise your output and damage your nipple. Hospital grade breast pumps can be hired from Medela and Ardo online as well as from shops such as Mothercare and from some breastfeeding counsellors.
Increasing your output when expressing
The amount of milk you can express is not a good indicator of your supply. A well attached baby will generally be much more efficient at drawing milk out of your breasts than your hands or a breast pump, so don’t be disheartened or worried about your supply if you are unable to express much milk! See how you can tell if you are making enough milk here.
The following things can help you to express more milk:
- Start by relaxing. Oxytocin, the hormone which triggers your let down reflex, flows more easily when you are relaxed. If you are with your baby, try having some skin to skin contact or a cuddle. If not, try taking a few minutes to practice relaxing breathing techniques. Where possible, express in a room you feel comfortable in and consider dimming the lights
- massage your breasts for a couple of minutes before expressing by rolling your breast in a circular motion between your hands, gently kneading your breast, tapping on your breast with your finger tips, and stroking from your chest wall towards your nipple
- apply a warm flannel or a (clean) nappy filled with hot water to your breast for a minute or two immediately before expressing, or have a hot shower
- If you are with your baby, having them close to you or (better still) feeding them from the other breast can help to maximise your output. If you are not with your baby, having a photo or video of them can help, particularly a video of them feeding or looking hungry!
- Breast compression, as described from around the 2 minute mark in this video by Global Health Media, is a method of gently squeezing the breast tissue to maximise milk flow.
- Breastfeeding and expressing more often
- power pumping
The image above shows the current breastmilk storage guidelines for healthy babies born at full term as set out by the NHS and the Association of Breastfeeding Mothers. If your baby is unwell or was born prematurely, talk to your midwife or health visitor about storing expressed milk.
You can store your milk in any clean and sterile airtight container. Milk storage bags are handy if you’re expressing large amounts of milk as they take up little space, but they are single use only so create a lot of waste and the fat globules do not release as easily from bags than from bottles. Milk storage bottles are generally reusable but do take up more room. It is a good idea to store your milk in small amounts, as once defrosted it can not be refrozen, and once baby has drank from a bottle of expressed milk any left over must be discarded within an hour.
If you need to use frozen milk quickly, it can be defrosted at room temperature and used within 12 hours of taking it out of the fridge, or it can be defrosted by running it under a warm tap and used immediately. Never refreeze defrosted milk.
Feeding expressed milk to your baby
The most commonly used method of feeding expressed milk is to use a bottle. However, there are lots of other options which may be worth considering if you are concerned about nipple confusion! These include:
- Cup feeding. This method is particularly helpful for newborns or premature babies who have not yet learnt to feed effectively. If you would like to cup feed your baby, ask a healthcare professional to show you how because there is a risk of aspiration if done incorrectly. More about cup feeding can be found here.
- at-breast supplementers, such as Medela’s supplemental nursing system (SNS), can be a great way to get more milk into a baby who needs supplements without introducing a bottle. This consists of a container of milk connected to a very fine tube that can either be taped along side Mum’s nipple or inserted into the corner of baby’s mouth when they are latched on. This allows baby to receive supplemental milk whilst they are breastfeeding. Using this method may help to increase supply as baby will be feeding at the breast whilst using it. Dads have also been known to use an at-breast supplementer on their own nipple when Mums have been unable to feed their baby themselves!
- finger feeding is similar to an at-breast supplementer, except the tube is attached to an adult’s finger instead of Mum’s breast. More about finger feeding can be found here.
- For older babies, there is no need to introduce a bottle. Milk feeds can be given in a sippy cup/open cup as soon as your baby is able to use them
There are LOTS of different bottles out there to choose from. For the most part, these differences are just marketing ploys. There is no evidence that any one bottle is better than another for feeding a breastfed baby. Some babies take to a bottle straight away, but for others it can take a little trial and error and a lot of perseverance to get them to accept it. It can help to offer the bottle before your baby gets too hungry or too tired, and it can also be helpful if someone else feeds baby whilst Mum is not in the room.
When bottle feeding, it is really helpful to practice paced feeding. Milk often flows quicker from a bottle than from a breast, which can sometimes lead to babies developing a flow preference to the bottle. Paced bottle feeding, as explained in this video, is a great way to avoid that.
If you have a copious milk supply you may wish to consider donating breastmilk. Milk banks collect breastmilk donated by mums to give to very premature or sick babies. When a baby is born prematurely, mothers are often unable to produce enough milk to meet their needs. The risks of formula are higher for these babies. One of the main risks for premature babies is a condition called necrotizing enerocolitis, a condition which causes parts of their intestine to die. This is a life threatening condition and the risk of developing it can be greatly reduced by using donor milk, but unfortunately not enough mums are willing or able to donate milk, so many babies go without this protection. If you have a spare 20 mins a day and some room in your freezer, check out the UK Human Milk Bank website to find out how you can donate breastmilk.
Other uses for breastmilk
There have been so many times when I have spent ages expressing my milk and then forgotten to put it in the fridge, or I’ve defrosted a full 6oz only for my baby to refuse to drink it, or I’ve left milk in the fridge a little too long to be suitable to feed him. Sound familiar? When you’ve put so much effort into expressing your milk it is almost physically painful to pour it down the sink! Thankfully, thanks to all the amazing properties of human milk there are lots of other things you can use it for! Some of these include:
- Milk baths. Lots of mothers find that popping a couple oz of breastmilk into baby’s bath leaves their baby with wonderfully soft skin. Breastmilk is full of anti-infective and anti-inflammatory properties which can be great for treating dry skin and eczema
- Breastmilk can be used to make into soaps or lotions (check out Pinterest for recipes!)
- Jewelry. There are lots of companies who can preserve your breastmilk in a bead or stone to make beautiful breastmilk jewelry
- Nettle/bee stings. Where I live in the English countryside stinging nettles are everywhere, and my garden is full of flowers so we always have lots of bees buzzing around in summer. When my children (or I!) get stung by a nettle or bee, rubbing a few drops of breastmilk into the sting relieves pain and inflammation quicker than anything else I’ve tried. The bumps left by nettle stings disappear within seconds!
- Ear/eye infections. There is little evidence to support the use of breastmilk for treating ear infections, conjunctivitis and blocked tear ducts, but anecdotally many women find that it helps. Breastmilk contains anti-infective properties such as lysozyme and Lactoferrin so, theoretically, it should help to treat these types of infection. However, it is important to see a health care professional if your baby is unwell and use the treatment that they recommend. For further information and links to studies looking specifically at this topic, see this information from La Leche League.
- Nappy rash. When applied topically, some mothers find that breastmilk can help to soothe nappy rash. The only time this is not suitable is when the nappy rash is caused by a fungal infection such as candida (thrush or yeast)
Further info and resorces: