Guidelines For Expressing Breastmilk
By: Anne Smith
There are many situations in which a mother may need to pump milk from her breasts. Some are short term – for example, occasional separations, mother on medication incompatible with breastfeeding, breast engorgement, severe nipple soreness, or increasing milk supply. Some are long term – a premature hospitalized infant, or regular separations such as those encountered with returning to work or school. Whatever your reasons for expressing your milk, certain tools and techniques can help you be successful in obtaining the milk you need and maintaining your milk supply.
First, you need to decide if you need a pump, and if so, choose one that meets your individual needs. For occasional short- term separations (such as a weekly evening out) a manual pump or hand expression may be adequate.
I think every nursing mother should learn the technique of hand expression, because it can come in handy on so many occasions. You may need to soften your areola (the dark area around the nipple) before the baby nurses to make it easier for him to latch on, you may want to express a little milk in the shower if your breasts are uncomfortably full or you have a plugged duct, or you many want to express a little milk directly into your baby’s cereal bowl once he starts solids. There are many occasions when you just want to get out a little milk but not empty the whole breast, and at these times you may not need to use a pump at all.
This is the basic technique for hand expression:
- Wash your hands before you start.
- Express into any clean container – bottle, cup, bowl, etc. You don’t need to boil it, just wash with hot soapy water or run it through the dishwasher. Don’t touch the inner surface after you clean it.
- The key to any kind of milk expression is to get the milk to ‘let-down’. Electric pumps stimulate the let-down reflex automatically by mimicking the baby’s sucking action, but when you are hand expressing or using a manual pump, you may need to stimulate the let-down reflex yourself. Some women’s milk lets down easily, but many mothers have to work at it. To help your milk let down, try: looking at a picture of your baby, smelling and holding a blanket or piece of clothing that smells like him, massaging the breasts, gently rolling the nipple between your fingers, taking a hot bath or shower before expressing (or try expressing while you are in the tub), apply warm compresses to the breast, look at your baby’s picture, or drink a glass of water or juice before starting to express. Anything that helps you relax will help your milk let-down – this can include settling into a comfortable spot, listening to music, taking deep breaths, having your partner rub your shoulders, etc. Some mothers report that the first few times they pump, they are nervous and don’t get much of a let down, but after they get into the routine, they find that their milk is leaking out as soon as they look at their baby’s picture or hear the sound of the pump motor if they are using an electric pump.
- Hold the breast with one or both hands depending on the size, with the thumb on top and the fingers underneath. Gently compress the tissue between the fingers and thumbs while rolling them forward, rotating around the breast. Or, use the tips of your fingers to massage in small circles all around the breast, similar to a breast exam. You can also do this type of massage during pumping to encourage the flow of milk.
- As the milk begins to flow, you may feel a distinct feeling of heaviness or tingling as the milk begins to spray or drip out. Some mothers never feel a distinct sensation when their milk lets down, while for others it is strong enough to be almost painful. Some mothers don’t feel the sensation in the early days of nursing, but will feel it later on. As long as your baby is getting milk, you know it is letting down. You will also experience milk leaking from the other breast as it lets down on one side. This is normal, as your milk always lets down on both sides at once (your body doesn’t know you’re not nursing twins!) Another sign that your milk is letting down is ‘afterpains’, which are abdominal pains similar to menstrual cramps. These cramps are caused by the release of the hormone oxytocin. The same hormone that makes your milk let down also causes your uterus to contract. The afterpains may be mild or severe, and are usually stronger in women who have had children before than in first time mothers. The uterine cramping, while not pleasant, is a sign that your uterus is contracting and returning to its pre-pregnant state. This occurs faster in nursing mothers than in formula feeding mothers – another advantage of breastfeeding. Your uterus will continue to shrink for about six weeks, but the afterpains are usually only uncomfortable for the first few days after birth. Don’t be surprised if the cramping is much stronger while your baby nurses – that’s a sign that your milk is letting down effectively. You may also experience increased blood flow during the first few days after birth while your uterus is contracting, especially during nursing when your milk lets down.
- Place the container under the breast and lean over it. Grasp the areola by putting your thumb on the top and your forefinger on the bottom. Press the breast tissue back toward your chest and squeeze your thumb and finger together, rotating forward, just behind the areola. Do this a few times, then move the fingers half an inch to the left or right and compress again. Continue rotating around the areola until you reach all around the breast. You may want to use your other hand to alternate massaging and compressing.
- Another method is to hold the breast with your thumb on the top of the areola, and the other four fingers cupping the breast from underneath, with your little finger touching your ribcage. To start expressing, begin a wave-like motion by pushing your little finger gently into the breast, followed by the fourth, third, then index finger while you compress the tissue with your thumb from above. Rotate until all areas of the breast are compressed.
- With both these techniques, repeat the procedure on the other breast once
you have rotated all around the first breast. You may want to alternate
breasts more than once, which encourages multiple let downs.
While there is always some milk in your breasts, it is easiest to hand express when your breasts are full, especially in the morning.
The techniques described above may sound complicated, but they really aren’t once you practice a little. Some mothers are very successful at manual expression, but others find it frustrating and tiring. It is not a good method to use on a regular basis, or to use after feedings when the breast is relatively empty. It usually takes at least 20-30 minutes to empty the breast with hand expression or manual pumping.
Manual pumps are portable and relatively inexpensive. They are fine for occasional use, or for the mother who has an abundant milk supply and an efficient let-down reflex. All manual pumps work on the principle of creating a vacuum that creates pressure which causes milk to flow from an area of high pressure in the breast to an area of low pressure in the pump. It is important to remember that no breast pump is as efficient as the baby at removing milk, and manual pumps are generally less effective than electric ones.
There are three types of manual pumps: the rubber bulb pump which looks like a bicycle horn (avoid these – they are terribly inefficient, hard to clean, and can damage your breast tissue), the cylinder type which consists of two cylinders, an outer one and an inner one, which generates a vacuum when it is pulled in and out, and the squeeze handle pumps. Squeeze handle pumps generate suction when you squeeze and release a handle. They can be very effective, but can cause your wrist and arm to tire quickly with the repeated use, so are not a good choice if you have arm or hand problems such as arthritis or carpal tunnel syndrome.
Make sure that the flange (the funnel shaped part) of the pump fits correctly. Some, such as the Medela pumps, come with adapters that fit inside to adjust for different size breasts and nipples. The nipple and areola should be surrounded by the flange. The flange should not extend way past the areola, and the areola should not extend way past the flange. If the flange fits correctly, part of the areola and all of the nipple should slip comfortably and easily into it. While Medela’s pumps have a flange size that fits most mothers, (most don’t need to use the plastic inserts), some mothers with very large nipples may need the PersonalFit Breastshield kit, which can be used with any of Medela’s pumps and contains two different size flanges.
When you are ready to start pumping, moisten the flange (or you may want to use a few drops of olive oil) and center the nipple in the flange. Follow the instructions on the pump, because the technique will differ depending on which type of pump you are using. If the pump has an adjustable vacuum (and it should – all of Medela’s pumps do), start out on minimum and increase as your milk starts flowing. Most pumps will give the better results on the higher suction settings, but if your nipples are sore or your breasts are tender due to engorgement or infection, keep the pump set on the lower setting. Some mothers get better results with medium suction levels and higher cycling speeds if you are using a pump like the Pump In Style which allows you to adjust the cycling.
There are a number of electric pumps on the market. Some are terrible, some are not so bad, and some work quite well.In general, the small semi-automatic pumps like the Gerber and Evenflo are not very effective. Because of their small size, relatively low cost, and battery options, these are big sellers in the department and baby stores. Many people buy them without realizing that there are tremendous differences in electric pumps. Anyone who has told you that she tried and electric pump and it didn’t work, or it hurt, was probably talking about one of the small semi-automatic models rather than the more expensive hospital or professional grade models.
If you are going to be pumping regularly, or if time is an important consideration, you really need to be double pumping with a larger, more efficient (and more expensive) professional or hospital grade pump. In situations where you must be separated from your baby for extended periods of time, such as a premature infant, and the only stimulation your breasts will receive is from the pump, you ideally should use a hospital grade pump such as Medela’s 015 Classic. This type of pump is much heavier than other pumps, and would cost about $1450.00 to purchase, so most mothers rent it.It provides the best possible stimulation for maintaining your milk supply when medically indicated.
The Medela PumpInStyle is the only portable, autocycling, professional-grade breastpump for sale to mothers. I think it is by far the best pump on the market, and it is the pump most popular with mothers. It is an excellent choice for mothers who want convenience, portability, and efficiency. It’s a great investment, especially if you intend to breastfeed long-term or are planning to have more children.
Double pumping is an important feature. Not only does it cut your pumping time in half (from 20-30 minutes with single pumping) to 10-15 minutes or less, but your prolaction levels are higher when you double pump, so you actually produce more milk in less time. This is especially important when you are pumping frequently, or when you are working or in school and have limited break time in which to pump.
Don’t be surprised if you get more milk from one breast than the other when you double pump, because each breast functions independently of the other. Some mothers will get 3 or 4 times as much from one breast as the other, and some will notice only a subtle difference in the amount they get from each side. It would be unusual for each breast to produce exactly the same amount.
Anne Smith is an IBCLC – International Board Certified Lactation Consultant and La Leche Leader since 1978. More importantly, she is a mother to 6 breast fed kids with twenty plus years experience of counseling nursing mothers. Her site, www.BreastfeedingBasics.com , provides expert advice and solutions to breast-feeding problems and gives basic information on how to breast feed. Anne also features her recommended breast feeding products and breast pumps.