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Clinical Specialties - Maternity

Breastfeeding Information Resources


Benefits of Breastfeeding

The Sydney Adventist Hospital (SAH) recognises that breastfeeding is the normal way to feed infants. It is one of the most precious gifts that you and your partner can give to your baby, ensuring the best possible nutrition and protection from disease. The key to successful breastfeeding is motivation and support.

How babies benefit from breastfeeding

Breast milk is a complex living fluid containing many different components that maximise a baby’s growth and development as well as protecting babies from illness. It is species specific and contains ingredients not found in any formula.

  • Breastfeeding is particularly valuable while the infant’s immune system is immature but also continues to offer significant protection throughout lactation against infection (e.g. gastrointestinal, urinary tract, respiratory and ear infections, pneumonia and meningitis)
  • There is a reduced risk of developing childhood Type 1 and Type 2 Diabetes if you have fed for at least 3 months
  • There is a reduced incidence of allergic disease if a baby is breastfed exclusively for approximately 6 months
  • Breastfeeding is associated with lower cardiovascular disease risk factors, including high blood pressure and elevated total and LDL cholesterol and obesity
  • Exclusive breastfeeding contributes to improved cognitive development
  • Breastfeeding for at least 6 months has shown a lower risk of acute lymphocytic leukaemia
  • Babies who are breastfeeding at the time of introduction of gluten have a reduced risk of developing coeliac disease
  • Breastfeeding has a significant protective effect against developing inflammatory bowel disease


Mother’s milk is a complete food, providing your baby with optimal nutrition until the age of six months when it is recommended that other foods should be introduced, while continuing to breastfeed until 12 months or longer. Breastfeeding can continue to provide health benefits in your baby’s second year of life and beyond. As long as you continue to breastfeed, your baby will gain nutrition and immunity from the breastmilk.

How women benefit from breastfeeding

Studies have shown that women who breastfeed have:

  • a decreased risk of ovarian and pre-menopausal breast cancers
  • a delay in the onset of menstruation after birth
  • a reduced risk of developing Type 2 Diabetes (if they have gestational diabetes)
  • assists the uterus to contract down to its pre-pregnancy size more quickly


How breastfeeding works

The baby suckling at the breast stimulates sensory nerve endings in the areola and nipple, sending signals to the brain, allowing the pituitary gland to release the hormones oxytocin and prolactin. When released into the circulation, these hormones trigger the production and release of milk.

Prolactin is the hormone required to maintain successful breastfeeding. Nipple stimulation and the emptying of the breast increases its concentration. Oxytocin is the hormone that assists the milk to be released from the breast. When your baby suckles at the breast, oxytocin is released and milk is "let down" from your breast. This is often referred to as the "let down reflex". Hearing a baby cry or just thinking about your baby may stimulate this reflex also. This is why some women leak milk even when not feeding. The let down reflex may be inhibited by pain or anxiety and this may interfere with the adequate removal of milk. An increase in thirst and a feeling of relaxation may often be experienced due to the effect of these hormones. You may also feel your uterus contract and/or a tingling in the breast.

Stages of milk development

The first milk the breasts produce is colostrum. This is a thick, yellow fluid, which is rich in nutrients and antibodies. It lines the baby’s gut and helps to protect against infection. Your supply of milk will usually increase between the second and fifth day after delivery. During this time your breast may become noticeably fuller and heavier. The milk changes from the yellow colostrum to a creamy, white transitional milk and then to a thin looking greyish blue mature milk.

The two most important factors affecting the continuing success of lactation are:

  • the efficient removal of milk from the breast and
  • the ability of the correctly latched baby to feed to need


We recommend that you keep your baby with you as much as possible and that your baby has unlimited access to the breast from birth according to their individual needs. This will help to establish a good milk supply that is perfect for your baby.

Breastfeeding is a learned skill, which often takes a little time to master. Due to the evolution of nuclear families, some women have very little exposure to breastfeeding as they are growing up. They have not had the opportunity to observe and learn the art of breastfeeding. Correct positioning and attachment of baby at the breast is the key to the prevention of most breastfeeding problems. Offering the breast frequently is important in establishing a good milk supply. Skin to skin contact is also very helpful for this. Please ask for help with attachment if you are experiencing pain when breastfeeding. We have a DVD which is available to watch in the Visitors Lounge.

Please ask your midwife to turn this on when you have time to watch this.

Reviewed August, 2015 by Lactation Consultants: Kerry Adams, Deborah Westhoff-Glenn, Chris Hedges and Amanda McCamey, RN/RM.


Tips for Breastfeeding Success

  • Please ask for help if you are unable to attach your baby to the breast or if breastfeeding is painful.
  • Try to attend the breastfeeding class as soon as possible . They are held regularly throughout the week,the location and time will be confirmed at the start of each day.
  • In the first 24 hours after delivery, your baby may be sleepy and/or mucousy. Please attempt at least 4 feeds in this period.
  • After the first 24 hours, aim for a minimum of 6 feeds in a 24 hour period. The demand-feeding pattern is ideally 2–5 hours between feeds. Try to feed your baby more frequently during the day and allow longer sleep periods at night. Some babies cluster feed just as we do and this is quite normal.
  • You may find that your baby is more unsettled just as the milk is coming in. Please feed on demand as this prevents breast engorgement and jaundice in the baby. This behaviour usually resolves as the milk comes in fully.

Breastfeeding - Positioning & Attachment

Ensure you are comfortable – perhaps with a pillow to support your back and a glass of water nearby. If you are wearing a bra, it may be helpful to remove this while you are learning.

  • Unwrap your baby.
  • Bring the baby to you, not the breast to the baby.
  • Baby should be facing flat against you, chest to chest, supporting your baby behind the shoulders and neck (with a flat hand).
  • Tuck baby’s bottom arm under and around your chest.
  • Holding your baby at the same level as your breast, align your baby’s nose with the nipple.
  • A well-positioned finger or thumb may be useful to tilt the nipple towards the baby’s nose, keeping the fingers well out of the way under your breast, towards your rib cage.
  • Encourage your baby to have a wide gape prior to attaching, by gently brushing the baby’s bottom lip against your areola.
  • As the baby’s mouth opens widely the baby is brought quickly onto the breast. With your flat hand, extra pressure on the baby’s back will assist with attachment.
  • The baby’s chin will be pressed firmly into the breast, with the head tilted back slightly so that the nose is free. Pulling in the baby’s bottom and legs close to your body will help achieve this.
  • The baby’s lips will be flanged outwards.
  • Baby’s cheeks will be puffed out and be close to the breast.
  • Baby will have a good mouthful of breast and when baby begins to suckle you will not feel any pain.
  • After an initial period of rapid suckling, your baby will commence steady, rhythmical sucking and swallowing with pauses. This is the normal pattern of suckling once your milk has come in. (There is less swallowing and more suckling in the first few days as the volume of colostrum available is less than that of the breast milk).


Reviewed August, 2015 by Lactation Consultants: Kerry Adams, Deborah Westhoff -Glenn, Chris Hedges and Amanda McCamey, RN/RM.


Has My Baby Had Enough?


How often will my baby feed?

In the first 24 hours or so following birth, the baby may be quite sleepy and will need to recover. The time taken by the baby when it is breastfeeding will be minimal, as the protein and calorie-rich colostrum will meet its needs. The baby is well hydrated from being in the amniotic fluid with continual feeding from the placenta, so it will not require frequent feeds.

Postnatal day 2-3
From approximately 24-72 hours old, the baby will become more wakeful and want to feed more frequently. The baby’s thirst intensifies a few days after birth and this triggers the need to breastfeed more frequently. The mother’s breast milk will change from colostrum to transitional milk with the volume of the milk slowly responding to the baby’s needs. We recommend the baby receives a minimum of 6 feeds in 24 hours however most breastfed babies feed on average around 8-12 times in a 24 hour period.

How often a baby feeds can depend on many factors such as the individual physical needs and on the amount of milk available at each feed. The storage capacity for milk can vary greatly between mothers and between breasts. Most mothers will feed from both breasts but a mother with a lot of milk may only need to feed her baby from one side at a feed.

Duration between feeds may also vary. Some babies may routinely feed for example every 2-3 hours. Other babies may “cluster feed”, where they feed very frequently, one feed after another, for several feeds and then have a sleep for several hours. Every mother/baby relationship is individual. Unrestricted feeding is an important factor in the establishment of successful breastfeeding. It’s best to allow the baby to regulate breast milk intake.

Do not wait until your baby is crying before offering the breast, as this is often a late sign of hunger. The optimal time to feed is when baby is in a quiet, alert state, immediately after waking up. Cues the baby may give you to indicate that they are ready for a breastfeed include:

  • Mouthing movements
  • Sucking bedclothes
  • Making hand to mouth movements
  • Generally becoming restless and starting to move


How do I know when my baby has had enough time at the breast?

It is not necessary to time feeds at the breast. Some babies require only as short a time as 10-15 minutes, whilst others may need to feed for longer. The volume a baby takes at one feed is not always related to the time spent at the breast.

Before the milk comes in, you may find it useful to switch sides frequently, stimulating supply and allowing the baby to access the colostrum available in both breasts. This is also helpful when the milk is in and the breasts are softer, for example in the late evening. When breasts are full it is suggested to begin each feed on the alternate breast. This means start with the right breast for one feed, then the left breast for the next feed. When your baby comes off the breast, consider either the first breast again or the second breast -depending on the fullness of your breast. Initially during the first few weeks, this may change at each feed as your milk volume is changing in response to your baby’s needs. Allowing your baby’s appetite to regulate your milk supply establishes a basis for the rest of your breastfeeding. As long as your nipples are comfortable and your baby is sucking, time is unimportant. Babies become more efficient at breastfeeding as they grow and the time of each breast feed generally shortens. Your breasts should be free from lumps at the end of the feed.

The following points may be helpful in guiding you on how your baby will feed once your milk has "come in":

  • Initial rapid sucking by the baby triggers the "let-down" reflex. The baby will then settle into longer rhythmical sucks – a pattern of approximately 8-12 suck/swallows, then a pause of up to 30 seconds. Swallowing may be seen, felt or heard.
  • This sucking will continue without prompting if the baby is well attached. There is no fixed time that this will last.
  • The suck/swallow cycles will become shorter as the baby nears the end of the feed and the pauses will become longer. Some babies detach themselves automatically at this stage, but others may continue to suckle for comfort. If you wish to detach your baby from the breast, you can do this by placing your finger in the corner of the baby’s mouth, breaking the suction and then easing the baby from the breast.
  • You may like to change your baby’s nappy at this point, waking the baby up before continuing with the feed.
  • It is a good idea to feel your breast at this stage. If you think that there is more milk available in the first side, then offer this side again before offering the second side. You will learn how your breasts are draining by feeling them before, during and after the feed.
  • The baby’s body language changes throughout the feed. Initially, the limbs are bent, muscles tight and fists clenched. Once the baby starts to feel satisfied, muscles begin to relax and the fists unclench. The baby looks content and floppy and should then sleep for a while.


Rooming-in is encouraged from birth. It promotes bonding, enables breastfeeding on demand and allows you to get to know your baby. Separation, even to the bassinet, may cause some babies to become very distressed. Skin-to-skin contact can be very helpful to calm your baby, maintain body temperature and promote the release of hormones enabling breastfeeding. If you are having strong pain relief, become ill or need some time out, your baby may be cared for in the nursery between feeds.

Night feeding has many advantages:

  • Your milk supply will be established more quickly.
  • Frequent feeding day and night reduces possible breast engorgement when establishing lactation.
  • Promotes quality sleep due to the release of hormones whilst breastfeeding.
  • Your breasts will be more comfortable and you will therefore sleep better.
  • Early frequent feeding promotes a good milk supply.
  • Reduces possible jaundice in the baby.


If attempts to breastfeed are unsuccessful, then expressing and offering colostrum helps the establishment of lactation and a more vigorous baby.

Reviewed August, 2015 by Lactation Consultants: Kerry Adams, Deborah Westhoff-Glenn, Chris Hedges and Amanda McCamey, RN/RM.


Monitoring Baby's Progress when Breastfeeding


Infant behaviour

Infants are generally content after feeds, although most will have one period each day when they want to feed frequently and will not settle. This often happens in the evening and it should not be interpreted as 'running out of milk at the end of the day'. Milk production is a continuous process over a 24-hour period, although the rate of production varies according to the fullness of the breast.

Feeding patterns

Few babies develop a feeding and sleeping pattern during the first months. Most prefer to sleep and feed with no pattern. At approximately 6 weeks of age, many babies experience a growth spurt, when they want to feed more frequently. Your breasts are likely to be feeling more comfortable and softer by then, which is quite normal and not a sign of a low milk supply.

Urine output

Your baby will not pass much urine in the first few days prior to the milk coming in. As long as the baby passes urine once or more every 24 hours, there is no cause for concern. As the milk volume increases, the infant’s urine output will increase.

Bowel actions

The first bowel actions consist of meconium, which is greenish-black in colour. After 24-48 hours, this changes to a brownish ‘transitional’ stool and then by the fourth or fifth day to typical breastfed infant stools, which are loose and mustard-seed yellow (sometimes with milk curds). Occasionally, the stools become green or orange. None of these changes is significant in a healthy breastfed infant. Frequent, runny stools indicate a good milk supply and not diarrhoea (diarrhoea entails very frequent, watery stools). The number of bowel motions tends to decrease between 6 weeks and 3 months of age. Intervals of several days or more between stools are common. If the infant is receiving breast milk only and no other food or fluid, there is no cause for concern. Formula fed infants pass fewer motions than breastfed infants (once a day or every second day, often khaki coloured and with a plasticine-like consistency). An exclusively breast-fed baby will never become constipated.

Infants’ weight

An initial weight loss of 5-10 per cent of the birth weight is normal. Between 4 and 6 days of age the infant starts to regain weight and by 2 weeks of age should have returned to their birth weight. The following growth rates are a guide:

  • birth to age 3 months - a gain of 150-200 grams per week
  • age 3 to 6 months – a gain of 100-150 grams per week
  • age 6 to 12 months – a gain of 70-90 grams per week


Indications that your baby is getting enough milk:

  • 6-8 pale wet nappies in 24 hours when milk is in
  • some weight gain
  • an active and alert baby, who is content after feeds and has some sleep
  • soft, mustard-coloured bowel motions (which may occur at every feed to only once or twice a week)


Most women find at least the first couple of weeks of breastfeeding challenging. Learning to feed, recovery from the birth, combined with lack of sleep, all contribute to make breastfeeding seem difficult. It may take up to six weeks to feel comfortable with breastfeeding. Take the time that you need, relax and enjoy your baby and breastfeeding will become a most rewarding experience for you and your baby.

Reviewed August, 2015 by Lactation Consultants: Kerry Adams, Deborah Westhoff-Glenn, Chris Hedges and Amanda McCamey, RN/RM.


Nutrition During Breastfeeding

Good nutrition is always essential for good health. During breastfeeding, your nutrient requirements increase in order to make milk for your growing baby. This means choosing more nutrient dense foods from the five food groups. Be sure to choose nutritious meals and snacks from the following guidelines where possible:

Breads and Cereals: 9 serves

  • One serve is a slice of bread, ⅔ cup of breakfast cereal, ¼ cup of muesli or ½ cup cooked rice or pasta.
  • Wholegrain varieties of breakfast cereal, bread, crackers, pasta and rice are best and contain more fibre, vitamins and are normally more slowly absorbed and more 'filling'.


Fruit and Vegetables: at least 7 ½ serves of vegetables and 2 serves of fruit

  • One serve is a cup of salad vegetables, ½ cup of cooked vegetables, 1 small potato, 1 medium piece of fruit, ½ cup fruit juice, 1½ tablespoons of sultanas or 4 dried apricots.
  • Choose from fresh, canned and dried fruit and fresh or frozen vegetables. Frozen vegetables are just as nutritious as fresh and are a useful stand-by.
  • As fruit juice contains a lot of natural sugar, it is better not to drink large amounts, if consumed try diluting with water.
  • Include at least two fresh pieces of fruit per day.


Meat, Legumes, Eggs and Nuts: 2 ½ serves

  • One serve is 2 large eggs, 30g of nuts, 1 cup canned beans/legumes (e.g. baked beans or kidney beans) 65g of cooked lean meat, 80g cooked poultry or 100g of cooked fish.
  • As well as being a rich source of protein, these foods are good sources of iron and zinc. If you do not eat animal products, be sure to include legumes and nuts as part of a well-balanced vegetarian diet and ensure an adequate vitamin B12 intake.


Dairy Products: 2 ½ serves

  • One serve is a cup of milk or calcium-fortified soy/nut milk, 40g of cheese or a 200g carton of yoghurt. Milk can be used on cereals, in smoothies, hot drinks, desserts, soups and white sauces. Fat reduced varieties are generally best and are higher in calcium. If you do not drink milk or a soy/nut drink which is fortified with calcium, it is wise to talk to your doctor or Dietitian about taking a calcium supplement.


Extra Nutrients:

  • Iodine – Iodine is needed for your baby’s growth and development. It is recommended that breastfeeding take a supplement containing iodine, as well as eating foods that are good sources of iodine.
    • Foods high in iodine include: fortified breads (mandatory in all commercial non-organic breads), seafood, eggs and iodised salt.
  • Fluid – During breastfeeding, your fluid requirements increase to replace fluid lost in breast milk (~700ml/day). It is a good idea to have a glass of water every time your baby feeds, or keep a bottle of water close to you when feeding.


Meal and Snack Preparation:

  • The first weeks at home with a new baby pass more smoothly if meal preparation can be kept to a minimum. Rice and pasta dishes, soups and casseroles are all quick and easy to prepare. Try to do some meal preparation early in the day when you feel less tired.
  • It can be useful prepare enough for 2-3 meals and freeze the remainder for another meal.
  • Healthy, quick meals include things like baked beans on toast with a salad and fresh fruit, an omelette and pasta with grated cheese and frozen vegetables and/or a bottled pasta sauce.
  • Healthy snacks such as yoghurt, fruit smoothies, cheese and crackers, nuts, fruit loaf or muffins are also a good idea to keep on hand.


Helpful Hints:

  • Use sugar and fat in small amounts - remember these are often hidden in cakes, soft drinks, pastries and chocolates.
  • Take time out each day for a rest; try sleeping when the baby sleeps
  • Eat regular meals, try not to skip meals.
  • Eat according to your appetite.
  • Accept offers of help from others.
  • Try shopping for groceries using an internet/home delivery service.


Weight Management

Some women find it difficult to return to pre-pregnancy weight as exercise routines are likely to change significantly and appetite may increase during this time. Breastfeeding helps you return to your pre- pregnancy as some of the fat stores deposited during pregnancy are used as energy to make breast milk. Some nutrient requirements are increased during breast feeding, so it is not recommended that you skip meals or start any crash dieting. It is also important that you eat to your true hunger and recognise other reasons that may lead you to overeat, such as stress, tiredness and emotional reasons. It is helpful to note that when breastfeeds decrease, so should your body’s need for extra energy. Try to adjust your diet accordingly.

Alcohol

It is preferable not to drink alcohol at all while breastfeeding, especially in the first month, as it readily passes through your breast milk. Keep in mind the level of alcohol in your breast-milk will be similar to the level in your blood at the time. If you choose to drink alcohol, drink no more than 1 standard drink per day and drink after a feed. Wait 2-3 hours after drinking before feeding again. If in doubt, express before drinking and discard your next feed after drinking.

Caffeine

Caffeine will also pass into breast milk, so if you choose to drink tea or coffee consume this after a feed. Most babies tolerate 2-3 cups of tea, coffee or cola a day in your diet.

What foods might upset my baby?

Exclusion of any particular foods from your diet during breastfeeding is not recommended; as there is no evidence that this can prevent allergies. However if you do feel that every time you eat a certain food your baby seems upset 4-6 hours later, you can try eliminating the food from your diet to see if the situation improves. If not, add the food back into your diet.

Remember an upset baby may need a cuddle, a nappy change or some attention.

If you are concerned that your baby may have allergies, it is best to speak to your GP and/or Accredited Practising Dietitian.


Management of Mastitis

Mastitis is an inflammatory condition of the breast, which may or may not be accompanied by infection.

Possible causes include:

  • Inadequate drainage of the breast
    • Initial oversupply of milk
    • Change in feeding pattern
    • Missed night feed
    • Ineffective sucking
  • Nipple damage
  • Pressure on breast ie tight bra, finger
  • No obvious cause, but predisposing factors include tiredness, stress and skipping meals


Prevention of Mastitis

  • Correct attachment:
    • The shape of the nipple should look healthy and not distorted. Early nipple tenderness should be improving. The nipple will look slightly stretched when the baby finishes feeding but should not be squashed or flattened.
  • Breast drainage:
    • Check breasts after feeding to ensure there is no tenderness or lumps. Ensure that the first breast is soft and comfortable before you offer the second breast. Avoid tight fitting bras and any pressure to the breast during feeding.
  • Hygiene:
    • Maintain good hygiene after nappy changes and before handling your breasts.


Signs that you have mastitis

  • A reddened area on the breast, which may be hot and tender
  • Flu like symptoms (chills, shivers, aching body)
  • High temperature – more than 38.5 degrees Celsius
  • You may also experience a headache or nausea


Management

  • Empty the breast – continuing to breastfeed speeds up the recovery
    • Feed from the sore breast first, for two feeds in a row. Express the second breast for comfort if the baby does not feed from this breast. This is not the time to wean. It is advisable to continue breastfeeding to reduce the risk of further problems developing.
    • If the baby is unwilling or unable to feed, hand express or use a breast pump to empty the breast. The breast should be kept as well drained as possible by frequent feeding or expressing.
    • When the breast is less painful, gentle massage to the area during feeding, may help drainage.
    • Pain relief eg Panadol or Nurofen (if required)
    • Try to rest and increase your fluid intake.
    • Cool compresses after feeding will help relieve the inflammation
  • Use of Antibiotics
    • Continue management as above
    • If there is no improvement in symptoms or the situation worsens over the next 2-3 feeds, antibiotics must be commenced.
    • The antibiotics prescribed are usually safe to use when you are breastfeeding. If you are concerned regarding the medications, talk to your Doctor or call Mothersafe on 9382 6539 or 1800 647 848. Your baby will not become unwell as the infection involves the breast tissue, not the breast milk. Your baby may have runny bowel motions
    • Your breasts should improve within 48 hours, but it is important to continue the course of antibiotics and care of your breasts to prevent recurrence. Please contact your GP if there is no improvement in the condition within 48 hours of taking antibiotics.


References

  • Hale, T. (2010). Medications and mothers’ milk. 14th Edition. Texas: Hale Publishing
  • World Health Organisation (2000). Mastitis-causes and management.
  • Mannel, R., Martens, P.J. Walker, M. (2007). Core curriculum for Lactation Consultant Practice 2nd Edition.
  • Mothersafe.org.au

Engorgement / Breast Fullness

When your milk "comes in", usually about 72 hours following the delivery of your baby, your breasts may become full, heavy and slightly tender. This is a normal physiological response to the establishment of your lactation.

At this point it is suggested to keep your breasts well supported with a well-fitting, but not restrictive bra or singlet top, and to remove this when feeding to allow proper drainage of your breast and also to allow the other side an opportunity to "drip" for some relief.

If your breasts are too full you may find some gentle hand expression prior to attachment to be beneficial.

Ensure correct positioning and attachment of your baby to the breast. If your baby is well attached you will find that he or she drains your breast so much more efficiently. Good attachment, frequent feeding and good drainage of your breast is the key to successful breastfeeding into the future.

During the breastfeed it is a good idea to gently massage the breast you are feeding from with oil on your fingers. The oil allows your fingers to slide over your breast tissue and prevents your skin from being damaged.

Another good idea, if your breasts are very full and uncomfortable, is to apply ice packs to your breasts after feeds. The ice acts as a "vaso-constrictor", reducing the amount of blood flow to your breasts. It’s sort of like icing a bruise. You can use the ice as much as tolerated between feeds. You will find it to be very soothing and will help to reduce the swollen tissue of your breasts and therefore help the milk to flow.

If at any time during the post natal period you find that your breasts feel lumpy, painful or "blocked" (the milk is not flowing) you can try any or all of the above ideas.

Usually this feeling of large and swollen, warm and painful breasts only lasts a few days. The swelling settles and your breasts will only feel full again when it is time to feed.

Reviewed August, 2015 by Lactation Consultants: Kerry Adams, Deborah Westhoff-Glenn, Chris Hedges and Amanda McCamey, RN/RM.


Expressing and Storing Breast Milk

While the best way to remove milk from your breasts is undoubtedly by breastfeeding your baby, there may be situations in which this is not possible and you need to express your milk, either by hand or pump. Most mothers, at some point during their lactation, will wish to express their milk. For some, it will be a rare event to reduce breast firmness or to relieve engorgement or mastitis. For others, it is a routine, which occurs a number of times a day to maintain their milk supply and provide milk for their babies on a short or long term basis.

Reasons for expressing may include:

  • Your baby was born prematurely or your baby is unable to suck effectively
  • Your baby is hospitalised and you cannot be there for every feed
  • Your nipples are too sore
  • To help the baby attach to a full breast Stimulation of your milk supply
  • You need to express and discard temporarily due to medications or tests for yourself You are going out and cannot take your baby with you
  • You are returning to work


Some helpful hints:

  • Express in a comfortable, private place
  • Have a glass of water nearby
  • Skin-to-skin contact may be helpful prior to expressing
  • Have your baby near to you. If this is not possible or your milk is not flowing, it may be helpful to have a photo or something that the baby has worn recently near to you.


Hand Expressing

  • Wash your hands with soap and water
  • Use a container that has been washed in hot soapy water, rinsed and dried
  • Gentle massage of the breast using a small amount of olive oil on the fingers prior to expressing may help your milk to "let down".
  • Place your thumb and forefinger on either side of your areola, well back from the nipple. Gently press your thumb and forefinger back into your breast tissue, until you feel the bulk of your breast tissue.
  • Press your thumb and forefinger towards each other, in a rhythmical way. Be patient - the milk may take a little while to start flowing ("let-down").
  • When the flow eases, move your fingers to another area of the areola and continue as before. Once the flow from the first breast reduces, switch sides and repeat the procedure for a total of approximately 10 minutes each side. Switching back and forth helps to increase supply.


Pumps

  • Hand pumps can provide you with another option for expressing your breast milk. Hand pumps are compact, inexpensive and portable and there are many different brands available on the market.
  • Electric Pumps are more expensive and are generally hired when expressing for longer periods or if your baby is sick or premature. For mothers returning to work there are several mini electric breast pumps available which are reasonably priced. Some pumps can express both breasts at one time; some can convert to a hand pump for convenience. Electric breast pumps can be purchased or hired from the Australian Breastfeeding Association or from a pharmacy in your area.


Storing Breast Milk at Home

Breast milk can be stored in plastic containers, including sealable, sterile plastic bags. Freshly expressed milk can be chilled in the refrigerator and added to frozen milk in the freezer. The following is a simple guide for mothers storing expressed breast milk at home:

BREAST MILK ROOM TEMPERATURE REFRIGERATOR FREEZER
Freshly expressed, in
a closed container

6 – 8 hours if the temperature is
260 C or lower. If refrigeration is available it is better to store
milk there

72 hours if the refrigerator
temperature is 40 C or lower –
store in the back section rather
than in the door

3 months in freezer section of refrigerator with a separate door
6-12 months in deep freeze (-18 C)

Previously frozen -
thawed in refrigerator but not warmed

4 hours or less (i.e. the next feed) Store in refrigerator 24 hours Do not refreeze
Thawed outside refrigerator in warm water For current feed Store for four hours or until next feed Do not refreeze
Infant has begun feeding Only for current feed Discard Discard

Feeding with Expressed Breast Milk

  • Expressed breast milk can be fed to the baby with a bottle. (If your baby is still in hospital the midwife may feed colostrum to your baby using a syringe). If you wish to introduce a bottle we suggest a wide-necked peristaltic teat for breast feeding babies. The same procedures for sterilisation and storage apply.
  • Shake the milk gently if it has separated
  • Warm the milk by placing the cup/bottle in a container of hot, not boiling water. Test after a minute or two by placing a few drops on the inside of your wrist. It should be body temperature, or just a little warmer
  • Do not use a microwave to thaw or heat milk as this heats the milk unevenly and can lead to accidental burning. The microwave can also destroy some of the components of breast milk.
  • If offering a full feed of expressed milk the amount will depend on the baby’s age and weight. To work this out: baby’s weight x 150 (mLs per kilogram) / Number of feeds per day


Transporting Breast Milk

  • Use an insulated container (an esky with a freezer brick)
  • If some of the frozen milk has thawed it should be used within 24 hours, do not refreeze
  • Put in the refrigerator or freezer immediately on arrival


If you have any questions about any of the above please ask your health professional.

References and for Further Information

NHMRC Infant Feeding Guidelines for Health Workers (2012), Australian Breastfeeding Association: http://www.breastfeeding.asn.au
Adapted from CMC Lactation CCH June 2008. Revised May 2010

Reviewed August, 2015 by Lactation Consultants: Kerry Adams, Deborah Westhoff-Glenn, Chris Hedges and Amanda McCamey, RN/RM.

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