Tips for expressing Breastmilk

Everyone knows how to express breast milk, don’t they? Surely, you just buy a pump and out it comes, like milking a cow? I bet you, or one of your friends has tried this easy approach to expressing breast milk and found hardly any breast milk to flow. Many women struggle to express breast milk. This can be very distressing, especially if you really need extra breast milk and it won’t flow; perhaps for your baby in special care nursery, returning to work in a few days/weeks or you want to increase your supply.

Here are a number of easy ways to enhance your expressed breast milk supply and some tips on improving your expressing breast milk technique, based on the most up to date research.

You cannot express breast milk in an area where you feel conscious of being watched or while reading Facebook or watching TV. Why doesn’t this work, I hear you cry? The hormone responsible for delivering milk from the milk cells high up in your breast to your nipple is called Oxytocin. Oxytocin is also known as the “love hormone” – this hormone only works when you are feeling loving and relaxed. Oxytocin is released in many settings; when we look lovingly at our baby, when we fall in love, it was used to make the contractions of labour and it is essential when we make love and orgasm.

Can you see how this hormone likes the right environment to be stimulated? Writing your shopping list, playing on the computer, and answering emails are not conducive to allowing this hormone to work or for you to get any milk. You need to be in the right headspace. A good example of this was when a new mum came into my breastfeeding clinic wanting help with her poor flow of breast milk whilst expressing. She became quite upset at this stage and told me how she could only ever get 5mls out. I asked her to show me how she expressed breast milk. After 3 minutes she exclaimed, exasperated “look, it’s all stopped now and only 5mls has drained, stupid breasts!” I talked to her about the Oxytocin hormone and we followed the guidelines I am about to tell you. I also put the baby’s wrap over the pump and her breast so she could not see what was draining. After 10 minutes we stopped the pump and looked, she had 60mls in the pump bottle. She was over the moon and could not believe how such simple methods could work. She promised never to get angry at her breasts again!

• Start by gently massaging around your breast, using your fingertips or your knuckles when holding your hand in a fist. Do this for 2-3mins.
• Stroking will also assist a letdown of milk. Do this with the back of your fingers, so your fingernails touch your skin. This should be extremely light touch, and possibly feel quite stimulating and pleasant. Again, do this for 2-3 mins. Do not skip this step at first, it is mimicking the baby being close, and touching your breast, which releases a huge surge of Oxytocin hormone.
• If you are expressing in a special care unit or are finding it particularly difficult to get any milk to flow, express while looking at your baby or a picture of your baby. Even smelling your baby’s used blanket or clothing will help release the Oxytocin hormone.
• Start with a few minutes of hand expression. Do this until the milk begins to flow and only then move on to using the pump. This has been shown to yield more milk.
• If you are using a single pump, start on one side and pump for 5-10 minutes or until the flow starts to slow, then switch to the other side and repeat. After you have spent 10-20 minutes pumping both sides, go back and repeat this cycle on each breast. The second time you pump the breast you will probably notice the flow slows quicker, so you will probably be pumping for less time; perhaps 5-7 minutes each side. This is called switch pumping. This ensures you get a good letdown (milk flowing from the breast cells to the nipple) and that you fully drain the breasts.
• On the last round of expressing, ensure you keep pumping for about two minutes after the milk has stopped flowing.
• During pumping, it is good to do breast compression. Take one hand and place it over your breast, whilst maintaining the pump at the same breast. Squeeze your fingers together in a ‘C’ shape and hold the squeeze for five or so seconds. Then repeat in different places on the breast. This will push extra milk out. Be careful not to continuously place your fingers on the same area every time as this may lead to blocked ducts.
• If you are double pumping, start as above but then double pump with the breast compression. Once the flow has stopped/slowed remove the double pump and hand express again for two or so more minutes, to get another let down started. Then place the double pump back on the breasts and keep pumping up to two minutes after the milk has ceased flowing or slowed significantly.
• Power pump – this is for those mums who may have to increase their milk supply while their baby is in the special care nursery. Most term babies will start having ‘cluster feeds’ in the evenings from about 3 weeks. If your baby has been in the special care nursery a long time it can be difficult to maintain a good supply, as your breasts are not experiencing real, non-scheduled feeds. Therefore, you need to mimic a baby’s normal ‘cluster feeds’ with a power pump. Set aside a 4-hour time slot to do this. Then, every hour on the hour, you need to pump for 10 minutes. I.e. 1pm – do a 10-minute double pump, 2pm – repeat, and do a 10 minute double pump, then the same again over the next two hours. After this, return to your usual three hourly pumping routine for the next 24 hours. You can do this once daily to help boost your supply. At first, you will see very little milk; this is because it has not been produced yet. Always remember, what you take out this feed/expression is about what you produce in the next 24 hours, not for the next feed, so do not be disappointed!

Goodness, there are so many on the market, how can you choose? A good rule of thumb; the higher the price usually means it has a better motor inside. A basic bottom of the range electric single pump is only up to working a few times a day, probably a maximum of 6 pumps daily for several months. A double electric pump or more expensive single pump on the other hand will have a better motor, enabling you to be pumping up to 12 times daily for several months and will not/should not stop working with over use! The heavy duty, expensive pumps are for mums whose baby may not be feeding yet as they are in special care nursery, or those with twins, or for those who choose to pump and bottle feed expressed breast milk rather than breastfeed. If you just need a pump for when you return to work 3 days a week and you are likely going to pump two or three times a day, then there is no point forking out for an expensive brand. If you are in the previous category, then the extra cost will be likely worth it.

This is a very difficult question to answer, as many women will have different results with different breast pumps. I would research online and ask friends. Perhaps have a look at what breast pump brand your hospital uses. It does seem that the cost reflects the quality with breast pumps, but that does not mean you need to buy top of the range to get what you need.

I would advise you to think about how long you need the breast pump and your purpose. Do you need a hospital grade breast pump? Do you need top of the range? Then work out: How much does it cost to hire per week? How much are the hidden costs, such as the price of the tubing and equipment plus the inside parts? Does this add up to more than the cost of a good enough breast pump to buy?

Don’t forget speak to your local Lactation Consultant as well, she/he will be a wealth of knowledge, and be able to help out with a more hands on approach, looking at your breastmilk expressing techniques to see where changes can be made.