For most mothers the easiest and most efficient way to feed your baby breastmilk is usually at the breast, but there may be occasions when this is not possible and you need to express your milk.
- your baby is premature or unable to suck well
- your baby is in hospital and you can't be there for every feed
- you are in hospital and your baby can't be there for every feed
- you have returned to the paid work force, study or other commitments
- you are leaving your baby with a sitter while you are out, or
- your breasts sometimes feel too full and uncomfortable.
Some mothers like to keep a small store of breastmilk in the freezer for emergencies.
There are several techniques you can use to encourage your let-down reflex when expressing. For example:
- Consciously try to relax, using whatever method suits you. Try to express in a quiet, warm, relaxing area, away from distractions. While expressing, breathe slowly and deeply. You could express in the place you usually sit to feed. Some mothers have a warm drink first or listen to soft music. Warmth (expressing after a warm shower, warm face washers on the breast for a few minutes before starting) may also help.
- Gently massaging your breasts by stroking down towards the nipple, and gently rolling the nipple between your fingers. While you can't actually push the milk out of your breasts by massage, you can help trigger the let-down by touching your breasts.
- Thinking about your baby and how much your breastmilk is helping her will encourage your let-down reflex. If she is premature or sick in hospital,you might find it easier to express near her cot or just after you leave her. If you are away from her, looking at her photo can help.
- Having someone support you. Many mothers find they manage much better when they have an encouraging partner or friend. Your ABA breastfeeding counsellor can also give you ideas and encouragement as you learn to express.
How much you need to express depends on your reason for expressing. If it is to relieve engorgement, you may only need to express enough to feel comfortable. If you are expressing for a premature baby, you may need to express fully and frequently. Some mothers who are expressing regularly can quickly get large volumes of breastmilk from each breast every few hours. While other mothers simply cannot express big volumes at one time, and find it easier to express small amounts more frequently (eg up to 30mL every one to two hours). A few mothers find it difficult to express, although they have a good supply and their baby is thriving.
It is important not to judge overall milk production by the amount of milk you can express. The baby's technique of extracting the milk is the optimum, and he will always be able to get more milk than you; expressing is second best.
Hand expressing might not be easy when you first try it - you might feel quite discouraged if, after all your efforts, you only manage a few mL or even a few drops! Take heart, gradually you will become more familiar with the feel of your breasts and how to make the milk flow most easily. When you are able to put your baby to the breast, you will find your supply quickly increases to meet his needs.
Storage of Breastmilk for home use *
|Freshly expressed into a closed container||6–8 hrs (26ºC or lower). If refrigeration is available store milk there||
No more than 72 hours. Store in back, where it is coldest
2 weeks in freezer compartment inside refrigerator (-15°C)
3 months in freezer section of refrigerator with separate door (–18°C)
6–12 months in deep freeze (–20°C**)
|Previously frozen— thawed in refrigerator but not warmed||4 hours or less
(ie the next feeding)
|Store in refrigerator
|Do not refreeze|
|Thawed outside refrigerator in warm water||For completion of feeding||Hold for 4 hours or until next feeding||Do not refreeze|
|Infant has begun feeding||Only for completion of feeding, then discard||Discard||Discard|
**Chest or upright manual defrost deep freezer that is opened infrequently and maintains ideal temperature
*Reproduced with permission from National Health and Medical Research Council 2012, Infant Feeding Guidelines. NHMRC, Canberra p59.
Freshly expressed breastmilk should be cooled in the fridge before being added to other chilled or frozen expressed breastmilk.
A mother's own expressing equipment does not need to be disinfected or sterilised for a healthy, term baby.1
If you are expressing several times a day for a healthy baby, your expressing equipment should be rinsed well in cold water after each use to remove the milk. Store it in a clean, closed container. If you have a fridge, you may simply store the unrinsed expressing equipment in there, in a clean, closed container or plastic bag. If you cannot store your expressing equipment in the fridge between sessions, have extra parts, so you are not always rinsing and washing. This information is consistent with the NHMRC breastmilk storage guidelines as per table above. For example breastmilk may be stored for up to 6-8 hours at room temperature and up to 72 hours in the fridge.
The expressing equipment should be cleaned really well at least once every 24 hours while it is in frequent use.2 If the expressing equipment is only being used once a day or less, clean it after each use.
Thorough cleaning is important to make sure you have removed all milk from the breast pump parts and storage containers.
1. Wash your hands well with soap and water. Dry them on something clean — a new paper towel or a clean, unused cloth towel.
2. Take apart all containers and the breast pump so that every part can be cleaned well. Rinse in cold water to remove milk from all the parts.3
3. Take care to remove all traces of grease, milk and dirt with a small amount of dishwashing liquid and hot water. Use a brush kept just for this purpose.
4. Rinse at least twice in hot water.
5. Drain bottles and containers upside-down on clean paper towel or a clean cloth towel. Cover while they air dry. Before putting away, ensure no water droplets remain in the containers or on any parts. If any water remains, dry carefully.
6. Store the dry kit in a new plastic bag, plastic wrap, more paper towel or clean, covered container until next use.2,3
Except for the sterile expressed breastmilk bags or new plastic bags, all containers and breast pump parts used to collect or store breastmilk will need to be cleaned before use.
In areas where there are different water supplies for drinking and washing, use drinking water to wash and rinse the pump equipment.
If your baby is sick, be guided by the advice of your baby’s medical team about cleaning your equipment. Also, if you and/or your baby have thrush or you have any type of infection on your nipples, you might need to disinfect your equipment after cleaning it. Talk to your medical adviser, child health nurse, lactation consultant or an Australian Breastfeeding Association counsellor for suggestions.
For further information
Breastfeeding: expressing and storing breastmilk, is one booklet written by the Australian Breastfeeding Association that covers everything you need to know about expressing: how the milk lets down, hygiene, photos of how to hand express, discussion on how to use different types of breast pumps, what to store the milk in and for how long, and how to clean your pump and containers. Other topics are thawing breastmilk, transporting breastmilk, and cup feeding. Booklets can be purchased from the Australian Breastfeeding Association by calling 03 9885 0855 or emailing firstname.lastname@example.org.
1. Academy of Breastfeeding Medicine 2010, Clinical Protocol #8: Human Milk Storage Information for Home Use for Full-Term Infants. Retrieve from http://www.bfmed.org/Media/Files/Protocols/Protocol%208%20-%20English%20revised%202010.pdf 27/10/15.
Pittard WB 3rd, Geddes KM, Brown S, et al 1991, Bacterial contamination of human milk: Container type and method of expression. Am J Perinatol 81:(25-27).
2. Gilks J, Price E, Hately P, Gould D, Weaver G 2012, Pros, cons and potential risks of on-site decontamination methods used on neonatal units for articles indirectly associated with infant feeding, including breast pump collection kits and neonatal dummies. Journal of Infection Prevention 13(1):16.2.
3. Jones F 2011 (3rd ed), Best practice for expressing, storing and handling human milk in hospitals, homes, and child care settings. Human Milk Banking Association of North America.
© Australian Breastfeeding Association Reviewed October 2015