UK Expressing Milk

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Once established, breastfeeding is a real joy, but there are times when being able to express milk so that someone else can feed your baby is important. HOWEVER, unless there is a medical or other problem, you SHOULD NOT begin expressing milk before your feeding routine is established: probably when your baby is about six weeks old. Giving expressed milk before this can lead to several problems including your baby rejecting the breast in favour of a bottle, and reduced stimulation of your milk supply.

There are two main issues associated with giving expressed breastmilk:

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Hand Expressing

This is really good when you get the hang of it: you can express anywhere, anytime with no fuss or special equipment and anyone can do it, but can be a bit tricky to start with. If you can bear it, I really recommend that you to get someone to show you how... yes literally! It was a little embarrasing, but I had a midwife express my milk for me, and without such "hands on" help I'm sure I would never have got the technique right. Qualified assistants are there to help in whatever way you need it, but they will be understanding and noone will be offended if you say what you are, and what you are not, comfortable with.

To hand express:

  1. Find somewhere quiet, relaxed and warm. Be sure you won't be receiving embarrasing interruptions, and try to have a picture of your baby near by.


  2. Collect together a STERILE collection container, and any additional bottle teats, breast shells etc that you will need.


  3. Gently massage the milk in your breasts towards the nipple, by stroking you breast firmly but gently downwards towards the nipple, all the way around. It may also help to apply a warmed flannel to your breasts, to improve the let down.


  4. Position your thumb and first finger around the base of the areola (the part of the breast near your nipple where the skin changes colour). You need your fingers positioned behind the 'resevior' where the milk begins to collect. This is roughly in line with the edge of the areola, but you will need to experiment to find the correct position. The milk will flow easily when you get it right


  5. Squeeze your thumb and finger together gently, whilst pressing the nipple slightly in towards your breast. It should not hurt, and you should see a drop of milk appear. You may need to squeeze a few times in quick sucession before the milk will flow, but then you should be able to settle into a gentle rhythmn with a good jet of milk being expressed each time.


  6. Take care not to block or miss any of the ducts, which are positioned all the way around your breast: It is a good idea to rotate your hand position through 45 degrees every so often to ensure complete the expressing of your milk


  7. Continue to express milk from one side until the flow begins to decrease, or you are ready to stop, and then change sides. It is best to express on alternating sides for 20 minutes or so. You will probably find that you swap sides two or three times, and that the amount of time spent expressing milk naturally reduces with each change.

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Using a Breast Pump

There are various different types of pump available to rent and to buy, some are undoubtedly better than others, but in general you will find that the actual differences are less important - and what works best will be a very personal choice. Ideally you need to try out a few to see what suits you best, and if a friend or relative offers you the chance to borrow a pump I strongly recommend that you give it a go, you can buy your own later! Unfortunately most of us can't try out different pumps before buying, so you will have to base your choice on the manufacturers packaging and advertising, plus as many reviews and word-of-mouth recommendations as possible. I have put together my own personal experience, and my friends opinions, on various pumps as a start.... ask other people too.

HOSPITAL STYLE, FULLY ELECTRIC PUMPS:

£150 upwards to buy, £1/day rental
Medela Classic These pumps are large and expensive, you would probably only see one if you need to express milk in hospital, or you decide Medela Lactina to rent one for whatever reason. They are mains powered suction units, about the size of a day bag, to which you attach a collection kit via plastic tubing. There are two makes that I know of: Egnell have an old fashioned one that is still widely seen, and a more compact modern pump known as the "Elite". The "Elite" is very adjustable, you can taylor the level of suction Medela Pump-in-Style and speed of the cycles to best suit your body, and so it can be extremely sucessful. Egnell pumps tend to be used throughout the NHS, and can be rented from the NCT. Medela also produce rental pumps which can be privately hired. The "Lactina" is very similar to the "Elite" with a three level adjustable suction. It boasts a "natural sucking cycle" with a "relax phase", I found it to be the only pump which I actually managed to get significant amounts of milk from. The Medela "Pump-in-style" is supposed to be a very good breast pump, based on the Lactina, and is availble to buy. It is pretty expensive, but I would recommend it for someone needing to express milk daily, for example if you return to work and wish to continue complete breastfeeding.

BATTERY/MAINS PUMPS:

£25-£45 to buy
Babytec Battery Pump Medela Mini Electric These are often "converted" hand pumps, which have had an electric motor attached where the hand pump has a lever. I haven't actually heard of anyone who is particularly impressed with this type of pump. However, the Medela collection kit which is used with the Lactina or Pump-in-style pumps can be converted to a two-handed hand pump, and there is also an upgrade kit to make it into a "mini-electric": If I was going to use a pump of this type this is the one I would try! I have heard that the battery operated ones are very "battery hungry", and I have also heard them described as noisey, but to be fair I cannot comment on this.



ONE HANDED, HAND PUMPS:

£20-£35 to buy
Boots Hand Pump Avent Isis Maws Hand Pump Egnell Hand Pump These are essentially a cone which attaches to a bottle, and there is some kind of lever which you pump. You are supposed to be able to hold the pump, correctly positioned on the breast, and activate the mechanism with just one hand! They are meant to be pretty straight forward to use. I believe they are considered the best type of pump for occasional use, and perhaps what you should go for if you need to pump a few times a week... maybe even upto once a day. You can naturally vary the suction and rhythm of the pump by you own action, and they are not too hard to operate. The Avent ISIS pump is an example of this type of pump, and one which has been strongly recommended to me by a friend.

TWO HANDED, HAND PUMPS:

£15-£30 to buy
Medela Hand Pump Again a cone which attaches to a bottle, with a pump action requiring one hand to hold the pump in position against the breast, whilst the other hand actions the mechanism. There are a few types of mechanisms available, and I have been told that the "bulb" type mechanism is rarely effective because you cannot get enough suction. I can however recommend the Medela hand pump which relies on a handle that you pull in and out at the top of the pump: this type of mechanism is common, effective, and VERY HARD WORK. This pump would be fine for very occasional use and emergencies. It is not something you could use daily, for example when returning to work.

Cylinder Pump

CYLINDER HAND PUMPS:

£8-£15
A cheap pump. The old fashioned design is supposed to be very effective, I have no idea how easy they are to actually use, but I suggest they are comparable to the two-handed pump - probably more difficult to begin with, but easier with practice. If you only need to pump occasionally why not have a cheap pump?

Keep an eye out for silicone cushions which help to stimulate milk, and can make pumping more comfortable. It is also worth checking what other accessories come with a pump...(even if they are not useful you are probably paying for them indirectly).

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Feeding Expressed Breast Milk

This may be a bit trickier than expected: a baby who has only ever been breastfed won't know what to do with a bottle!
  • If your baby is still tiny you may find a cup, spoon or dropper is the easiest way to feed him: but this will be hard work if he needs more than a few ounzes.
  • A baby over four months may prefer a beaker to a bottle, you can get various designs of training cup and it is worth experimenting with different ones to see which your baby likes best.
  • However if you need to give a lot of expressed milk, for example if you are returning to work, a bottle has got to be the easiest all round.
You may find that your baby will prefer to take a bottle from someone other than yourself, and often a good way to introduce the idea is for dad to give the first bottle. Your baby will be able to smell the "real thing" when you hold him, and it is natural that he may not bother trying the bottle you are offering. I have heard of a mother who got around this by wearing some of the daddy's clothes in order to feed her baby! Matthew would never take a bottle of me... but he was quite happy to take it, if he was allowed to hold it himself, this may be worth bearing in mind if you have a slightly older baby.

Teats come in every imaginable shape and size under the sun...and if you are having trouble introducing a bottle it is well worth trying out different ones. Even one brand can be subtley different from another and this could make all the difference to your baby!
Considerations when choosing a teat:
  • Material: Generally teats come in latex (yellow rubber) or silicone (clear), latex smells more and has a distinct taste, but it can be softer and warmer in your baby's mouth than silicone. Matthew would only take silicone teats... much more expensive, but still in perfect condition for number two to use!
  • Shape: There are so many variations from the 'classic' teat including angled versions, orthodontic versions, anti-colic versions etc etc. My personal favourite are the "nature flow" teats by Pur, and I wouldn't use anything else if they were more widely available. These teats are supposed to mimic the mechanics of breastfeeding, although they certainly don't mimic the shape! The baby takes the whole teat into their mouth unlike a "normal" teat, I have tried sucking both kinds and the "nature flow" ones are very a differnt technique. They were Matthew's favourite by far.
  • Flow: different flow rates are supposed to suit different age ranges, but they are just a guide. It is a good idea to initially choose the recommended flow for your baby's age but don't be afraid to use a different size if it doesn't work out. Look out for signs that the milk is going too fast, such as if you baby pulls away every few sucks. If the flow is too slow you baby may become annoyed with the bottle. If you do change the flow note whether the situation gets better... if it gets worse try the other way, it is not alway obvious! Matthew always preferred 0-3month teats, even at one-year-old. However he didn't like the small size of some "newborn" teats.

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GOOD LUCK!

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