Sometimes a mother finds that it is very difficult or impossible to be able to breastfeed her baby. She may choose instead to exclusively express and provide her milk to her baby in a bottle. Some reasons for exclusively expressing include:
· mother and baby being separated
· emotional (victim of abuse)
· embarrassed with feeding in public
· baby is unable to feed well at the breast (eg due to cleft, heart problem, low tone, un-released tongue-tie etc)
· unresolved breast refusal
· thinking it will be easier.
Some mothers who exclusively express worry that they won’t be able to bond as well with their baby, compared to if they breastfed. It can be reassuring to know that a mother will still bond with her baby because she is the primary caregiver and because there are many other ways that a mother can bond with her baby besides breastfeeding. For example, with lots of skin-to-skin contact while feeding or while cuddling.
A mother who may be exclusively expressing because she has retured to full-time work or because her baby is in the NICU, expressing and providing her breastmilk to her baby means that she is maintaining a special bond with her baby even though she cannot physically be there at all times with her baby.
When exclusively expressing, it is important to use a quality double electric pump designed for long-term use (eg by hiring hospital-grade electric pump). See the Breast pump hire article on this website. Some mothers also purchase a personal electric pump to use when they are out but use the hospital grade pump when at home. Some mothers find that by purchasing a pumping bra they can express hands free. This bra allows you to double pump while caring for your baby or getting work done.
How often and how much?
Ideally, bottle-feeding a baby should mimic, as much as possible, how a mother breastfeeds her baby. When exclusively expressing and bottle-feeding, it is possible to feed on demand by looking out for your baby’s feeding cues.
When a baby breastfeeds, the amount of milk they take from feed to feed varies and the length of time at the breast doesn't always reflect the amount of milk taken. So when exclusively expressing, the trick is to make up smaller bottles (eg about 60 mL) and top them up with further small amounts as needed.
Knowing how much an exclusively breastfed baby commonly drinks, can help exclusively expressing mothers work out approximate amounts to offer their baby.
In the early days, a newborn baby takes in small amounts of colostrum per feed (see table below). Then when a mother’s milk ‘comes in’ after a few days, the volume of milk she makes, and that her baby takes in, increases rapidly, levelling out at anywhere from about 1 week post-partum.
Table 1. Average Intakes of Colostrum by Healthy, Term Breastfed Babies*
|Time (hours)||Intake (mL/feed)|
Research has shown that an exclusively breastfed baby between the age of 1 to 6 months drinks an average of about 750–800 mL in a 24-hour period (though the range is less than 500 mL to 1000+ mL).1
Once solid food has been introduced, the amount of breastmilk that a baby takes in depends on the amount of solid food that is offered. It is important to remember that breastmilk remains the most important source of nutrition for a baby’s first 12 months.
Mothers vary in the amount of time it takes them to express. The length of expressing time depends on many factors (eg time of the day, pump used, technique used, setting on pump used, mother’s own flow rate etc). Many mothers find that their expressing session goes for about 15 minutes. Some may need a little more or a little less. For most mothers pumping for 30 minutes or more is too long. It is generally suggested to continue to express for a few minutes past when the milk stops flowing, as often by doing so another let-down may be triggered.
Exclusively expressing mothers are very aware of how much milk they are producing. In this way, they often notice even small changes in their supply. Here are some tips:
· Add in another few expressing sessions over the course of a 24-hour period. Expressing more often is more effective at increasing supply than longer expressing sessions.
· Increase the skin-to-skin time spent with your baby.
· While pumping, do a combination of squeezing and massaging your breasts.
· If you continue to pump for a few minutes after your milk flow stops, you might get another let-down.
· After pumping, hand express for a few minutes.
· Try some short pumping sessions close together to mimic a baby cluster feeding. Pump for 5 to 10 minutes at a time but repeat this several times over the course of an hour or two.
If a mother is still finding that her supply isn’t increasing enough, despite the above suggestions, there are substances (called galactagogues) available that can help some mothers to boost their milk supply. You will still need to express often. You may like to discuss the use of galactagogues with your medical adviser.
Pacing bottle feeds
A caregiver’s guide to the breastfed baby is useful reading for any exclusively expressing mother, as it tells how to look after the milk, and also how to pace bottle-feeds so the baby is more in control of how much he drinks. Alternating which side a baby is held when being bottle-fed can help ensure that both sides of his vision and neck muscles develop equally.
Mothers who are exclusively expressing are very dedicated mothers. They deserve and need respect and support.
Also, see the following articles on this website:
1. Kent JC, Leon MR, Cregan MD, Ramsay DT, Doherty DA, Hartmann PE 2006, Volume and Frequency of Breastfeedings and Fat Content of Breastmilk Throughout the Day. Pediatrics 117:(3)e387-e395.
© Australian Breastfeeding Association April 2021