What is express breast milk

Expressing and storing breast milk

Expressing milk means squeezing milk out of your breast so you can store it and feed it to your baby later.

You might want to express milk if:

• you have to be away from your baby, for example, because your baby is in special care or because you're going back to work
• your breasts feel uncomfortably full (engorged)
• your baby is not able to latch or suck well, but you still want to give them breast milk
• your partner is going to help with feeding your baby
• you want to boost your milk supply

How to express breast milk

You can express milk by hand or with a breast pump. How often you express your milk, and how much you express, will depend on why you're doing it.

Sometimes it takes a little while for your milk to start flowing. Try to choose a time when you feel relaxed. Having your baby (or a photo of them) nearby may help your milk to flow.

You may find it easier to express if you cover your breasts with a warm towel first, or after you have a shower or bath.

Expressing breast milk by hand

Some find it easier to express milk by hand, especially in the first few days or weeks. It also means you can express without needing a pump, or an electricity supply.

Hand expressing allows you to encourage milk to flow from a particular part of the breast. This may be useful, for example, if one of the milk ducts in your breast becomes blocked.

Hold a sterilised feeding bottle or container below your breast to catch the milk as it flows.

These tips may help:

• Before you start, wash your hands with soap and warm water.
• Have something clean ready to collect the milk in.
• Some find gently massaging their breasts before expressing helps their milk to let down.
• Cup your breast with one hand then, with your other hand, form a "C" shape with your forefinger and thumb.
• Squeeze gently, keeping your finger and thumb a few centimetres away from your nipple, just outside the darker area around it (areola). Do not squeeze the nipple itself as you could make it sore. This should not hurt.
• Release the pressure, then repeat, building up a rhythm. Try not to slide your fingers over the skin.
• Drops should start to appear, and then your milk usually starts to flow.
• If no drops appear, try moving your finger and thumb slightly, but still avoid squeezing the darker area near your nipple.
• When the flow slows down, move your fingers round to a different section of your breast, and repeat.
• When the flow from one breast has slowed, swap to the other breast. Keep changing breasts until your milk drips very slowly or stops altogether.

Watch a video about expressing milk by hand on the UNICEF website

Expressing milk with a breast pump

There are 2 different types of breast pump: manual (hand-operated) and electric.

Manual pumps are cheaper but may not be as quick as an electric pump.

You may be able to hire an electric pump. Your midwife, health visitor or a local breastfeeding supporter can give you details of pump hire services near you.

The suction strength can be altered on some electric pumps. Build up slowly. Setting the strength to high straight away may be painful or damage your nipple.

You may also be able to get different funnel (the part that goes over your nipple) sizes to fit your nipples. The pump should never cause bruising or catch your nipple as it's sucked into the funnel.

Always make sure that the pump and container are clean and sterilised before you use them.

Find out how to sterilise baby bottles

Storing breast milk

You can store breast milk in a sterilised container or in special breast milk storage bags:

• in the fridge for up to 8 days at 4C or lower (you can buy fridge thermometers online) – if you're not sure of the temperature of your fridge, or it is higher than 4C, use it within 3 days
• for 2 weeks in the ice compartment of a fridge
• for up to 6 months in a freezer, if it's -18C or lower

Breast milk that's been cooled in the fridge can be carried in a cool bag with ice packs for up to 24 hours.

Storing breast milk in small quantities will help avoid waste. If you're freezing it, make sure you label and date it first.

Defrosting frozen breast milk

It's best to defrost frozen breast milk slowly in the fridge before giving it to your baby. If you need to use it straight away, you can defrost it by putting it in a jug of warm water or holding it under running warm water.

Once it's defrosted, give it a gentle shake if it has separated. Use it straight away. Do not re-freeze milk that's been defrosted.

Once your baby has drunk from a bottle of breast milk it should be used within 1 hour and anything left over should be thrown away.

Warming breast milk

You can feed expressed milk straight from the fridge if your baby is happy to drink it cold. Or you can warm the milk to body temperature by putting the bottle in a jug of warm water or holding it under running warm water.

Do not use a microwave to heat up or defrost breast milk. This can cause hot spots, which can burn your baby's mouth.

Storing breast milk if your baby is in hospital

If you're expressing breast milk because your baby is premature or sick, ask the hospital staff caring for your baby for advice on how to store it.

Read more about breastfeeding a premature or sick baby

If you're having difficulty expressing breast milk

If you're finding it difficult or uncomfortable to express your breast milk:

• Ask your midwife, health visitor or breastfeeding supporter for help. They can also tell you about other breastfeeding support available near you.
• Search online for breastfeeding support in your area.
• Call the National Breastfeeding Helpline on 0300 100 0212 (9.30am to 9.30pm daily).

The Bliss website also has advice about expressing milk for a premature or sick baby

Expressing breastmilk & storing breastmilk

Expressing breastmilk and storing breastmilk: the basics

Expressing breastmilk is when you take milk out of your breast.

Expressing and feeding from a bottle or cup can be handy. You might want to express your breastmilk because you:

• have swollen or engorged breasts
• need to clear a blocked milk duct
• are sick and don’t feel well enough to breastfeed
• want to store some breastmilk in the fridge or freezer.

Some women find it easy to express, and other women find it more difficult. It can sometimes take a while to learn how to express.

Women express varying amounts of breastmilk. It depends on many things, including your body, your baby’s last feed and your baby’s age. It can also depend on how often you express.

If you can’t express much (or any) milk, check with your midwife, child and family health nurse or lactation consultant to make sure you’re expressing correctly. An Australian Breastfeeding Association (ABA) counsellor can also help – phone the National Breastfeeding Helpline on 1800 686 268 or use ABA LiveChat.

There are 3 ways to express:

• by hand
• with a manual pump
• with an electric pump.

Most people find expressing breastmilk easier if they’re in a comfortable, private place. Get yourself relaxed and comfortable, and have a glass of water handy to drink. Give yourself plenty of time too – especially when you’re first learning to express.

Expressing breastmilk by hand

Here are the basic steps for expressing breastmilk by hand.

Getting ready

• Wash your hands with soap and warm water. Dry hands with a clean towel.
• Encourage your let-down reflex. You can do this by gently massaging the top and underside of your breast several times. Or you can put a warm washcloth or heatpack on your breast.
• Place a clean plastic dish or a wide bowl under your breast, either between your legs or on a low table. You can express into the dish or bowl and leave both your hands free. You might need a clean towel on your lap to catch any spills or to wipe slippery, wet fingers.

Expressing by hand

• Support your breast with one hand. You might find this is particularly helpful if you have large and heavy breasts.
• With the same hand, place your thumb and finger directly opposite each other, either side of and well back from your nipple near the top of the areola.
• Gently press inward towards the centre of the breast, until you feel the bulk of the breast. Expressing shouldn’t hurt.
• Gently press finger and thumb towards each other using a rhythmic rolling movement. This will compress the ducts, and milk will flow out of your nipple. There might be only drops until your let-down reflex happens. After this, you should get sprays from the nipple with each squeeze.
• Once the milk flow slows, move your thumb and finger to a different position around the areola and press again. This expresses more milk and empties all sectors of the breast. Change hands if your fingers get tired.
• Repeat the process on the other breast. Expressing milk can be tiring, so stopping for a drink of water might help you relax before you start again.
• If you need more milk, change from breast to breast, or wait and try again later.

Expressing breastmilk with a manual pump

Manual breast pumps usually consist of a breast shield attached to a pump handle and collection bottle or container.

Just as with hand-expressing, the first step in expressing breastmilk with a manual pump is getting yourself relaxed and comfortable. This can help to trigger your let-down. Gentle massage and warmth as described above is a good idea too.

Here are the next steps:

• Place the breast shield of the pump directly over your breast with your nipple centred.
• Squeeze the pump handle gently and rhythmically. You might see only drops of milk until your let-down happens and then it’ll spray.
• Pump until your milk flow stops.
• Switch to the other breast. You can go back and forth several times.

Expressing breastmilk with an electric pump

Electric breast pumps are much like manual pumps, except that you don’t have to do the pumping yourself. Attach the breast shield to your breast (or breasts, in the case of double pumps).

As with expressing breastmilk by hand or by manual pump, get comfortable and relaxed to start. This helps with your let-down.

Here are the next steps:

• Place the breast shield of the pump directly over your breast with your nipple centred.
• Start with low suction and increase it to a level that’s comfortable for you.
• Pump until your milk flow stops.
• If you’re using a single pump, switch to the other breast. You can go back and forth several times.

You can often get more milk by hand-expressing after the flow with the pump has stopped.

You can buy or hire electric breast pumps. The ABA hires them out, as do some pharmacies. You’ll need to buy your own pump kit to attach to a hired electric breast pump.

There are many manual and electric pumps on the market. If you’re interested in using a pump to express, it might be a good idea to speak with your child and family health nurse or an ABA counsellor. They can help you choose the right pump for your needs.

Storing expressed breastmilk

After you’ve expressed, put your breastmilk into a clean, closed container or a special breastmilk storage bag. You can buy storage bags from your pharmacy or other shops that sell baby stuff.

It’s best to refrigerate or freeze breastmilk after expressing. Don’t forget to write the date of expressing on the storage container or bag before you refrigerate or freeze the breastmilk.

If you’re adding fresh breastmilk into the same container or bag as other chilled or frozen breastmilk, cool the fresh breastmilk in the fridge first. The date on the whole container or bag should be the date when the oldest breastmilk was expressed.

The guidelines below explain how long you can store breastmilk at different temperatures and when you should use stored or frozen breastmilk.

Freshly expressed breastmilk
You can store breastmilk:

• at room temperature (26ºC or lower) for 6-8 hours
• in the fridge (5ºC or lower) for up to 72 hours – the best spot is the back of the fridge where it’s coldest
• in the freezer compartment (-15ºC or lower) inside a fridge for 2 weeks
• in the freezer section (-18ºC or lower) of a fridge with a separate door for 3 months
• in a chest or upright deep freezer (-20ºC or lower) for 6-12 months.

Previously frozen breastmilk (thawed in the fridge but not warmed)
You can store breastmilk:

• at room temperature (26ºC or lower) for 4 hours or less – that is, until the next feed
• in the fridge for up to 24 hours – the best spot is the back of the fridge where it’s coldest.

Don’t refreeze previously frozen breastmilk.

Breastmilk thawed outside the fridge in warm water
You can store breastmilk:

• at room temperature (26ºC or lower) until the end of the feed
• in the fridge for 4 hours or until the next feed.

Don’t refreeze previously frozen breastmilk.

If your baby doesn’t finish their feed of expressed breastmilk, you can’t use it for another feed. You should throw it away. Offering small amounts of expressed breastmilk at a time might help to reduce wastage.

Transporting expressed breastmilk

You can transport expressed breastmilk between home and other places. Expressed breastmilk can travel:

• in an insulated container like an esky or cooler bag with one or more freezer bricks
• either frozen or fresh – if the milk has thawed, use it within 4 hours and don’t refreeze it.

Place the labelled breastmilk in the fridge as soon as you arrive or in the freezer if it’s still frozen.

Preparing expressed breastmilk for use

You can give your baby expressed breastmilk with a cup, spoon or bottle. Warm your container of breastmilk by placing it in warm water. Use fresh breastmilk first if you have some, but if you’re using frozen breastmilk, you can thaw it by placing it in either cool or warm water.

Test the temperature of the milk before feeding your baby. The temperature should be lukewarm or around body temperature. Some babies don’t mind milk that has been thawed but not warmed.

Don’t use a microwave oven to thaw or warm the milk, because this destroys some of the components of breastmilk. It can also result in hot spots, which can burn a baby.

You might notice that expressed and stored breastmilk has a surface layer of fat, with lighter milk underneath. This is normal. You can gently swirl the bottle or container after heating to mix the fat through.

Cleaning expressing equipment

Clean all breast pump parts and storage containers used to collect and store breastmilk before use. But you don’t need to clean sterile expressed breastmilk bags or new plastic bags before use.

If you’re expressing once a day or more, you should thoroughly clean your expressing equipment at least once every 24 hours. Here’s how:

1. If your water supply is different for drinking and washing, use drinking water to clean your expressing equipment.
2. Check the manufacturer’s instructions to find out how to pull apart your breast pump.
3. Wash your hands well, and dry them with a clean cloth or paper towel.
4. Take apart your breast pump and rinse with cold water to remove any milk.
5. Wash all equipment well in hot water and detergent. Scrub with a brush that you use only for cleaning this equipment.
6. Rinse equipment at least twice in hot water.
7. Place equipment upside down on a clean cloth or paper towel, and cover it with another clean towel while it dries.
8. If there’s any water left on the equipment, dry the equipment with a clean cloth.
9. Store the dry equipment in a clean, closed container or plastic bag until next use.

In between cleans, here’s what to do if you have access to a fridge:

• Store expressing equipment in a clean, closed container or plastic bag in the fridge until next use.
• Make sure that you place the equipment in the fridge immediately after use.

And here’s what to do if you don’t have access to a fridge:

• Thoroughly rinse expressing equipment in cold water after each use.
• Store equipment in a clean, closed container or plastic bag until next use.

If you and your baby are well, you don’t need to sterilise expressing equipment after cleaning.

You do need to sterilise bottle-feeding equipment after cleaning for babies under 12 months. You can read more about cleaning and sterilising bottle-feeding equipment.

This information applies to normal healthy babies being fed their own mother’s breastmilk. If your baby is premature or sick, the health professionals caring for your baby will tell you what to do.

Feeding with expressed milk | breastfeeding

When can I start breastfeeding my baby with expressed breast milk? How to do it right? Is it worth worrying that the child will confuse the pacifier with the breast? In this article we will answer your questions.

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When can I start breastfeeding my baby?

If your baby is healthy and breastfeeding well, there is no need to give him expressed milk. For the first four weeks, you work together to start and increase milk production, and your baby also learns to suckle properly at the breast. There is not enough scientific data on this yet, ¹ but there is an opinion that bottle feeding in the first month may adversely affect the process of establishing breastfeeding.

However, if the newborn is unable to latch on or suckle for some reason, start expressing milk as soon as possible after delivery. Read more about this in our articles on coping with problems in the first week, breastfeeding premature babies and babies with special needs, and seeking help from your healthcare provider.

How can I feed my baby with expressed breast milk?

There are many expert feeding solutions that allow you to give your baby expressed milk in a variety of ways, depending on your and your baby's needs.

For example, the innovative Calma smart pacifier only lets milk through when the baby creates a vacuum by suckling. This means that when feeding from a bottle, he will make the same movements with his tongue and jaws as when sucking at the breast. ^2.3 Calma was developed with the help of breastfeeding experts from the University of Western Australia. When using this pacifier, the baby can suck, swallow, pause and breathe in the same way as when breastfeeding. ⁴ Preserving natural sucking habits allows baby to transition easily from breast to bottle and back.

In addition, Medela also offers regular bottle teats* in two versions that produce milk at different rates. All Medela* nipples can be placed directly on bottles used for expressing milk, minimizing the risk of spillage.

If you need to feed your baby with expressed milk, but you do not want to bottle feed him until he is learning to breastfeed, you can use a sippy cup* for temporary feeding. The baby will be able to drink milk from such a mug, but you should be careful not to spill the milk. For the first time, it is advisable to feed the child from a drinking cup under the supervision of the attending physician in order to learn how to do it correctly.

If your baby needs to be supplemented with expressed milk in addition to regular breastfeeding, the Supplementary Feeding System (SNS)* can be used. It is equipped with a thin, flexible capillary that can be clipped close to the nipple to give your baby expressed milk while breastfeeding. Thanks to this, the baby suckles the breast for longer, thereby developing sucking skills and stimulating the production of milk from the mother. This can be helpful when there is a shortage of breast milk, as well as when feeding adopted or surrogate children.

If the baby is unable to breastfeed because he is too weak or has a congenital disease, you can use the Special Needs Cup*, which releases milk with gentle pressure, making it suitable for feeding these babies.

How to teach a child to bottle feed?

If breastfeeding is going well and you decide to start bottle feeding your baby with expressed breast milk, follow these guidelines.

Start early and take your time

Don't wait until the first day of work or the first time you leave the house to start bottle feeding your baby. Start accustoming your baby to small portions of expressed milk a couple of weeks before the desired date, calmly and without haste. Gradually build up to one full serving of pumped milk from a bottle.

Choose a time

Ideally, at the first bottle feeding, the baby should be hungry, but not too hungry - in this state, he is as relaxed as possible.

Let others feed

Your baby is used to feeding from your breast, so when you offer him a bottle it can be confusing. The process can go faster if the first time the baby is bottle-fed by someone else while you are not in the room, so that your sight and smell do not embarrass the baby.

Maintain optimal temperature

Your baby will be more willing to eat expressed milk if the temperature is around 37°C, close to body temperature.

Dip the nipple in milk

Try dipping the nipple in expressed milk before offering it to your baby. This way it will taste and smell like your breast milk. Lightly touch the baby's upper lip with the nipple to open the mouth.

Choose the right position for bottle feeding

Feed your baby on demand and keep him reclining during feeding. Never bottle feed your baby when he is lying or sitting, otherwise he may choke. Listen to the wishes of the child - take as many pauses as he needs. You can even try to shift it from one hand to another during feeding.

Be patient

Don't worry if your baby doesn't take the bottle right away - it may take several tries. If he pushes the bottle away or starts crying, calm him down, wait a few minutes and try again. If he still doesn't want to bottle feed, wait a few more minutes and breastfeed him as usual. Repeat the bottle experiment at a different time of day.

How much pumped milk should I give my baby?

All children are different. Research shows that between the ages of one and six months, a baby can consume between 50 and 230 ml of milk per feeding. To start, prepare about 60 ml and observe how much your baby needs - more or less. You will soon realize how much milk he usually eats. Just never force him to finish the cooked portion.

How can I keep my baby safe when bottle feeding?

Always clean and sterilize your pump and bottles according to the manufacturer's instructions. Wash your hands before expressing, pouring milk, and feeding your baby. Follow our instructions for safely storing and thawing your expressed milk.

If breastmilk needs to be warmed, place the bottle or bag in a bowl of warm water or a heater or under running water at a maximum of 37°C. Never heat breast milk in the microwave or on the stove.

Will the baby be able to transition from breast to bottle?

Some mothers worry that if they start bottle feeding too early, they will get used to the artificial nipple and not want to breastfeed. Others, on the contrary, are worried that if the child is not immediately accustomed to the bottle, then he will no longer eat from it. In general, in these cases, they say that the child confuses the nipple with the breast.

Experts disagree on whether such confusion is a problem. ¹ Without a doubt, it is easier for a baby to suckle milk from a regular bottle with a nipple, which does not require a vacuum, than from the breast, since the milk flows faster, also under the influence of gravity. And some babies really have clear preferences: only the breast or only the nipple. However, many babies are comfortable suckling both the breast and the pacifier.

If you are unable to feed your baby with expressed breast milk, seek help from a lactation consultant or specialist.

Literature

1 Zimmerman E, Thompson K. Clarifying nipple confusion. J. Perinatol. 2015;35(11):895-899. - Zimmerman I., Thompson K., "On the issue of breastfeeding." Zh Perinatol (Journal of Perinatology). 2015;35(11):895-899.

2 Geddes DT et al. Tongue movement and intra-oral vacuum of term infants during breastfeeding and feeding from an experimental teat that released milk under vacuum only. Early Hum Dev . 2012;88(6):443-449. - Geddes D.T. et al., "Language Movements and Oral Vacuum Generation in Term Infants During Breastfeeding and Feeding from an Experimental Vacuum-Driven Teat". Airlie Hume Dev. 2012;88(6):443-449.

3 Segami Y et al. Perioral movements and sucking pattern during bottle feeding with a novel, experimental teat are similar to breastfeeding. J. Perinatol. 2013;33(4):319-323. - Segami I. et al., "Perioral movements and sucking during bottle feeding with a new experimental nipple are very similar to sucking from the breast." Zh Perinatol (Journal of Perinatology). 2013;33(4):319-323.

4 Sakalidis VS et al. Oxygen saturation and suck-swallow-breathe coordination of term infants during breastfeeding and feeding from a teat releasing milk only with vacuum. Int J Pediatr. 2012;2012:130769. - Sakalidis V.S. et al., "Oxygenation and Coordination of Sucking, Swallowing, and Breathing in the Term Infant During Breastfeeding and Feeding from a Purely Vacuum Teat". Int J Pediatrician 2012;2012:130769.

Read instructions before use. Consult a specialist about possible contraindications.

* RC № ФСЗ 2010/07353 dated 07/19/2010

Storage, freezing and thawing of breast milk

Expressed breast milk is the best food for your baby when you are not around. How to store and use breast milk correctly?

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If you go to work, go to the gym or simply ask your partner to feed your baby and you want to get some sleep yourself, you can express breast milk so that the baby can eat even when you are not around. Most of the beneficial properties are retained in expressed breast milk, so if you are forced to skip breastfeeding, it will be a better replacement than any formula. But an important guarantee of the safety of expressed milk for your baby is hygiene. Read the article to learn how to properly store breast milk.

What is the best way to store breast milk?

Any type of breast milk is better for the baby than formula. But freshly expressed breast milk is better than chilled, and chilled breast milk is better than frozen. The fact is that freshly expressed milk fights bacteria better, it contains more antioxidants, vitamins and fats than chilled or frozen milk ⁴ .

How long expressed breast milk lasts

Once your breast milk is properly collected in a clean container, you can store it at room temperature, in the refrigerator or in the freezer, depending on how soon you plan to use it. Follow the guidelines below:

Recommendations for the storage of expressed breast milk (for healthy term infants) ^{2, 3}

* The term "very clean environment" implies strict adherence to the instructions given in the article on cleaning and sterilizing the Medela 9 breast pump0104 . These instructions for storing and thawing breast milk are guidelines only. For more information, contact a lactation consultant or healthcare professional.