By Dr Clare Macdonald, General Practitioner
Expressing breastmilk is, for many mothers a key skill in their breastfeeding journey. Broadly speaking, its application is important in the following areas:
Initiation of Breastfeeding
There is evidence that hand expression in the immediate postpartum period helps to improve breastfeeding rates at 2 months when term infants have had early latching and sucking difficulties1. In an ideal world all mothers would be shown how to hand express so that those who need it have the skills.
Hand expression in the early days is more effective than pumps largely due to the viscosity of colostrum and its comparatively low volume.
This 2 minute video explains the importance and technique for hand expression.
In terms of practical application, many families do have contact with a GP in the first few days following delivery, particularly in areas where GPs commonly complete the standard neonatal examination; this would be an ideal time to ensure that this skill is in place.
Feeding Premature or Sick babies
Expressing breastmilk is of significant importance in the neonatal unit setting which is not covered in detail here, suffice to say that units should provide support in terms of education, breast pumps and storage as well as encouraging breastfeeding as appropriate. Where this is not possible, babies should have access to donor breastmilk where suitable.
Further information on breastfeeding sick or premature babies is here.
Maintaining Supply and ‘Topping Up’
There are many situations whereby frequent and effective latch and milk removal is not easily achieved. These can be maternal issues such as traumatic birth or significant physical illness as well as infant issues such as tongue-tie, acute illness or congenital malformation. Expressing milk in this instance can provide comfort, help to maintain supply and provide ‘top ups’ of expressed breast milk. This can be achieved through hand expression but for many women use of a pump is faster and more effective. Hospital grade double pumps are generally the most efficient and can also increase prolactin levels2. Availability of pumps for hire is widespread but varies from region to region. Local Infant Feeding Co-ordinators, NCT, or hospital neonatal units are the best points of contact. Various commercial companies also provide this service.
Supporting Ongoing Breastfeeding when Mother and Baby are Apart
Breastfeeding continues to have health benefits beyond the first few months, it is a common misinterpretation of the WHO advice for ‘6 months exclusive breastfeeding’ to equate to ‘no benefits beyond 6 months’. Ongoing breastfeeding should be promoted and facilitated. Expressing breastmilk can play an import role in this, particularly with regard to return to work. Breast feeding mothers are given specific protection in the workplace within the same health and safety regulations that apply to pregnant women. Employers may not discriminate against breastfeeding women and the Health and Safety Executive recommends it is good practice for employers to provide a healthy, private and safe environment for breastfeeding mothers to express and store breast milk. See our webpage on ‘The Law’.
Choice to Feed Expressed Milk by Bottle Longterm
For some women, expressing milk and feeding expressed milk to their baby by bottle is a long term choice. This may be for a variety of reasons including ongoing, unresolved nipple pain or flexibility to leave the baby in the care of others for work or social reasons. When exclusively expressing from the early postpartum period, frequency of expressing is key to establishing and maintaining supply, aiming to mimic the feeding pattern of a newborn baby. The Unicef BFI recommendation is that a woman expresses 8-10 times in a 24 hour period and does not leave longer than 6 hours between expressions at night when establishing a supply. The aim is for 750-900mL per 24hours by day 104.
Colostrum production usually begins at around 32 weeks gestation (see our webpage on the ‘Anatomy and Physiology‘ of breastfeeding). There is some weak evidence that antenatal expressing can help women to be more confident at breastfeeding3. From 36 weeks, colostrum can be expressed and stored so it is available soon after delivery if required. This is particularly useful where there is gestational diabetes and therefore risk of neonatal hypoglycaemia, and in the case of multiple births.
There have been concerns in the past about antenatal expressing raising oxytocin levels and therefore risking inducing labour. A large randomised controlled trial is currently underway (DAME study) to establish the safety and efficacy of antenatal expression5.
Australian Breastfeeding Association: Antenatal Expression of Colostrum Includes examples of when antenatal expression would be beneficial, and circumstances in which it is not advised.
Breast Pump Hire
The following provide breast pump hire nationally:
NCT branches hold details of local breast pump hire availability (use the local branch search option)
- Flaherman V, Gay B, Scott C, Avins A, Lee K, Newman T. Randomised trial comparing hand expression with breast pumping for mothers of term newborns feeding poorly. Archives of Disease in Childhood – Fetal and Neonatal Edition. 2011;97(1):F18-F23.
- Jones E, Dimmock P, Spencer S. A randomised controlled trial to compare methods of milk expression after preterm delivery. Archives of Disease in Childhood – Fetal and Neonatal Edition. 2001;85(2):91F-95.
- Brisbane J, Giglia R. Experiences of expressing and storing colostrum antenatally: A qualitative study of mothers in regional Western Australia. Journal of Child Health Care. 2013;19(2):206-215.
- Unicef UK Baby Friendly Initiative: Assessment of Breastmilk Expression Checklist 2013
- Forster D, Jacobs S, Amir L, Davis P, Walker S, McEgan K et al. Safety and efficacy of antenatal milk expressing for women with diabetes in pregnancy: protocol for a randomised controlled trial. BMJ Open. 2014;4(10):e006571.