Expression of breast milk: why and how is it carried out?

In order not to disturb the natural process of lactation after the birth of a child, but, on the contrary, to promote normal breastfeeding and avoid problems with the mammary glands, you should know when it is necessary to express breast milk, as well as how to do it correctly. [1]

What is milk expression for?

In explaining how to properly attach a baby to the breast, care for the mammary glands during lactation, when and how to express milk from them, a certified  breastfeeding consultant  - who is also a specialist in milk expression - must clearly define the fundamental purpose of this manipulation in each case, considering the possible  complications of lactation .

They can be avoided if the baby is not breastfed according to the “schedule”, but as needed (as they say, how much he needs), because the stimulation of lactopoiesis or lactogenesis, that is, the secretion of milk, occurs in a reflex way - when the baby actively sucks.

Sensory receptors on the nipple and its areola stimulated by sucking initiate nerve impulses to the brain, which causes an increase in the synthesis of the hormones prolactin and oxytocin. The first is responsible for the secretion of breast milk in the mammary glands, and the role of the second hormone is the contraction of the myoepithelial cells of their tissues, leading to the release of milk from the alveoli into the milk ducts. Experts call this the endocrine control of lactation.

During the first week of the postpartum period, the mother's body produces breast milk automatically - at the peak of the increase in prolactin synthesis, but after a certain time its level drops, and the process of milk production goes into the "supply-demand" mode, that is, the control of lactopoiesis becomes autocrine, frequency-dependent and the degree of emptying of the mammary glands (which, after feeding, should become soft before the next “portion” of milk arrives). Thus, the easiest and most effective way to support the production of breast milk - without pumping - is considered to be frequent breastfeeding of the baby at any time of the day.

But if there is not enough milk to meet the needs of the baby, as evidenced by insufficient weight gain, decreased urination and a darker color of urine, then breast milk is expressed after or between feedings. For more details, see -  Insufficient milk secretion: how to increase lactation?

But if it is impossible to breastfeed the child directly due to respiratory distress syndrome and weakness of the sucking reflex during prematurity, perinatal pathologies of the infant, etc., as well as due to the health of the mother or her temporary separation from the child, without regular pumping (at least five -six times a day) is indispensable. And it is recommended to start it six hours after birth.

It is necessary to express breast milk with your hands in case of stagnation of milk and severe engorgement of the glands; pumping with  lactostasis , which is observed with an excess of milk, which at first the child is simply not able to suck out; with  blockage of the ducts of the mammary glands .

In women with hyperlactation (often accompanied by dilated milk ducts) or with an increased oxytocin reflex, too much milk passes quickly from the breast, which, when feeding, leads to choking of the baby and swallowing of air, causing colic. To slow down the release of milk, it is recommended to express it a little before feeding, and also to express a little bit of excess milk (no more than three times a day) - in order to alleviate your own condition.

In most cases, the first expression of milk is due to the fact that at the beginning of lactogenesis there is  breast engorgement . It is recommended to start pumping only when the milk, as they say, “approached”, and this, as a rule, occurs on the second or third day after childbirth, but in primiparous it is possible a little later. And if milk does not flow during decantation during the first three days after childbirth, then its full secretion has not yet begun, since the process of transformation of the acinar epithelium of the mammary glands from presecretory to secretory state has not yet been completed. At this time, the newborn sucks out the thick protein secret of the mammary glands, colostrum (colostrum), which stimulates his immune system. In addition, milk does not come out when a woman expresses it incorrectly, in particular, she squeezes the nipple hard. [2]

Rules for expressing milk

There are rules for expressing milk, explaining how to perform this manipulation so as not to injure the mammary glands.

Methods of expressing milk: manual and using devices for expressing milk - breast pumps.

How is the correct expression of milk by hand into a bottle or other container, and how to increase the milk when expressing?

When there is enough milk, and you just need to express its excessive balance to avoid stagnation - this is one situation, and three to five minutes are enough for the mammary gland to become soft after feeding.

Another thing is when you need more milk to feed a premature baby without applying it directly to the breast. Then the question arises of how to cause a rush of milk during pumping and in general, how to increase milk during pumping so that the newborn really has enough of it.

Lactation consultants recommend taking a moderately warm shower on the breast area before pumping, applying a warm compress to the same area for five minutes, and then gently massage while expressing breast milk for several minutes, see Breast  Massage While Feeding for more details .

Followed by:

• with one hand to support the chest from below;
• place the thumb of the other hand above the nipple (on the border of its areola);
• put the index finger at the same distance from the nipple, but on the opposite side, that is, from below - opposite the thumb (in shape, the position of the fingers is similar to the letter "C");
• then with your fingers you need to press on the gland towards the chest wall (in no case until pain appears) and release it without removing your fingers, without sliding them over the skin, without touching the nipple, but gently squeezing them towards each other behind the nipple for a couple seconds, and letting go.

How should milk come out when pumping? Such rhythmic movements will lead to the fact that at first drops of milk will appear from the nipple, and then it can come out in trickles. If the mother is dairy, the milk comes out in streams under pressure, which causes breast milk to foam when expressed.

If drops do not appear, you need to slightly move the fingers (in a circle around the areola), and when the milk stops flowing out, the fingers are brought to another part of the chest and repeat the described actions.

Another question that lactating women turn to doctors is how long does it take for milk to arrive after pumping. If during feeding it arrives in a quarter of an hour, then after pumping - after 40-60 minutes.

How much milk should be when expressing?

The amount of milk expressed after the next breastfeeding is individual and depends on the total volume of its secretion, as well as the baby's appetite. According to pediatricians, most newborns in the first month of life consume 30-60 ml of breast milk per feeding, and as they grow, the volume of one feeding reaches 90-120 ml (with a daily intake of up to 700-900 ml).

If a mother is forced to express both breasts five or six times a day for 20 minutes to ensure feeding without putting the baby to the breast, then one should proceed from the need for milk for one feeding, which is carried out every two hours.

When it seems to a woman that there is not enough milk when expressing, it is worth focusing on the data provided, and not panicking about not having enough milk. Because excessive excitement and stress adversely affect lactation. And complaints that milk was lost after pumping are actually caused by negative emotions and stress, in which adrenaline, which is an antagonist of prolactin, is released into the blood.

It should also be borne in mind that milk production in the morning is higher than in the afternoon and evening, and fatigue and poor nutrition of the mother reduce milk secretion.

In addition, the influence of the so-called lactation crises may also affect, when the secretion of milk is reduced for several days when the child is from three weeks to one and a half months, and such declines can be repeated at an interval of about one and a half months from three to eight months. [3]

Expressing breast milk with a breast pump

The better the mammary glands are emptied, new milk is produced there faster, and in some cases, devices for expressing milk - breast pumps can help.

The simplest of them is a pear for pumping (with a glass lining and a reservoir).

There are also types of piston-action breast pumps, but manual mechanical pump-type breast pumps are more often used: Canpol babies, (Manual Breast Pump) Avent Philips), Lovi, Baby Team, Mamivac Easy, Chicco Natural Feeling, Tommee Tippee, etc. Many models come with special jars for expressing milk and bottles with nipples for feeding.

For more serious breastfeeding problems or when you need to stockpile breastmilk, there is the Medela Mini Electric electric breast pump and the Medela Swing electronic two-phase pump (sucking effect).

How to use them is indicated in the attached instructions. [4]

Storing milk after pumping

An equally important question is, where to put milk after pumping? As lactation consultants point out, if the child is satiated without finishing the next portion, then the remains should simply be poured out, and if the excess is intact, it should be stored for additional feeding if necessary or as a safety net.

Where, how and how much to store milk after pumping?

It is allowed to store milk after pumping at room temperature: at +25°C - no longer than 5 hours, at lower temperatures (+20 °C) - up to 10 hours.

But it is much more rational to store milk after pumping in the refrigerator, since its shelf life increases to two to three days. And if you freeze it, then up to six months.

How to freeze breast milk after pumping?

For freezing, plastic containers with a lid or hermetically sealed sterile bags for storing expressed milk are used. Each serving of milk must be labeled with the date it was expressed.

In a conventional freezer, milk can be stored for three months, and in a freezer compartment (at -18°C) twice as long. After thawing a portion of milk, it must be fed on the same day.

Can I mix milk from different pumps? You can, but only portions received within 24 hours, which must first be kept in the refrigerator for an hour.

How to warm breast milk after pumping? Before feeding the baby with expressed milk, it is heated to body temperature by placing the bottle in a container of warm water. [5]

Pumping problems

When the temperature rises after expressing milk, this may be due to a rush of milk or irritation of the nipple and areola, which leads to the release of oxytocin and the action of the oxytocin reflex. In addition, thirst and headache may occur.

But chest pains during and after pumping appear when this manipulation is performed incorrectly (too much squeezing of the chest) or in cases of development of  lactational mastitis .

If the outflow of milk is disturbed, its partial coagulation in the milk ducts is possible, and then milk clots appear during pumping.

Yellow milk when expressed may mean that it is more fatty hindmilk. Also, pigments of food products or used drugs (for example, the yellow dye contained in the shell of vitamin pills and tablets) easily get into milk. In general, the normal color of breast milk is slightly bluish or yellowish. [6]

Pink milk during pumping can be if a capillary burst in the nipple or the mother used beets the day before. Also, a pink or brownish color gives blood in the milk when decanting, which can get into it from a broken capillary of the glandular tissue of the gland or damage (cracks) to the nipples. This does not affect the nutritional properties of milk in any way and does not harm the child.