manual expression of breastmilk
Manual expression of breastmilk is a valuable skill for the breastfeeding mother to have. The benefits of this method of collecting breastmilk include that it requires no extra equipment (which minimizes clean up and the chance of harboring bacteria), and it uses massage rather than suction—similar to the way the baby’s gums massage the breast. During the first week postpartum, the mother probably won’t be able to express a large quantity of milk, but a small amount, gently expressed, will help alleviate the excess fullness many mothers experience. Gradually, with daily practice, many women are able to manually express enough milk to provide a bottle for their baby’s later use. Daily practice will stimulate the production of milk, which will make milk expression easier. Also, it’s helpful to perform the beginning steps of manual expression prior to using a breastpump in order to assist the flow of milk.
preparation for manual expression
It is helpful to relax and release tension before beginning to express milk. Lying down for 10 minutes, listening to soft music, or doing deep abdominal breathing are some ways to relax. Apply heat to the breasts by taking a hot shower or bath or by applying warm compresses. Wash the hands well with soap, using a brush on the fingernails, and dry the hands with a clean towel. Have a clean cup or bottle available. A wide mouth container works well.
Begin massaging the breast first with the fingertips in circular motions all the way around the breast (fig.1). Then press the breast firmly, starting from the outside edges and moving toward the nipple, using either a flat open hand or by circling the breast with the thumbs and forefingers of both hands (fig. 2). This massage will help the milk flow toward the nipple. Sometimes it is possible to put the baby to the breast briefly to trigger the release of milk. Hearing, seeing or thinking about the baby can also help.
expression of milk
Support the breast from beneath with one hand. Place the thumb of the other hand on top of the breast near the outer edge of the areola and place the forefinger similarly on the underneath side of the breast (fig. 3). Press the thumb and forefinger firmly toward the ribs and then, continuing with this firm pressure, press them toward each other to squeeze the milk out of the milk sinuses. The fingers should not slide on the skin or pinch the nipple. In order to extract the milk from all the milk sinuses, the placement of the thumb and forefinger should be rotated around the areola. Some areas will be more productive than others. It helps to establish a rhythm while expressing milk. When the amount of milk extracted lessens, start massage and expression on the other breast. The first breast may also be massaged and expressed again. It is helpful to learn to express with both hands to minimize tiredness. The process of manual expression takes approximately 20 minutes.
Human milk is sweet and does not look or taste like cow’s milk. The first milk expressed (foremilk) has less fat and may appear bluish. The milk expressed later (hindmilk) is higher in fat content and appears creamier. The milk may separate after a few hours of refrigeration. This is normal. Bottles should be gently swirled to disperse the cream. Vigorous shaking damages the milk cells. Some mothers notice variation in the color and taste of milk according to the foods they have eaten. This is also normal.
storage and handling of expressed breastmilk
Breastmilk can be stored in glass or plastic bottles*. Small amounts can be stored separately and combined later when the milk is going to be used. Be sure to leave enough room at the top for the milk to expand if it is going to be frozen. Bottles should be labeled with the date of expression so that the oldest bottles can be used first. For a healthy, full-term baby, fresh unfrozen milk can be stored for up to three months. In all cases, place the bottle in the back of the freezer and away from the fan where the temperature will remain most stable. Use a freezer thermometer to be certain the milk will stay adequately frozen.
Frozen breast milk should be thawed overnight in the refrigerator or in warm water. Microwave thawing is not recommended because it destroys some of the components in the milk that help prevent illness in the infant, and, by heating the milk unevenly, may create hot spots which can burn the baby. Thawed milk should be used immediately or refrigerated unopened for no more than 24 hours.
The following are approximate amounts of milk to offer an infant: 3 weeks to 3 months, 3–6 oz.; 3 to 6 months, 6–8 oz.; and over 6 months, 8 oz. If the baby does not drink all of the milk in a bottle, the milk must be discarded, as it has been contaminated with bacteria from the baby’s mouth. Small bottles containing 4 oz. or less can be used to minimize the amount of milk discarded. Portions as small as 2 oz. can be used to pacify the baby when the mother is expected soon and will then be breastfeeding, or to supplement a feeding when the normal portion was not enough.
Manual expression of breastmilk should be practiced on a daily basis to maximize effectiveness. Times that are often productive for manual expression are in the morning (when the milk supply is most abundant), before the baby wakes from his/her longest sleep period, or when the baby does not complete a feeding and one or both breasts are still full.
*Disposable nurser bags can be used to store milk for healthy, full-term babies. Milk stored in this way should be double-bagged to prevent freezer burn and breakage and stored in a hard-sided container. Thicker bags specifically designed for freezing milk are available from Medela and Ameda.