Expressing Breast Milk

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).

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:

1. Wash your hands.
2. 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.
3. 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.
4. 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.
5. 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.
6. 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.
7. 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.
8. 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.
9. Repeat the whole process for your second breast.

For more information about hand expressing, please watch the content under Video Showcase.

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:

1. Sterilise your pump according to the manufacturer’s instructions before you begin.
2. Wash your hands thoroughly before you put together your pump.
3. 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.
4. 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.
5. 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.
6. 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.
7. When the flow of milk stops, remove the breast pump funnel (flange) and put a lid on the collecting container.
8. Make sure the milk is stored correctly.
9. Wash and sterilise the pump.

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.

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