Why express milk?

There are a number of reasons why a breastfeeding mother might wish to express milk rather than feeding the baby directly from the breast:

• your baby may be premature and too small to suck properly. Your expressed milk can be fed to the baby through a tube
• some babies with a cleft lip or palate find it difficult to suck and need to be fed expressed milk with a specially shaped spoon or teat
• you may wish to leave your baby with someone else. Your expressed milk can be fed to your baby via a bottle, a cup, an eyedropper or a spoon.
• if you are working outside the home and wish to provide breast milk for your baby when you are at work
• breast milk also contains antibodies which will help protect your baby against illness - which can be especially valuable if the baby attends a day care centre with other children
• you may simply wish to express a small amount of milk to mix with your baby's first solid foods.

How to express milk?

There are several ways you can express milk:

By hand

Expressing milk by hand needs a fair bit of practice and is time consuming. You may need to enlist the help of your midwife or La Leche League. There are slightly different methods, but the main aim is to assist the 'let down' of milk and drain the milk sinuses. To stimulate the 'let down' you have to:

• Start at the top of each breast and with each hand press inwards, moving your fingers in a circular motion on one spot for a few seconds.
• Work around both breasts doing this.
• Working around the breast again, stroke gently with a tickle-like stroking action, towards the areola (the dark area around the nipple).
• To drain the milk sinuses, put your thumb about 2cm above your nipple and your first two fingers about 2cm below your nipple.
• Gently roll your thumb and fingers around in a slight twisting action by pushing inwards.
• Do not press too hard.
• Work all around the areola repeating this action.
• Keep expressing like this until the milk flow slows down and do the same on the other breast after about three to five minutes.
• Repeat on both breasts.
• The milk comes out in small bursts at first and then flows freely.

Using a pump

Whether you use an electric or a hand vacuum pump you still have to stimulate the 'let down' as you would for expressing by hand. If using a pump be careful not to exert too much suction on the nipple. Pumps can occasionally be a bit fierce and crack or split the nipple. A pump should be treated like a baby's feeding bottle and needs to be sterilised thoroughly after use.

How to store expressed milk

It is best to express directly into a sterilised plastic container. The milk can be kept in the fridge for 24 hours. It can be frozen for three to four months in a fridge/freezer or up to six months in a separate deep freeze.

Store the milk in small amounts. Ice cube trays are ideal as they are easy to thaw. Label each container with the date, month and year. Also write 'Expressed Milk' on the container in case someone mistakes it for something else. Do not add fresh, warm expressed milk to milk which is already frozen or cold.

How to thaw expressed milk

Frozen milk is best thawed by holding the container under cold running water then gradually warmer water to bring the milk to body temperature. Breast milk is not homogenised (milk, fats etc all mixed together) so it will separate. Swirl gently to mix. Do not leave expressed milk standing around at room temperature. It is not safe to refreeze milk either. Throw away any leftover milk.

Further information

For further information and support talk to your midwife or Plunket nurse. Your midwife may be able to put you in touch with a lactation consultant if she feels it is appropriate.

Plunketline offers advice, freephone 0800 933 922, 7am to midnight seven days a week, 365 days a year, or ask your Plunket nurse for advice. Website: www.plunket.org.nz

La Leche League has counsellors. Look in the telephone book for the contact telephone number of your local branch. Website: www.lalecheleague.org.nz

Also see the Ministry of Health's websites, promoting the benefits of breastfeeding via a national campaign: www.breastfeeding.org.nz and offering detailed information for mothers, supporters, employers and health practitioners about breastfeeding: www.moh.govt.nz/breastfeeding - you can also phone the Healthline (including Well Child line) on freephone 0800 611 116 for advice about breastfeeding.

Look for marae-based clinics in your area. Mother Support Groups are in most towns and cities. Ask at your local Parents Centre www.parentscentre.org.nz or Plunket Family Centre.

Written by Anna Mickell RCpN. Reviewed by everybody.