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When I start advising new parents that they need to express they often interrupt with, ‘Oh, I don’t need to because I have so much milk already’, or, ‘There’s no need as I’m not planning on returning to work or leaving my baby with a carer while I’m breastfeeding’.
Often parents are willing to take my advice on board but then the hectic reality of looking after a baby means expressing is often a forgotten task. A number of these parents contact me a few weeks down the track tearing their hair out because their baby is unsettled or constantly feeding. At this point they finally realise just how important expressing is during the first few weeks.
Breastmilk is produced on a supply-on-demand basis. At first you will have much more milk than your baby needs, but after a few days your breasts will start to regulate and produce only the amount your baby is taking. And that would be fine if your baby grew at a nice, steady rate, but the reality is babies go through growth spurts which are accompanied by a voracious increase in appetite.
Even if you have a good milk supply you may not have enough to fill up your baby during one of these growth spurts. During this growth mummies usually end up feeding their baby more often, which gets them off track if they are following a routine.
Inevitably some of these extra feeds will occur close to a sleep time so there is the risk your baby may start using the feed as a going-to-sleep aid. There is also the risk that all this extra feeding will cause you to develop cracked, painful nipples. When you get off your routine the milk your baby is drinking can change because if she is snack feeding she will not reach the hindmilk and only be drinking the watery foremilk, which can cause reflux.
If you follow my advice and express in the early days, you will have extra milk stored in the freezer to feed your baby during these growth spurts and her routine will remain uninterrupted. Expressing is much easier if you are following my routine as the times I suggest you express are the times when you will have plenty of milk.
The signs to look for that indicate a growth spurt are your happy, settled baby will stop sleeping so well and will demand feeds sooner than normal. If your baby becomes unsettled, offer her a top-up of expressed breastmilk in a bottle. You will see the amount she is taking reduce as the growth spurt comes to an end.
When you are following my routines you will notice the amount of expressing you do before a feed is reduced, so you have more milk in your breast during a growth spurt. For example, when following my routine on weeks four to six, you express 90 ml at 6.40 am and then weeks six to eight you express 30 ml which means the other 60 ml your breasts are used to producing are left in your breasts for your baby to drink during these growth spurt weeks.
In the first eight weeks the best time to express is first thing in the morning because your breasts are usually fuller then. You can either express before you get your baby up in the morning or you can feed your older baby on one breast while expressing the other, although this needs practice. It’s a case of what suits you best. But expressing before a feed will give your breastmilk more time to build up for the next feed. If your baby is over eight weeks old I recommend expressing after the 7 am feed and possibly after the 11 am feed depending on how much you can express and how much milk you need.
If you are following my routines from week one to eight, you will also be expressing a few times during the day including before the morning feed. Milk expressed in the morning can be fed to your baby later in the day if she is still hungry after emptying your breasts, or if you want your partner to give her one of her feeds from a bottle. Expressed breastmilk not needed that day, can be frozen for future use, such as during a growth spurt.
Bear in mind that it’s often easier to express in the morning – it may take around 20 minutes but in the evening it can take up to 35 minutes. As your milk will let down more easily if you are relaxed, try taking a warm bath or shower or a very gentle massage before you begin. Expressing does get easier with practice.
Find somewhere comfortable to sit and relax. Gently stroke your breast for a minute to stimulate let-down. Work from the top of your breast towards the nipple. After a few minutes, use your thumb and third finger to gently squeeze and release the areola (the skin around your nipple) until you see drops of milk appear. Once this happens, use your breast pump to express your milk. There is no reason why you can’t go straight onto the pump without stimulating your breast first, but it may take a lot longer to get your milk flowing.
Sitting with your baby or where you can see your baby can help with let-down, especially if your baby is in a special care baby unit.
Some mothers’ breasts produce just enough for their baby and therefore they can’t express. If this happens to you, try the milk-making recipes on page 67 of the Save Our Sleep feeding guide to try to increase your milk supply. If these don’t help, don’t panic as it’s possible to modify my breastfeeding advice to help you through sticky patches such as a growth spurt. If your baby is hungry between feeds and you have no expressed milk, offer an extra feed for a few days. Just make sure there is at least two and a half hours between the start of one feed and the start of another. If you are not expressing, you can use my routines as guides to feeding and sleep times until week eight. From week eight you can follow my routines to the minute because expressing is not required to make the routine work successfully.
Freshly expressed breastmilk can be stored in a closed sterile container or in a breastmilk freezer bag at room temperature for four hours, but it is better to store it in the fridge or freezer. If breastmilk stored at room temperature hasn’t been used within four hours it should be discarded, not frozen.
Expressed breastmilk can be stored in the fridge for three to five days; try to place it at the back, which is normally colder. Breastmilk can be stored in the freezer compartment of the fridge for up to two weeks, in a freezer with a separate door for up to three months and in a deep freezer for up to six months (at –18°C or lower).
After taking breastmilk out of the freezer, defrost it in the fridge where it can be stored for up to 24 hours. If defrosted at room temperature, it needs to be used within four hours. Never refreeze breastmilk. If you need the breastmilk sooner, you can sit the container or bag in a little bit of warm (not boiling) water, but use it straightaway.
To warm expressed breastmilk stand the bottle or bag of milk in warm water. Never use boiling water as it could curdle the milk or make the milk storage bag melt. Do not use a microwave oven to thaw or warm breastmilk as the milk heats unevenly. This may change the immunological and nutrient quality of breastmilk and could lead to hot spots in the milk that could scald your baby’s mouth.
Never reuse bottled fresh or defrosted breastmilk after the feed is finished. If you are not sure how much your baby will drink, start out with a small amount in the bottle and top up the bottle with warmed milk that was stored in the fridge or freezer if required.
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