Your milk coming in and how to express it correctly

If you are breastfeeding, or intend to, one of the situations you will face in the first few days is the famous “milk coming in” and, if you need it, how to express breast milk. That is why our team of midwives at Happymami has prepared this post to answer all your questions about this moment, the milk coming in and expressing breast milk, the first days of breastfeeding.

How long does it take for your milk to come in?

As the AEPED reminds us, breastfeeding is not always easy, and you and your baby will probably need a period of adjustment.

One of the general recommendations to bear in mind is to make sure from the very start that you have all the support and help you need if a problem arises. Such as the mother-to-mother support offered by breastfeeding groups, which almost certainly exist near where you live.

Milk coming in: what is it?

You should know that breast engorgement, or the milk coming in as it is commonly known, is not actually caused by a build-up of milk, but by congestion of the mammary gland. Let me explain: it is the inflammation that occurs with the vascular dilation of the gland as it prepares for breastfeeding.

Milk coming in: when does it happen?

Your milk coming in can happen two or three days after the birth in both breasts, making them very tight, swollen and hot. It can cause you a lot of worry, because your breasts are swollen and sore. And your baby may find it hard to latch on, which can make you feel helpless as you try to empty the breast without succeeding.

Symptoms of your milk coming in

Your milk coming in is a natural process after the birth, marked by changes in the breasts as they start producing breast milk. Here are the main symptoms:

• A feeling of fullness or swelling in the breasts.
• Warmth or tenderness in the breasts.
• Milk leaking spontaneously.
• Tension or hardness in the breasts.
• Tingling or shooting pains during the let-down.
• An increase in size of the breasts.
• Possible discomfort or mild pain in some cases.

Milk coming in: what should I do?

If your milk comes in heavily, the AEPED recommends that you relax before the feed. To do this you can take a warm bath or shower, have a pleasant massage on your shoulders or back, listen to music, etc. A few minutes before putting your baby to the breast, have skin-to-skin contact with your baby and apply local warmth to encourage the breast milk to flow.

It is important to feed more often, offering the breast to your baby about every two hours. To ease the discomfort you can also apply local cold (thermal gels, ice packs, cold compresses…) between feeds and even take an anti-inflammatory such as ibuprofen if you are not allergic and do not have any condition that rules it out. If these measures do not help your baby to latch on, you can try the gentle reverse pressure softening technique, which involves pressing around the base of the nipple, or consult an experienced professional.

Stimulating the breast for your milk to come in

Gentle reverse pressure softening technique

How do I express breast milk?

There are many occasions when expressing breast milk is recommended, for example mothers who want to feed their baby their own milk but cannot breastfeed. For instance mothers who work outside the home, or when the mother or a premature baby is in hospital, whenever rooming-in is not possible.

Steps before expressing breast milk

Hygiene:

• Washing your hands
• There is no need to wash the areolas and nipples before every expression of breast milk. A daily shower is enough

Comfort

• Find a quiet, private and comfortable place, with clean equipment ready to use if you decide to use mechanical expression of breast milk.
• Plan ahead so you can have a herbal tea or another drink while using the breast pump.
• Do relaxation exercises and take deep, calm breaths. It can help to have a photo of your baby (if they are not with you) and to listen to soft music. Breastfeeding positions.

Stimulating your milk flow

Before you start expressing breast milk, it is worth explaining that you need to stimulate the let-down reflex (your milk flow).

There are 3 steps to stimulate the let-down reflex:

1. Massaging: press the breast firmly with your fingertips against the chest wall, moving your fingers in a circle on the same spot without sliding them over the skin. Start at the top and make the spiral movement around the breast towards the areola as you massage. The movement is similar to the one used in breast examinations.

2. Stroke or comb the breast area from the top down towards the nipple, using your fingertips with a light, tickling touch. Continue this movement from the outer edge towards the nipple all the way around the breast

3. Shake both breasts gently while leaning forward.

Breast milk expression techniques.

The milk can be expressed by hand or with a breast pump. The results will improve as you gain practice and confidence. Remember that the first few times you may only get a few drops, and this is completely normal.

If you use a breast pump, compared with expressing by hand, it improves how well the breast is emptied and, as a result, significantly increases your milk production.

1. Expressing breast milk by hand or the Marmet technique

It is worth bearing in mind that expressing by hand is more laborious, but many mothers prefer it because the skin-to-skin contact makes the let-down reflex easier to trigger. It is usually more convenient for occasional expressing and for use at home. The full process is as follows:

• Hygiene
• Massage (as explained above)
• Express the breast for 5-7 minutes
• Massage
• Express each breast for 3-5 minutes
• Massage
• Express each breast for 3-3 minutes.

Place your thumb and your index and middle fingers in a “C” shape about three or four cm behind the nipple, making sure the breast does not rest on your hand. Push your fingers back (towards the ribs) without separating them. For large or drooping breasts, it is best to lift them first and then push your fingers back.

Finally, rotate the position of your fingers to empty other parts of the breast. You can use one or both hands. The expression of breast milk must be done gently, avoiding stretching and pressure manoeuvres on the breast or nipple. The whole process usually takes between 20 and 30 minutes.

2. Expressing with a breast pump

First, make a quick assessment of which type of breast pump will be most suitable for you.

• Manual or single electric breast pump:
  • Sporadic use or daily use for one or two feeds.
  • Bulb or horn breast pumps are not recommended.
• Double electric breast pump:
  • Frequent, long-term use: premature babies, combining work and breastfeeding, increasing milk production.
  • It is possible to hire hospital-grade double breast pumps from some pharmacies, support groups or online.
  • Sharing electric breast pumps that are not hospital grade is not recommended.
  • And none of them should hurt.

3. Using a manual breast pump

The steps to follow are:

• Wash your hands.
• Prepare your breasts as for expressing by hand (massage, rub, shake).
• Place the correctly sized breast shield over your breast.
• Start with short, rapid pulls, imitating your baby's “calling for the milk”.
• Once you see some milk, use long, even suction, avoiding the temptation to use too much suction and cause pain.
• If your breast pump has a dial, start on the lowest setting and increase it until the milk flows freely and you feel comfortable.
• Use 5-7 minutes on each side (after massaging) or until the stream or the drops slow down. Switch breasts and repeat 2-3 times.

It is important to know that, as with expressing by hand, you may only get a few drops the first few times. This is normal, and with each subsequent session the amount will increase.

5. Using a double electric breast pump

In this case you follow the same process as with the single breast pump, but on both breasts at the same time. They are more effective and take less time.

In all cases, whatever expressing method you choose, to be more effective it is advisable to massage the breast while you express and to complete the emptying with hand expression.

Breast shield or funnel sizes

Expressing should not be painful. For that, you need to make sure the size of the funnels is right. If it is too big, it will not provide adequate suction and therefore will not stimulate production or achieve a good emptying of the breast. If, on the other hand, it is too small, it can cause pain, cracked nipples and inadequate suction. Occasionally you may need a different size funnel for each breast.

Conclusion: milk coming in and expressing breast milk

We always say that every case is unique, and if you have any doubts you should go to your midwife so that she can carry out a full assessment, recording the information in a clinical history, with an examination of the breast and observation of a feed. Breast milk is very important, and knowing its stages will help you to establish breastfeeding successfully.

We would also like to remind you that if you need to introduce a bottle, Happymami is the only made-to-measure bottle designed to protect breastfeeding.

Frequently asked questions about expressing breast milk

When is the best time to express breast milk?

The best time is usually in the morning, when your milk production levels are highest. You can also express milk between feeds, when your baby is not hungry.

How can I increase my milk production to express more?

Keep to a regular expressing routine, drink plenty of fluids and make sure you are well rested. Expressing often and emptying the breasts completely helps to increase production.

How long can I store expressed milk?

Breast milk can be stored at room temperature for up to 4 hours, in the fridge for 3 to 4 days, and in the freezer for up to 6 months, always making sure you use clean, sterilised containers.

How do I know if my milk has come in?

You can recognise your milk coming in by symptoms such as:

• A feeling of fullness or swelling in the breasts.
• Tingling or warmth in the breast.
• Milk leaking spontaneously.
• Breasts that feel tighter or more sensitive than usual.

These signs usually appear between 2 and 5 days after the birth.

Hard breasts when your milk comes in?

Yes, it is common for your breasts to feel hard while your milk is coming in, due to the build-up of milk and increased blood flow. This can cause discomfort or mild pain. To relieve it, you can:

• Breastfeed frequently.
• Apply warm compresses before feeding.
• Use cold compresses afterwards to reduce the inflammation.
• Express milk if you feel too much pressure.

If the pain continues or there are signs of infection, see a professional.