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Many
women are under the impression that it is
necessary to own or use a pump to breastfeed.
This is not so. There are very few circumstances
under which it is necessary to express your
milk. But women are being encouraged to
pump their milk and give it to baby via
bottle for the most unnecessary reasons:
Weddings, doctor’s appointments, shopping…why
not take the baby with you? How can babies
not be welcome at weddings? Or, “so
the father can feed the baby”! Partners
were not meant to feed babies milk, and
giving a bottle is not really helping. But
they certainly can help feed the baby by
helping mother with compressions, for example,
(see Handout: #15 Breast
Compression) and they can help mothers
in so many other ways as well. The pump
should not replace the baby; you and your
baby receive numerous benefits in addition
to nutrition by breastfeeding. No pump is
as efficient as the natural pump that was
made for your body, your baby! A baby who
breastfeeds well is the best pump, but,
granted some babies don’t breastfeed
well. You do not need a breast pump to breastfeed;
uninformed use of a breast pump can lead
to premature weaning.
- There is more to breastfeeding
than just the breastmilk.
- Obviously, if you can
pump a lot, you are producing a lot, but
if you cannot pump a lot, this does not
mean your milk production is low. Do not
pump to “find out how much you are
producing”.
- The most effective artificial
pumps are high-powered, double, electric,
and hospital-grade with adjustable pressure
and speed. There are many pumps on the
market that are just not very good.
- Improper use of a breast
pump can lead to problems. Read all instructions
thoroughly.
- It is important that
milk be expressed and/or pumped after
the feed as the breasts should be as full
as possible for the baby’s feeding.
Babies respond to fast flow (see Handout
#15, Breast
Compression), and pumping before the
feed will reduce the amount of milk in
the breast.
Pumping method
- Pump immediately after
the feed--waiting an hour or so decreases
the likelihood the breast will be full
as possible for the next feed.
- Place nipple in the
center of the flange (unlike nipple placement
in baby’s mouth, which should always
be off-centre and pointed toward the roof
of baby’s mouth (see Handout When
Latching).
- Put the pump on the
lowest setting that extracts milk, not
the highest setting you can tolerate.
- Pump for 15 minutes
each side. If breasts run “dry”
before 15 minutes is up, pump until dry
then add 2 minutes.
- Remember, pumping should
not hurt. If it hurts:
- Lower the suction setting
- Ensure the nipple is
centered in the flange
- Pump for a shorter period
of time
Cleaning the pump
- All pumping equipment
should be sterilized before first usage,
thereafter it only requires washing with
hot, soapy, water or by dishwasher.
- After each pumping:
either place the pumping kit (not the
tubes or motor) in the refrigerator until
the next pumping, or if not pumping the
same day, hot-water wash and hot-water
rinse well, then air dry.
- Remember to take apart
all pieces of the pump for cleaning---including
the smallest pieces, and to ensure that
no milk has clumped in the flange shaft.
Hand expression
Many women find that hand
expression is an efficient way to pump when
only occasional expression is required.
In fact, when the milk production is not
abundant (as in the first few days), it
is often easier to get milk with hand expression
than with a pump and many women fined this
the easiest way to express mature milk as
well.
- Place thumb and index
finger on either side of the nipple, about
3 to 5 cm (1-2 inches) back from the nipple.
- Press gently inward
toward the rib cage.
- Roll fingers together
in a slight downward motion.
- Repeat all around the
nipple if desired.
Breastmilk storage
Unlike formula, breast
milk is anti-infective, antibacterial, antifungal,
and antiviral.
- Breastmilk will
stay good:
- At room temperature
for at least 8-12 hours.
- In the fridge for
at least 8-11 days.
- In the freezer,
at the back, for many months.
Get used to the taste and
smell of breast milk so you’ll always
know if it is good.
- Due to the high fat
content of breastmilk, storage of any
kind will produce a separation in the
liquid. This is normal; a gentle mixing
will give it a homogeneous look once more.
- Breastmilk may taste
different after freezing; this is normal
- Never heat breastmilk
in the microwave.
- Babies will often take
cold milk, but if heating is desired,
or if milk needs to be defrosted, place
container or bag of milk in a cup of warm
water for a minute or two.
Encouraging the M.E.R.
(milk ejection reflex) or “let down”
If your baby is not present,
you can encourage the “let down”
reflex artificially, by having a picture
of your baby to look at, or by having a
piece of his clothing next to you.
- Apply a warm wet cloth
to your breasts.
- Massage the breasts
in small circular motions around the perimeter
of the breast.
- Gently stroke your breasts
with your fingernails in a downward motion
toward the nipple
- Lean forward and gently
shake the breasts.
- Gently roll the nipple
between your finger and thumb.
You may feel the milk ejection
reflex or notice your breasts leaking or
you may not. You are likely to pump more
milk faster if you pump both breasts at
the same time. You do not need to feel or
be aware of the milk ejection reflex in
order to make milk. Some women may feel
thirsty, sweaty, sleepy, or dizzy during
a let down. However, many women do not feel
this milk ejection response ever in their
whole breastfeeding experience. Some women
only become aware of it after the first
few weeks. This has absolutely no bearing
on milk supply. Breast compressions, while
pumping, can be very effective at increasing
the amount expressed, it may be a bit awkward
at first, but it can be done (mothers have
fixed the cups so that they sit inside the
bra and then use compressions) or the partner
can do it.
Questions?
(416) 813-5757 (option 3) or drjacknewman@sympatico.ca
or Edith Kernerman, breastfeeding@sympatico.ca
or Jack’s book, Dr. Jack Newman’s
Guide to Breastfeeding (called The Ultimate
Breastfeeding Book of Answers in the USA),
or our Video/ DVD: Dr. Jack Newman’s
Visual Guide to Breastfeeding.
Handout # 27.
Expressing Milk. January 2005
Written by Edith Kernerman, IBCLC, RLC and
Jack Newman, MD, FRCPC. © 2005
This handout may be copied
and distributed without further permission,
on the condition that it is not used in
any context in which the WHO code on the
marketing of breastmilk substitutes is violated
1. Breastfeeding:
Starting out right
a) The
importance of Skin-to-Skin contact
2. Colic in the Breastfed Baby
3. a) Sore Nipples
b) Treatments
for Sore Nipple and Sore Breasts
4. Is my baby getting enough?
5. Using a Lactation Aid
6. Using Gentian Violet
7. Breastfeeding and Jaundice
8. Finger Feeding
9. a) You should continue breastfeeding
(Medications and breastfeeding)
b) You
should continue breastfeeding (Illness in the mother or baby)
10. Breastfeeding and other foods
11. Some breastfeeding myths
12. More breastfeeding myths
13. Still more breastfeeding
myths
14. More and more breastfeeding
myths
15. Breast compression
16. Starting solid foods
17. What to feed the baby when
the mother is working outside the home
18. How to know a health professional
is not supportive of breastfeeding
19. a) Domperidone 1
b) Domperidone
2
20. Fluconazole
21. Breastfeed a toddler –
Why on earth?
22. Blocked ducts and
mastitis
23. Breastfeeding your adopted baby
24. Miscellaneous treatments for problems
25. Slow weight gain after
the first few months
26. When the Baby refuses to
latch on
27. Expressing Milk
28. Toxins and Infant Feeding
How breastmilk protects Newborns
Risks of formula feeding
Breastfeeding and guilt
Candida protocol
Protocol to increase the intake
of Breastmilk by the Baby ("Not enough milk")
When latching
Protocols for Induced Lactation
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