Expressing breast milk: how to do it correctly

Do you need to express breast milk? We are going to give you lots of tips that will make your expressing breast milk a much easier stage. In general terms, we know that to maintain an abundant breast milk supply, adequate breast stimulation is necessary.

And to protect your breastfeeding, it is advisable to avoid generic bottles and to use a custom-designed Happymami bottle, because if you offer your baby milk, whether your expressed breast milk or formula, in a generic bottle, you run two very important risks.

The first is that breastfeeding may come to an end, and the second is that they refuse the bottle, having a really hard time the whole time you are working and your baby eats nothing. So, to help you, here is the following post on expressing breast milk at work.

Expressing breast milk to build your own milk stash

If you breastfeed your baby and you need to express milk, for example to go back to work, clinical guidelines recommend starting to express milk between two and four weeks before returning to work, so that you get familiar with the breast pump and the expressing process.

When you go back to work, you will need to express your milk several times while you are away from your baby. This breast milk expression will allow you to keep up your production and give your baby the expressed milk while you are apart. Remember to use a custom-designed Happymami bottle and not a generic one, so you protect your baby from confusion and protect your breastfeeding.

How much and how often to express breast milk

Broadly speaking, it will be enough to express breast milk on a schedule similar to your baby's usual feeding routine. For most mums this means expressing breast milk two or three times over 8 hours.

If you need to express milk at work, it is true that finding the time and the space you need to express breast milk can be quite a challenge, especially for people who do not have a private office. You should therefore talk about your need for private space with the person in charge before returning to work. It can also be very helpful to talk to colleagues who have been through the same thing.

Expressing milk for a premature or hospitalised baby

If this is your case, with your baby in hospital because they are premature or ill, you may need to use a breast pump to increase your breast milk production, so as not to confuse your body, which without stimulation will think that it does not need to set the machinery of breastfeeding in motion.

In this way you will empty your breast, and by doing so often and completely, your body will understand that it must produce more breast milk. Bear in mind that the first weeks after birth are essential to establish a breast milk production that meets your baby's needs.

The amount and frequency of expressing breast milk will be essential to achieve this progress. If your baby is in an incubator and you are separated after birth, it would be ideal to start using the breast pump within six hours after birth.

How much milk should I express for one feed?

The amount of milk you express in a breast milk expressing session can vary from one mother to another and throughout the day. However, on average, many mothers usually express around 60 to 120 millilitres (2 to 4 fluid ounces) of milk per session. This may be enough for a single feed for your baby. It is important to remember that the amount of milk you get does not necessarily reflect the amount of milk your body produces. Some mothers may express more milk in a given session, while others may express less. The frequency and regularity of expressing milk, as well as adequate stimulation, can also influence the amount you can get. It is advisable to watch for your baby's hunger cues and offer the right amount of breast milk according to their individual needs. If you have concerns about how much milk you are expressing or about your baby's feeding, it is advisable to consult a health professional, such as a lactation consultant or a paediatrician, to get guidance specific to your situation.

Expressing breast milk in the first days after birth

Do a breast milk expressing session every three hours, including at night, for a total of 8 to 10 expressing sessions in 24 hours, lasting around 15 minutes each time.

At this point you have colostrum, so it is normal to express only a small amount. Keep to this routine until the volume of expressed breast milk increases, which usually happens around the third or fourth day after birth.

Expressing breast milk after your milk comes in

After your milk comes in, you will need to express breast milk at least 8 times a day, emptying the breast; the time can vary from one mum to another. What is recommended is that, once the breast milk stops flowing (breast emptied), you keep that stimulation going for about two minutes to maintain an adequate supply.

Expressing breast milk two weeks after birth

Two weeks after birth, if a good breast milk production has been established, you will be able to express milk less often, doing several expressing sessions during the day and leaving only one session for the night, as we will see below in the daily breast milk volumes.

Expressing milk without a breast pump

Another option you can use is expressing breast milk without a breast pump. This is known as hand expression and it is another option. This hand expression of breast milk can be an easy way to collect colostrum if you are separated from your baby during the first days after birth.

It can also be a good technique to know alongside expressing with a breast pump to stimulate your breasts to produce more milk, as you can read below.

Steps for hand expressing breast milk

• Make sure you have a clean container to hand to collect the breast milk. You can use a spoon or a wide-mouthed container for larger volumes of breast milk.
• Gently massage your breasts with your hands and fingers to trigger the milk ejection reflex.
• Hold the breast with your fingers and thumb in a “C” shape, placing them behind your areola.
• Express the milk with these movements

• Press your fingers and thumb towards the breast
• Compress the breast between your fingers and thumb, moving your hand towards the nipple without lifting your fingers off the breast
• Release without moving your hand
• Repeat this compress-and-release process while moving your hands around your breast

At first you will only express a few drops of milk. After a few minutes the flow will increase. Bear in mind that if you are expressing only colostrum, it is normal for the volume to be small. Hand expressing breast milk can take you 20 to 30 minutes on each breast.

How much is it normal to express with a breast pump?

If you need to express breast milk, whether partially or exclusively, it is important to make sure you keep producing enough milk for your baby over time. It will therefore be useful for your progress to keep a record of expressing, with which you will track the number of times and the volume of expressed breast milk. Records are available both in written form and in smartphone apps, such as the My NICU Baby app.

If in your particular case you express breast milk to feed your baby exclusively, you should aim for a milk volume of between 600 ml and 720 ml a day at the end of the second week of your baby's life. For a premature baby we will need a little less than the previous volume, but as your baby grows their needs will be greater. Below you will find how to estimate a baby's milk needs.

How to increase breast milk production

To help your body increase breast milk production, one way you can do this is through “hand expression”. To do so, massage both breasts before you start to express breast milk. And then express milk from both breasts at the same time, without stopping massaging and compressing the breasts during the expressing session as much as possible.

You can use a special bra or other breast pumps with a hands-free option, such as the Elvie Pump, which will make this task easier. And once the breast milk flow slows to drops, we stop the breast pump and keep massaging the breasts. In this way we will finish the expressing using our hands to get the breast milk into the container or using the electric breast pump in massage mode (if you have this option) to completely empty the breasts.

Here is a link to a video showing ways to increase milk production for mothers who express breast milk:

How can expressed breast milk be stored?

Once the expressed breast milk has been pumped, you can store it in different places and for different lengths of time depending on the temperature at which it is kept, giving us in general terms the following options:

• At room temperature up to 4 hours
• In the fridge up to 3 days
• In the freezer up to 9 months

How long does breast milk last after being expressed from the breast?

Before storing the expressed breast milk it is worth bearing in mind when we are going to offer that expressed milk to the baby, and depending on how long it takes us to offer it, we will use one temperature to store the expressed breast milk or another, as well as distinguishing whether we are talking about healthy babies or hospitalised babies.

Storage times for expressed breast milk for healthy babies

For healthy babies who are at home, this expressed breast milk can be stored safely in different ways:

• At room temperature (approximately 25 to 27ºC) it keeps for up to four hours.
• In an insulated cool bag with ice packs, for up to 24 hours if necessary.
• In a fridge, the storage time is 3 to 5 days. (There are studies where it has been stored safely for up to 8 days if it is collected very cleanly)
• In the freezer for up to 12 months. Thawed breast milk can be safely kept in a standard fridge for a maximum of 24 hours.
  • Breast milk that has been frozen and then thawed should not be frozen again.

Storage times for expressed breast milk for hospitalised babies

For babies who are in hospital, storage guidelines are stricter because they are premature or have other conditions. Most neonatal intensive care units (NICUs) allow milk to be kept in the fridge for a maximum of 96 hours (four days), but every hospital has its own protocol.

What container should be used to store breast milk?

The expressed breast milk can be stored in glass or plastic jars or in collection bags. It is worth knowing that the recommendation for the best storage and use is to do it in small quantities, between 50 ml and 100 ml. In this way we will use the amount the baby wants to consume, avoiding wasting as much breast milk as possible.

It should be labelled with permanent ink and a water-resistant label. On this label you should note the date of expressing breast milk. That way you can use the oldest milk first. If your baby is in hospital, some hospitals have different rules for storing breast milk. Check with your paediatrician or the nursing team to do it properly.

Can I mix milk from different expressing sessions?

Yes, milk from different expressing sessions can be mixed on the same day. In addition, breast milk must be cooled in the fridge before combining it, so that it is mixed at the same temperature, and mixing expressed milk from different days is not recommended.

Bear in mind that if you have warm breast milk or milk cold from the fridge, it should not be added to frozen milk. And we prioritise using the oldest milk first.

Can breast milk be mixed with formula?

Yes, it is possible to mix breast milk with infant formula if necessary, although it is preferable not to do so and to give it separately, so that we make sure that they take the breast milk first and then the formula. Just in case at the end of the feed some milk is left untaken, it will be formula.

This mixture is known as “milk combination”. Here are some guidelines to bear in mind when mixing breast milk with formula:

1. Hygiene: Wash your hands well before handling breast milk and formula.

2. Proper preparation: Follow the manufacturer's instructions to prepare the formula correctly. Make sure you use the right proportion of water and formula.

3. Temperature: Make sure that both the breast milk and the formula are at the same temperature before mixing them.

4. Feeding: Feed the baby with the mixture as soon as possible after mixing it to avoid bacteria multiplying.

5. Labelling: If you decide to store the mixture in the fridge or the freezer, label the container with the date to make sure it is used within the recommended time.

Remember that breast milk provides important benefits for your baby's health, so it is advisable to continue breastfeeding or expressing breast milk as much as possible. Mixing with formula is generally considered when it is medically necessary or when the mother cannot provide enough milk.

How can I warm stored breast milk?

Before you start, remember that warming breast milk in the microwave is not recommended. Rapid heating or the microwave adversely affect the immune and nutritional properties of breast milk; in addition, the microwave heats breast milk unevenly, which could burn your baby's mouth. A good option is to use a bottle warmer, which gives you safe, quick warming.

Thawing and warming breast milk

To warm the expressed breast milk, you can do it gradually by placing the breast milk storage container (your Happymami bottle or the collection bag) in hot water for a maximum of 20 to 30 minutes (in a pan with hot water, for example). Try to avoid submerging the bottle of breast milk completely under the water, because, if we do, water could get in and mix with your expressed milk.

After warming the breast milk, make sure you check that the temperature is right before giving it, so that it does not burn. In addition, breast milk should be swirled gently to redistribute the cream that usually rises to the surface while the breast milk is refrigerated.

You can use waterless breast milk bottle warmers, following the manufacturer's own instructions.

How do I take my breast milk out with me?

If you are going out and need to take your expressed breast milk with you, you will also need a thermos with hot water and a container to then place the custom-designed Happymami bottle with your expressed milk in.

Bear in mind that if a long time will pass between expressing the milk and offering it, and it is also very hot outside, it will be advisable to take the breast milk chilled. Conversely, if it is not very hot or you are going to offer it more quickly, you can take your breast milk at room temperature.

To warm the expressed breast milk when you are out and about, what we will do is put the hot water in a container, and into this container we will place your Happymami bottle with the milk inside. So, in a few minutes your bottle of breast milk will be perfectly ready to offer to your baby.

How much expressed breast milk should a baby normally eat?

To answer this question we must bear in mind that every baby is unique, although the most important sign that your baby is getting enough breast milk is that they seem satisfied after feeding and are also gaining weight.

Bear in mind that nowadays babies are monitored very closely by paediatrics, nursing and midwives, and it will be these professionals who help you track your baby's weight gain and let you know whether or not you are on the right track.

It will be a priority not to forget that the two most important factors for maintaining breast milk production are breast stimulation and expressing milk from the breasts. So, if you need to increase your breast milk volume, we must increase the stimulation and the milk demand we place on the breast.

How many millilitres of breast milk does a 1-month-old baby drink?

At one month of age, most babies are satisfied with approximately 90 to 120 ml per feed, making a total of about 720 ml per day.

How many millilitres of breast milk does a 2-month-old baby drink?

At 2 months of age and until the introduction of food (six months of age) a baby drinks between 120 ml and 240 ml per feed. So that as the intake of solid foods increases, the intake of breast milk will gradually decrease until it reaches about 600 ml a day.

Expressed breast milk in a Happymami bottle

The use of a generic bottle to offer expressed breast milk or formula to your baby will cause teat-nipple confusion in your newborn, with a very high risk of breastfeeding coming to an end, as well as of them not accepting the generic bottle, compared with your custom-designed Happymami bottle.

In addition, to improve the Happymami bottle experience, here are some recommendations on how to give expressed breast milk or formula in a bottle:

• Place your baby in the most upright position possible
• Stroke your baby's mouth with the bottle teat and, when they open their mouth, we put the bottle in
• Tilt the bottle upwards so that the teat is partially filled with milk, and let your baby suck for a few minutes (Do not leave the bottle horizontal, because if there is little milk the teat will not empty and when your baby sucks no milk will come out, making it an unpleasant experience for your baby)
• When your baby pauses, tilt the bottle downwards to empty the teat
• Repeat this process until your baby shows signs of fullness.

A bottle feed should last at least 10 to 15 minutes, just like the breast.

Can I reheat expressed breast milk?

If after the Happymami bottle feed there is milk left in the bottle, you can use it within two hours. This is because once your baby starts drinking the expressed breast milk from their bottle, they cause some bacterial contamination through their own mouth.

It is true that the time it can be kept at room temperature, once the baby has fed from the bottle and left leftovers, would theoretically depend on the initial bacterial load of that expressed breast milk, as well as on other factors such as how long it has been thawed and the room temperature.

Although there are no studies to make recommendations on this, and based on the currently available evidence, the recommendation is to discard the leftover milk from the bottle within 2 hours after the baby has finished eating.

Conclusion: expressing breast milk at work

As we always tell you, every case is different and, as you will have seen in this post, there are many tips and methods, and the most important thing is to adapt them to your needs. Always lean on the professionals around you; we will be delighted to help you, and we will always be here for anything you need.

Bibliography

The Happymami project is based on scientific evidence, and we are aware that science evolves every day. Therefore, if you have more up-to-date scientific evidence than ours, we will be delighted to receive it. We work every day to offer the best and most up-to-date information to our mums.

1. Lisa Enger, RN, BSN, IBCLCNancy M Hurst, PhD, RN, IBCLC. Patient education: Pumping breast milk (Beyond the Basics) . Uptodate.com. . Available at: https://www.uptodate.com/contents/pumping-breast-milk-beyond-the-basics?search=extractor%20leche%20materna&source=search_result&selectedTitle=1~97&usage_type=default&display_rank=1

Design your Bottle ®