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Expressing Breast Milk

How to express, store and feed your expressed breast milk to your baby.

You might express milk if your baby is not sucking well or is unable to breastfeed, your breasts are uncomfortably full, to boost your milk supply, or you have to be away from your baby. 

You can express your breast\milk by hand, pump, or hand and pump together.

Expressing

Expressing means pressing the milk out of your breasts to give to your baby. You might express milk if your baby is not sucking well or is unable to breastfeed, your breasts are uncomfortably full, to boost your milk supply, or if you have to be away from your baby.

You can express your breast milk by hand, by pump, or hand and pump together. 

Preparing to express milk
  1. Wash your hands well with soap and water. Clean under your finger nails. Dry hands with paper towels.
  2. Make sure all equipment is clean and dry. 
  3. Massage your breasts gently to help your milk flow. Move your fingers in a circular motion on one area of your breast towards your nipple. Move to the next part of your breast and continue this circular motion. 
  4. Warm each breast by wrapping them in warm moist towels for 10 minutes or take a bath or shower.
  5. Try to be patient. It can take time before any drops of milk appear. Practice for a few minutes after each feeding.
Hand expressing milk
Hand expressing may work better than using a pump when you first begin breastfeeding. Expressing by hand within an hour after birth, when your breasts are soft, can help get your colostrum (early rich milk) flowing. Use any drops of colostrum you express to encourage your baby to latch, or collect it in a spoon or cup to give to your baby. Using a breast pump too early may result in lost colostrum in the pumping process. 

  1. Hold your breast with one hand. Place your thumb and forefinger opposite each other and about 2.5 to 4 cm (1- 1.5 inches) back from your nipple. 
  2. Lift your breast slightly and use your fingers to press gently in toward your chest.
  3. Hold a clean container with a wide opening under your breast to catch the milk. 
  4. Press your thumb and fingers together, moving them towards your nipple.
  5. Relax your fingers and press back toward your chest wall and then towards your nipple again. Repeat the same motion.
  6. Move your hand around your breast so you express from your entire breast. Avoid squeezing the base of your nipple as that will stop your milk flow.
  7. Switch back and forth between breasts to help your milk flow.
  8. Express until no more milk comes out.

Start to express your breasts by hand as soon as possible after birth (within the first hour). Express often to increase your milk supply, at least 8 times or more in 24 hours (every 2 to 3 hours; at least 1 time during the night).


Video

Watch a video on expressing your milk

Using a breast pump

Pumping your breasts may be an effective way to establish and maintain your milk supply, especially if your baby is unable to breastfeed. 


  • Hand pumps are good for infrequent use when you have already established a good milk supply.
  • Mid-size electric pumps are for the individual home user. These pumps are good if you need to pump regularly.
  • Multi-user pumps: pumps designed to be used in hospital settings by many users. If your baby is unable to breastfeed or you are trying to establish a good milk supply, renting a hospital style pump is recommended. 

Renting, borrowing or buying a used breast pump is not recommended as they are not meant to be reused. Some pumps are hard to clean and are not meant be used by more than one person. Discuss your breast pump options with your healthcare provider. 

Visit Healthlink BC for more info on buying a new or used breast pump.

  1. Wash your hands with soap and warm water before pumping.
  2. Use clean pumping equipment and clean containers to collect your milk. 
  3. Massage and/or use hand expression to start the flow of milk.
  4. Follow the manufacturer’s instructions to find the right flange (breast pump shield) size for your nipple. Flange sizes are different. Choosing the right flange size will maximize how much breast milk you pump. 
  5. Centre the nipple in the flange of the breast pump and place the rim of the flange against the breast. Ensure the flange is firmly in place (but not too hard) so a seal is created. 
  6. Start at the lowest suction and increase the level slowly. If your nipples are tender, keep the suction low. Make sure the size of the flange fits your nipple. If you are unsure ask for help. 
  7. Cup your breast and hold the flange while you pump
  8. Lean slightly forward so milk flows with gravity into the collection container
  9. Pump or hand express for a few more minutes after your milk flow stops this may help establish your milk supply. 
You may find that your milk supply decreases if you have been pumping over a long period of time – 2 to 3 weeks or longer. Discuss any concerns with your healthcare provider or a lactation consultation.

If you are pumping for your premature baby, check with your nurse or healthcare provider in your Neonatal Intensive Care Unit for pumping instructions. Learn about Mother’s milk in the NICU.
 
Careful cleaning of pump parts is important to prevent contamination which can make your baby sick. 
  • Take all the pump pieces apart
  • Wash first  in a clean bowel with lukewarm water to remove milk residue
  • Wash a second time in hot soapy water and rinse
  • Make sure all traces of milk are removed
  • Dry the pump parts with paper towel or air dry in a clean area
  • Store dry pump kit in a clean container with fitted lid
If you are pumping at home, read the manufacturer’s instructions on how to clean your pump. If you are in hospital, ask your healthcare provider how often to clean your pump and replace your breast pump kit.
 
“Hands on” pumping is where you switch between hand expression and pumping. This method may increase the amount of milk you express. As you practice hands-on pumping, you may discover your own method for getting the most milk out of your breasts. The amount of time to express your milk varies. Hands-on pumping may be used with either a single pump or a double pump. 

How to hands-on pump: 

  1. Start by massaging both breasts before pumping.
  2. Feel for heavier areas in your breasts and massage those areas while pumping.
  3. Wear a bra with the nipple area cut out, purchase a pumping bra or ask your support person to hold the breast pump flange when you double pump.
  4. Use hand compression while pumping to help milk maximize milk flow.
  5. Stop hand pumping once your milk stops flowing.
  6. Finish by massaging your breasts again and hand express each breast. Let the milk drop into the breast pump flange.
Start hands-on pumping at about 24 hours after birth to help increase the amount of milk you express and to help drain your breasts more successfully. 

 



Storing + preparing
Here are some tips for storing and preparing your breast milk when you have to be away from your baby, or when your baby is unable to feed from your breast. 


  • Store your milk in the fridge or freezer in clean containers and label each container with the date and time you expressed your milk.
    • in hospital use hard plastic containers to store expressed milk. Express into a new container each time
    • For NICU babies in hospital: use containers supplied by the hospital to store your milk. Label with hospital labels. Use a new bottle for each pumping.
    • at home use small, clean, glass or plastic containers with a solid lid or milk storage bags. Do not use baggies. If adding milk to a container, chill the fresh milk first then add to the cold milk (do not do this if you plan to donate your milk to the Milk Bank). 
  • Each container should hold only enough milk for one feeding. The amount your baby will drink varies but below is a general guide for feeding amounts:
    • 1-2 week old baby generally takes 60-90 ml per feeding
    • 1-6 month old baby generally takes 90-150 ml per feeding
  • Leave space in the container (2 cm) as your milk will expand when frozen.
  • Put your milk in the fridge or freezer as soon as possible after expressing.
  • Place your milk in the back of the fridge or freezer (not in the fridge or freezer door).

 Click to download the PDF

Table - How Long Can You Safely Store BM.jpg


For information about breast milk storage for babies in the NICU, see: Mother’s milk in the NICU.‎


Defrost frozen milk

  • in the fridge;
  • under running warm tap water; or
  • standing in warm water (keep the lid or top of bag out of the water).

Check the milk and only leave at room temperature until the ice crystals in the milk disappear. Refrigerate until use.

Milk stored in the fridge

As long as your baby is full term, you can give them milk directly from the fridge.  There is no medical reason to warm your milk. Some babies like it warm, others prefer milk to be room temperature or chilled. If you want, you can:
  • warm the milk by running it under warm tap water; or
  • put the container with milk standing in a bowl of warm water (keep the lip or top of container out of the water).

Tips for using expressed milk

  • Gently swirl to mix the milk if the fatty part has floated to the top.
  • Do not use a microwave or stove to warm milk (some of the milk may be hot enough to burn your baby).
  • Use thawed milk within 24 hours if refrigerated after defrosting.
  • Throw out any milk that your baby does not eat in 1 hour. 
  • Do not refreeze milk.

Travelling with expressed milk

If you are travelling a short distance, cool your freshly expressed milk in the fridge first. Place the milk container in a thermal lunch kit with frozen gel packs.  For longer trips (1 to 3 hours), freeze your milk first and then place the container in a thermal lunch kit with frozen gel packs and a clean towel or paper to fill the empty space in the lunch kit. This will act as an insulator to slow down the melting of the milk.

Read more about how to store your milk


 

Transporting freshly expressed milk

  • After pumping, if possible, chill milk in the fridge.
  • Keep chilled while carrying it to and from the hospital by using a thermal lunch kit with frozen gel packs.
  • Keep milk in the fridge until you are ready to come to the hospital and then pack it in the thermal lunch kit for transport.

Frozen milk

For short trips of about 1 to 3 hours:

  • Pack frozen milk in a thermal lunch kit or a sturdy walled cooler with frozen gel packs.
  • Remove extra air by packing tightly with crumpled newspaper or paper towels.
  • Bottles that are only partly filled need extra frozen gel packs, especially on a warm day.
  • Bottles filled completely with frozen milk will stay frozen longer.

For longer trips or for shipping milk that takes between 4 to 24 hours you will need:

  • A cardboard box
  • Coolers
  • Frozen gel packs
  • Crumpled newspaper or styrofoam peanuts/chips
  • Packing tape
  • Address label and pen (if shipping)
Use a sturdy, hard-sided reusable cooler or place a styrofoam cooler into a cardboard box and line the cooler with foam chips or crumpled newspaper. This helps keep the milk frozen. Tightly pack the frozen milk into the smallest cooler you can.  Add frozen gel packs and remove all air with Styrofoam peanuts/chips, towels, or newspaper. Do not use regular ice.
 

Shipping milk

When shipping by courier, seal the styrofoam cooler with packing tape. Full bottles of milk will remain frozen for about 18 to 24 hours depending on the temperature outside. Milk will thaw faster in warmer weather, if bottles are only partially filled, or when only a few bottles are packed together. Address the box and place it back in your freezer. Leave it in the freezer until as close to pick-up time as possible.

If shipping will take more than 24 hours use dry ice. Check with the shipper about how much dry ice you can use. Containers with dry ice should not be transported in a closed car as dry ice is a hazardous substance. If transporting dry ice in a car, place in the trunk and keep car windows open.

Shipping companies

Call a shipping company and ask for their pick up and arrival times. Ask for a package pick up. A late pick-up or overnight delivery is best.

Couriers for transporting human milk

Outdoor temperatures should be considered when packing milk for shipping. Milk must be shipped frozen overnight by courier or bus. The hospital is not able to cover the cost of shipping. The milk should be placed in a freezer as soon as it arrives. If you are shipping human milk to your baby in BC Women's NICU, ask the shipping company to bring the milk directly to the NICU. 

Airline travel with human milk

Rules about carrying milk through airport security change.  Check with the airline if you:
  • Wish to carry on board more milk than your baby would need to reach your destination
  • Are flying without your baby but wish to carry greater than 3 ounces of milk.
Otherwise, let security know you are carrying human milk at the security checkpoint so they can inspect it. Separate the milk from any other liquids, gels, and aerosols in zip lock bags. Gel packs must be less than 100 mL. Be prepared to check your milk if the airline will not permit carry-on. 

Feeding
Feeding expressed milk to your baby

In the first few days after birth, express drops of colostrum (rich, early breast milk) after feeding. Give these drops of colostrum to your baby by spoon or cup. If your baby is in the NICU these early drops of colostrum may be used for Oral Immune Therapy (OIT).  

Tips:

  • Offer your baby your breast first, then give the extra milk.
  • Pump right after a breastfeeding.
  • Try to finish each feeding and pumping in about an hour or less so everyone can rest.
  • Watch your baby’s behaviour: the number of wet and dirty diapers and your baby’s weight gain will show you if your baby is getting enough food. 
  • Talk to your healthcare provider about how much extra expressed milk to give.
You have many different options for how to feed your expressed milk to your baby. You may need to try a few different methods before you discover what works best for you and your baby.

You can feed your baby expressed milk by:

  • spoon
  • feeding syringe
  • feeding tube
  • cup (small medicine measure cup or shot glass)
  • bottle (glass or BPA-free hard plastic)
Ask your healthcare provider how to clean all infant feeding equipment. 

Spoon-feeding- cropped from video.jpgSpoon feeding is good for small amounts of breast milk. It is easy to do at home and often results in less spillage than cup feeding.



To feed your baby with a spoon:

  • Hold your baby upright (not flat on their back).
  • Offer a taste of the milk.
  • Give your baby time to swallow.

 
Cup feeding. c.BC Laction Service.jpgCup feeding is good for feeding your baby larger amounts of breast milk than you could with a spoon. Cup feeding is easy to do at home. It may be messy at first but gets easier to do with practice.

To feed your baby using a cup: 

  • Offer the cup when your baby is wide awake.
  • Wrap your baby in a blanket so your their hands and arms won’t knock the cup over.
  • Fill the cup about half full with milk.
  • Sit your baby upright, facing sideways on your lap.
  • Support your baby’s back and neck with your hand.
  • Place a face cloth as a bib under your baby’s chin.

Syringe feeding expressed milk.jpg
‎Syringe feeding is a good
way to give your baby small amounts of milk. Giving your baby small amounts of milk provides immune protection and can act like medicine for your baby.
Syringe feeding most commonly used in hospital if your baby is premature or ill. Speak with your NICU nurse to get supplies. Syringe feeding is not a recommended method if you are giving your baby large amounts of milk. Once your baby needs larger amounts of milk, another method of supplementing is recommended.  


To feed your baby using a syringe:

  • Hold your baby to face you and lift your baby’s head.
  • let your baby suck on your clean finger.
  • Put the tip of the feeding syringe into the corner of your baby’s mouth along side your finger.
  • As baby begins to suck by pushing the plunger gently into the side of your baby’s mouth.
A feeding tube is commonly used only in hospital as a lactation aid. Commercial feeding tubes are available for purchase for use at home. If your baby is latching well onto your breast but still needs extra milk, a feeding tube can be put in your baby’s mouth to give extra milk while your baby breastfeeds. 

Using a feeding tube allows your baby to get milk while helping your breasts to make more milk. A feeding tube is not recommended when supplementing with colostrum as colostrum is sticky and will stay inside the tube.
Talk with your healthcare provider or nurse before tube-feeding your baby.


You may choose to use a bottle to feed your baby. Babies who are fed by bottle may find it harder to breastfeed. Consider getting support to maintain your breast milk supply so you are able to return to breastfeeding. 

When using a bottle, use responsive bottle feeding. Milk flows from a bottle more rapidly than from your breast. Responsive bottle feeding allows your baby to use a bottle, while preventing them from becoming used to the constant, rapid flow of milk. This makes it easier for your baby to alternate between breastfeeding and bottle feeding.


Responsive bottle feeding is thought to be less stressful for your baby, reduces the risk of overfeeding, and more closely mimics breastfeeding than traditional botte feeding. 


How to use responsive bottle feeding method

Responsive bottle feeding involves paying closer attention to your baby’s responses to feeding, holding your baby close, gently inviting your baby to take the bottle nipple, pacing the feedings and avoiding forcing your baby to finish the bottle.

  1. Hold your baby upright
  2. Feed skin to skin if possible
  3. Touch the baby’s upper lip with the bottle nipple 
  4. Wait for a wide gape (like a yawn)
  5. Allow your baby to take the nipple- do not force the nipple into the baby’s mouth
  6. Keep the bottle horizontal so that the nipple is partially full
  7. Count your baby’s sucks and swallows
  8. Pause every fifth or so suck by tipping the end of the bottle down ( leaving the nipple in your baby’s mouth)
  9. Tip the bottle back to horizontal when the baby begins sucking
  10. Switch sides – don’t always bottle feed holding your baby on the same side
  11. Let your baby decide when they have “finished” – don’t force the baby to feed by wiggling the bottle and pouring milk into your baby’s mouth
You can use these same methods if your baby is getting extra milk from pasteurized donor milk or formula.  

Every baby’s needs are different and your feeding options may change as your baby learns to breastfeed. No matter how you feed your baby, give your baby lots of skin-to-skin care during feeding.

Signs of stress during feeding:
  • coughing
  • gulping
  • worried face
  • breath holding
  • changes in colour 
If you see any of these signs, stop feeding. If your baby is not doing well with one feeding method, try a different one. Get help from your healthcare provider or lactation consultant.

Discuss your feeding options with your healthcare provider to decide what will work best for you and your baby. Learn more about different ways to feed your newborn

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