Expressing Breast Milk
Expressing your breast milk either by hand or with a breast pump helps you to establish and maintain your milk supply. It also ensures your baby receives the benefits of breast milk even if you are separated from them or your baby is unable to breastfeed. This may be because:
- your baby is premature or unwell and receiving neonatal care
- you are returning to work or study
- your partner or someone else is going to feed your baby
You may also wish to express your breast milk if:
- your breasts are feeling uncomfortably full
- you want to increase your milk supply
- you want to include some breast milk in your baby’s meal when you start introducing solid foods
If for any reason you are unable to breastfeed your baby after giving birth, it is important that you begin hand expressing your breast milk as soon as possible. This is because your breast milk, in particular your colostrum (the first breast milk your body makes), is the perfect source of nutrition for your baby. It contains antibodies which protect your baby from infection and help their immune system to develop. It also helps your baby’s digestive system to develop, which protects them from allergies.
Aim to express 8 to 10 times in 24 hours, including once overnight to establish your milk supply. Your breast milk supply is determined by how often you express, so if you do not express regularly, your milk supply will decrease. Remember the more milk you take, the more milk you will make.
If you do not need to express your milk straight away, it is better to wait until both you and your baby feel confident with breastfeeding before you start expressing milk regularly.
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FAQs
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Title
Description
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When should you worry?
Newborn
NEWBORN
Contact your health visitor or GP if your baby is newborn and they…
- Feel very stiff, for example:
- Hold their arms and legs in the same position, such as always pulling their arm into their chest, or always crossing their legs
- Find it difficult to change their position on their own
- You may also find it difficult to move your baby’s arms or legs, making it tricky to change their nappy or clothes
- Feel very floppy, or have floppy arms or legs when awake
- Move their arms and legs in repetitive jerky movements, or writhing movements
- Don’t have a Grasp Reflex (doesn’t grab your finger or small object when you put it in their hand)
- Are often startling and you cannot understand why
- Move one side of their body more than the other, for example:
- Rarely moves one of their arms compared to the other arm
- Rarely moves one leg compared to the other leg
- When your baby startles, one side moves or looks different from the other
6-8 weeks
6-8 WEEKS
Contact your health visitor or GP if your baby is 6-8 weeks and they…
- Feel very stiff, for example:
- Hold their arms and legs in the same position, such as always pulling their arm into their chest, or always crossing their legs
- Find it difficult to change their position on their own
- You may also find it difficult to move your baby’s arms or legs, making it tricky to change their nappy or clothes
- Feel very floppy, or have floppy arms or legs when awake
- Move their arms and legs in repetitive jerky movements, or writhing movements
- Have not started to bring both their hands to their face, or do not move their arms much
- Keep their hands fisted, and you find it difficult to open their hands
- Can’t lift their head when lying on their tummy
- Move one side of their body more than the other, for example:
- Mostly moves one arm or mostly brings one hand to their face
- Rarely kicks or moves one leg compared to the other leg
2-3 months
2-3 MONTHS
Contact your health visitor or GP if your baby is 2-3 months and they…
- Feel very stiff, for example:
- Hold their arms and legs in the same position, such as always pulling their arm into their chest, or always crossing their legs
- Find it difficult to change their position on their own
- You may also find it difficult to move your baby’s arms or legs, making it tricky to change their nappy or clothes
- Feel very floppy, or have floppy arms or legs when awake
- Move their arms and legs in repetitive jerky movements, or writhing movements
- Have not started to bring both their hands to their face, or do not move their arms much
- Keep their hands fisted, and you find it difficult to open their hands
- Can’t lift their head when lying on their tummy
- Move one side of their body more than the other, for example:
- Mostly moves one arm or mostly brings one hand to their face
- Rarely kicks or moves one leg compared to the other leg
3-4 months
3-4 MONTHS
Contact your health visitor or GP if your baby is 3-4 months and they…
- Have lost skills which they could do before
- Feel very stiff, for example:
- Hold their arms and legs in the same position, such as always pulling their arm to their chest, or always crossing their legs
- Find it difficult to change their position on their own
- You find it difficult to move your baby’s arms or legs, making it tricky to change their nappy or clothes
- Feel very floppy when awake
- Prefer to keep their arms by their sides. For example, they do not reach for things, or do not bring their hands together over their face or tummy
- Move their arms or legs in repetitive, jerky, or strange ways
- Still need you to support their head, or can’t lift their head when lying on their tummy
- Have very tight fists and it’s hard to open their hand
- Move one side of their body more than the other, for example:
- Rarely use one of their arms to pick up toys
- Rarely kick one leg compared to the other
4-6 months
4-6 MONTHS
Contact your health visitor or GP if your baby is 4-6 months and they…
- Have lost skills which they could do before
- Feel very stiff, for example:
- Hold their arms and legs in the same position, such as always pulling their arm to their chest, or always crossing their legs
- Find it difficult to change their position on their own
- You find it difficult to move your baby’s arms or legs, making it tricky to change their nappy or clothes
- Feel very floppy when they are awake
- Move their arms or legs in repetitive, jerky, or strange ways
- Move one side of their body more than the other, for example:
- Rarely use one of their arms to pick up toys
- Rarely kick one leg compared to the other
- Are unable to roll, or can roll in one direction but not the other
- Find it difficult to reach their arms out. For example, they do not reach for toys
- Still have their early reflexes, like the startle reflex and grasp reflex
- Keep their legs flat when lying on their back. For example, they do not bring their feet to their chest
- Still need you to support their head
6-9 months
6-9 MONTHS
Contact your health visitor or GP if your baby is 6-9 months and they…
- Have lost skills which they could do before
- Feel very stiff, for example:
- Hold their arms and legs in the same position, such as always pulling their arm to their chest, or always crossing their legs
- Find it difficult to change their position on their own
- You find it difficult to move your baby’s arms or legs, making it tricky to change their nappy or clothes
- Feel very floppy when they are awake
- Move their arms or legs in repetitive, jerky or strange ways
- Move one side of their body more than the other, for example:
- Rarely use one of their arms to pick up toys, or eat and drink
- Rarely kick one leg compared to the other
- Can’t sit without support. For example, they lean on their hand, or, when they sit, their back is very curved
- Still have their early reflexes, like the startle reflex and grasp reflex
- Keep their legs flat when lying on their back, for example, do not bring their feet to their chest
- Still need you to support their head
- Still need you to help turn their head when lying on their back
- Can’t crawl, or find it hard, for example, drags one of their legs behind them
- Find it difficult to stand, for example:
- Can’t stand with support
- Doesn’t try to pull themselves up to stand
- Can’t move a toy from one hand to the other
- Doesn’t use both hands to hold larger things
9-12 months
9-12 MONTHS
Contact your health visitor or GP if your baby is 9-12 months and they…
- Have lost skills which they could do before
- Feel very stiff, for example:
- Hold their arms and legs in the same position, such as always pulling their arm to their chest, or always crossing their legs
- Find it difficult to change their position on their own
- You find it difficult to move your baby’s arms or legs, making it tricky to change their nappy or clothes
- Feel very floppy when they are awake
- Move their arms and legs in repetitive, jerky, or strange ways
- Use one side of their body more than the other, for example:
- Lean to the side when they sit
- Use one arm to pull to stand more than the other
- Rarely use one of their arms to pick up toys, or eat and drink.
- Rarely kick one leg compared to the other
- Find it difficult to sit, for example:
- Only sit with support
- Lean on their hand when sitting
- When they sit their back is very curved
- Can’t move a toy from one hand to the other
- Don’t use both hands to hold larger things
- Don’t point to objects
- Can’t crawl, or find it hard, for example, drags one leg behind them
- Find it difficult to stand, for example:
- Can’t pull themselves up to stand
- Find it hard to pull themselves up. For example, they only use their arms and don’t push with their legs
- Can’t stand with support
2 months
Your Baby By Two Months
Social/Emotional Milestones
- Calms down when spoken to or picked up
- Looks at your face
- Seems happy to see you when you walk up to her
- Smiles when you talk to or smile at her
Language/Communication Milestones
- Makes sounds other than crying
- Reacts to loud sounds
Cognitive Milestones (learning, thinking, problem-solving)
- Watches you as you move
- Looks at a toy for several seconds
Movement/Physical Development Milestones
- Holds head up when on tummy
- Moves both arms and both legs
- Opens hands briefly
4 months
Your Baby By Four Months
Social/Emotional Milestones
- Smiles on his own to get your attention
- Chuckles (not yet a full laugh) when you try to make him laugh
- Looks at you, moves, or makes sounds to get or keep your attention
Language/Communication Milestones
- Makes sounds like “oooo”, “aahh” (cooing)
- Makes sounds back when you talk to him
- Turns head towards the sound of your voice
Cognitive Milestones (learning, thinking, problem-solving
- If hungry, opens mouth when he sees breast or bottle
- Looks at her hands with interest
Movement/Physical Development Milestones
- Holds head steady without support when you are holding him
- Holds a toy when you put it in his hand
- Uses his arm to swing at toys
- Brings hands to mouth
- Pushes up onto elbows/forearms when on tummy
6 months
Your Baby By Six Months
Social/Emotional Milestones
- Knows familiar people
- Likes to look at self in a mirror
- Laughs
Language/Communication Milestones
- Takes turns making sounds with you
- Blows “raspberries” (sticks tongue out and blows)
- Makes squealing noises
Cognitive Milestones (learning, thinking, problem-solving)
- Puts things in her mouth to explore them
- Reaches to grab a toy she wants
- Closes lips to show she doesn’t want more food
Movement/Physical Development Milestones
- Rolls from tummy to back
- Pushes up with straight arms when on tummy
- Leans on hands to support herself when sitting
9 months
Your Baby By Nine Months
Social/Emotional Milestones
- Is shy, clingy, or fearful around strangers
- Shows several facial expressions, like happy, sad, angry, and surprised
- Looks when you call her name
- Reacts when you leave (looks, reaches for you, or cries)
- Smiles or laughs when you play peek-a-boo
Language/Communication Milestones
- Makes a lot of different sounds like “mamamama” and “bababababa”
- Lifts arms up to be picked up
Cognitive Milestones (learning, thinking, problem-solving)
- Looks for objects when dropped out of sight (like his spoon or toy)
- Bangs two things together
Movement/Physical Development Milestones
- Gets to a sitting position by herself
- Moves things from one hand to her other hand
- Uses fingers to “rake” food towards himself
- Sits without support
1 year
Your Baby By One Year
Social/Emotional Milestones
- Plays games with you, like pat-a-cake
Language/Communication Milestones
- Waves “bye-bye”
- Calls a parent “mama” or “dada” or another special name
- Understands “no” (pauses briefly or stops when you say it)
Cognitive Milestones (learning, thinking, problem-solving)
- Puts something in a container, like a block in a cup
- Looks for things he sees you hide, like a toy under a blanket
Movement/Physical Development Milestones
- Pulls up to stand
- Walks, holding on to furniture
- Drinks from a cup without a lid, as you hold it
- Picks things up between thumb and pointer finger, like small bits of food
RED
RED
AMBER
AMBER
AMBER
AMBER
Green
Green
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Advice and Guidance
Tips to help milk flow
While you are expressing your breast milk, you may find it helpful to:
- hold your baby or have some skin-to-skin time with your baby
- sit near your baby or look at a photo of them
- touch or smell your baby
- hold and smell your baby’s clothes or blanket
- listen to relaxing music
This can help trigger your let-down reflex (a hormonal response that makes breast milk flow).
Expressing breast milk by hand
To have the best chance of achieving a full milk supply, it is recommended that you express your colostrum by hand within the first couple of hours after giving birth, and then aim to express 8 to 10 times in 24 hours, including at least once overnight.
Please ask your midwife to show you how to hand express. You can also follow the steps below:
- Wash your hands.
- If you are collecting your colostrum, you will need a clean, sterilised syringe, as well as a larger clean, sterilised container. Make sure you have these items ready before you start.
- Make sure you are feeling comfortable before you start. This will help you to feel relaxed. Gently massage your breasts and roll your nipples between your thumb and finger for a few minutes. This releases a hormone called oxytocin, which triggers the release of milk (also known as the let-down reflex). You may feel a tingling sensation when this happens.
- Using your fingers, work back from the base of your nipple until you feel a change in texture. This is normally about 2 to 3 cm from the base of your nipple.
- Make a ‘C’ shape with your thumb on top of your breast and your fingers below. Gently press your thumb and fingers together, release your fingers and repeat in a rhythmic movement. This should not hurt.
- It may take a few minutes before you see your breastmilk. You may also need to move your hand position forwards or backwards to get the best result. It is important to avoid sliding your fingers along your skin as this may cause damage to the breast tissue.
- Colostrum is very concentrated, so it will come out of your nipples as droplets. To collect your colostrum, use a sterilised syringe and decant into a larger sterilised container if necessary. If your breast milk supply is more established, you may prefer to express your milk directly into the larger sterilised container.
- When the drops slow down, move your fingers round your breast to express milk from a different section of your breast and repeat steps 2 to 6.
- Repeat the whole process for your second breast.
For more information about hand expressing, please watch the content under Video Showcase.
Expressing breast milk with a breast pump
It is recommended that you hand express your breast milk for the first two days after giving birth before using a breast pump. However, if advised by your neonatal nurse or midwife, a breast pump can be used six hours after giving birth.
Breast pumps are designed to mimic your baby’s sucking action. There are two different types: electric and manual. With the manual pump, you squeeze the plunger by hand, while the electric version does the work for you.
Your choice of breast pump will depend on your reasons for expressing. Manual pumps provide a cheaper alternative to electric pumps. They are light-weight, quieter and easier to use. However, they take longer to use and are less efficient.
When you have chosen the right type of pump for you, it is important to read the instructions carefully and ensure you are familiar with how to put it together and how it works before you use it. If you have any questions or concerns, please speak to your midwife, health visitor or a member of your infant feeding team.
Please follow the manufacturer’s instructions carefully. You can also follow the steps below:
- Sterilise your pump according to the manufacturer’s instructions before you begin.
- Wash your hands thoroughly before you put together your pump.
- Make sure you are feeling comfortable before you start. This will help you to feel relaxed. Gently massage your breasts and roll your nipples between your thumb and finger for a few minutes. This releases a hormone called oxytocin, which triggers the release of milk (also known as the let-down reflex). You may feel a tingling sensation when this happens.
- Place the correct size breast pump funnel (flange) over your breast, ensuring your nipple is positioned centrally. If you are using a hand pump, slowly start to pump. If you are using an electric pump, switch the machine on and start slowly with the suction on the lowest setting. You can increase the speed when your milk starts flowing. This may take a few minutes.
- When the volume of milk you are expressing starts slowing down, repeat the process for your second breast. Swap back to your first breast before you finish, as you may have more milk to express. It is normal for one breast to produce more milk than the other.
- If you are using an electric pump, double pumping (expressing milk from both breasts at the same time) not only reduces time, but it also increases your milk supply and hormone levels.
- When the flow of milk stops, remove the breast pump funnel (flange) and put a lid on the collecting container.
- Make sure the milk is stored correctly.
- Wash and sterilise the pump.
Storing expressed breast milk
Make sure your breast milk is stored in a labelled, sterilised container (this does not need to be a bottle) or breast milk storage bag. Storing your breast milk in small quantities will help you to avoid wasting milk, especially if you plan to freeze it, as milk that has been defrosted should be used within 12 hours.
Your milk should then be stored carefully to prevent the growth of harmful bacteria. You are advised to follow the storage guidelines below:
- Room temperature – Ideally you should refrigerate your breast milk as soon as possible after expressing. Expressed breast milk can remain at room temperature for a maximum of 6 hours.
- Fridge – You can store your milk in the fridge for up to 5 days if the temperature of your fridge is 4°C or lower (you may wish to buy a fridge thermometer if the temperature of your fridge is not clearly displayed). If you are not sure of the temperature of your fridge, or it is higher than 4°C, you should use the milk within 3 days or discard or freeze it. Your milk should be stored at the back of the fridge and not in the door, where the temperature is less likely to be consistent.
- Cool bag – If your milk has been cooled in the fridge, it may be carried in a cool bag with ice packs for up to 24 hours.
- Ice compartment – Your milk may be stored in the ice compartment of your fridge for two weeks.
- Freezer – If you are planning to freeze your milk, you should do this as soon as possible after expressing it (it must be done within 24 hours). Make sure you label it with the time and date of expression. Avoid using pens with ink that will smudge when wet. Your milk may be stored in the freezer for up to 6 months if the temperature of your freezer is -18°C or lower.
If your baby is premature and / or poorly and receiving neonatal care, stricter storage recommendations may apply. Please discuss milk storage with the neonatal team looking after your baby.
How to warm expressed breast milk
From the fridge
- Warm your breast milk gently by placing the container in some warm water
- Try not to overheat your breast milk
- Do not heat your milk in the microwave
From the freezer
- Defrost your breast milk in the fridge
- Use your defrosted breast milk within 12 hours of removing it from the freezer
- If you need to use your breast milk quickly, place the container under cool running water
- Do not refreeze defrosted breast milk
Self care and Prevention
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