Breast Milk: Expressing for Your Hospitalized Baby

The recommendations in this pamphlet are for mothers who are expressing and storing breast milk for hospitalized babies.

What does expressing breast milk mean?

Expressing breast milk or pumping is the removal of breast milk from your breast with a breast pump or your hand. You can then store your breast milk for your baby.

You may need to express breast milk for one or more of the following reasons:

• To build up and maintain a milk supply when your baby cannot breastfeed at your breast.
• To increase your milk supply.
• Your baby has a hard time latching (attaching) to the coloured, circular area around your breast called the areola (say: ar-ee-OH-la). Your nipples may be flat or turned in. Expressing for a few minutes before you try to latch your baby may help the nipples stand out more.
• Your breasts hurt because they are hard and uncomfortable. This is called engorgement. Expressing regularly relieves the hardness. Engorgement can flatten the nipple. Expressing to relieve the engorgement softens the areola making it easier for the baby to latch.

How does your body make breast milk?

Two hormones are important for making breast milk. These hormones are called prolactin and oxytocin.

Prolactin is the hormone that makes milk. The more prolactin you have in your body, the more milk you make. Your body will make more prolactin:

• If you express your breasts more often.
• If you breastfeed your baby more often.

Oxytocin is the hormone that helps your milk come out of your breasts. Oxytocin tightens the muscles around the cells in your breasts that make milk so that the milk is squeezed out. This action of squeezing milk out of the breasts is called let-down.

During a let down, these things may happen:

• Your breasts may tingle.
• The milk may leak or drip from the nipple you are not pumping or using to feed your baby.
• You may feel cramps, or contractions in your uterus, or womb.

Let-down can happen even when you do not feel or see any of these signs.

Some feelings decrease the level of oxytocin in your body. For example, you may find that you do not express a lot of milk if you are:

• worried
• tired
• in pain
• stressed
• hungry

These may temporarily suppress your milk supply, but as long as you continue to remove your milk, your supply will increase as your baby recovers.

When should I start to pump?

You should start to pump the day your baby is born or as soon as you are medically able.

What kind of pump should I use?

A hospital grade double electric pump is recommended to establish and maintain a breast milk supply for a baby who can not breastfeed. These electric pumps let you pump both breasts at the same time.

Their suction and cycling are set to best help your breasts produce breast milk without causing sore nipples. Cycling is the number of times the nipple is moved in and out of the pump and is similar to the number of times the baby sucks and swallows.

These pumps and sterile pump kits are available at most hospitals that care for infants. Ask your nurse or lactation specialist. Many hospitals rent and/or sell the equipment needed for breast pumping. New sterile kits are required for each pumping session, which need to be signed out then returned after each pumping session so that they can be properly sterilized.

Will my health insurance plan cover the cost of renting or buying a hospital grade pump?

Some private medical insurance plans will pay the cost of renting or buying a breast pump. Ask your baby's nurse to give you a letter for your insurance company.

Should you pump one breast after the other or both breasts at the same time?

It is better to express both breasts at the same time. This is called double pumping. Double pumping saves you time and helps make more milk. The amount of prolactin in your body goes up faster and higher with double pumping. To double pump you need 2 pump kits attached to both tubings connecting to the pump.

If you are not comfortable with double pumping you can pump one breast at a time. This is called single pumping. You will need only one pump kit connected to one tubing. Remove one tubing from the pump and close the remaining hole with the white plug. If you do not feel good suction when you are pumping check with your nurse.

How long should I pump at each pump session?

Pump for 10 to 15 minutes when you are double pumping. Pump for 15 minutes each breast when you are single pumping. If you have more milk coming you can pump longer especially as your milk comes in.

How often should I pump?

Try to pump every 2 to 3 hours from 6:00 AM to midnight for a total of 7 to 8 pumps in 24 hours. Your body makes more prolactin at night. Pump if you are awake at night. The longest stretch to sleep at night is a 6-hour stretch. If you sleep longer then 6 hours, your body can start to decrease milk production within 2 to 3 days.

“Can I wait to pump until my breasts feel full?’’

"If I wait until my breasts feel very full I get more milk. Why can't I keep doing this?" This is a common question. It is true if you wait longer between pump sessions you will get more milk at the beginning. However, the long time between pump times and the breast not being stimulated enough, tells your body there is not a need to provide breast milk. Then a process of decreasing breast milk begins. To reverse this, pump at least every 2 to 3 hours and try not to have more than one 6-hour stretch in 24 hours without pumping.

Ways to make pumping your breasts easier

Before you start pumping:

• Wash your hands with soap and water or waterless antiseptic available in the pump rooms.
• Wash your nipples with sterile water.
• Pump in a quiet and private place.
• Sit comfortably with your feet on a flat surface. Lean forward a little and put pillows behind your back. Leaning forward helps the milk flow to the nipple more easily.

To help with let-down:

• You can put warm washcloths on your breasts. This makes more blood flow into your breasts, which helps let-down.
• Gently massage the whole breast. Press the tips of your fingers toward your chest moving your fingers in a circle. Start at the edge of the breast and move towards the nipple.
• Stroke the whole breast lightly with your fingertips. Again, start at the edge of the breast and move down to the nipple.
• Lean forward and shake your breasts. This helps the milk flow down towards the nipples.
• If your milk flows easily and you have good milk volumes you do not need to apply warm washcloths or massage your breasts first.

Electric Breast Pump

When the funnel of the breast pump is placed correctly, the nipple will elongate part way down the length of the funnel neck.

To pump your breasts

• Assemble the breast kit keeping it as sterile as possible. Make sure someone shows you the first time.
• Place the cone shaped funnel from the pump kit over your breast and center the nipple. Make sure the suction setting is on the lowest setting before switching on the machine. Increase the suction slowly to allow the nipple to move in and out of the funnel without causing discomfort. Pumping at the maximum setting is recommended to best develop and maintain your milk supply.
• It is important that you pump at a level of suction that does not cause discomfort. If pumping is hurting you, turn the suction to minimum, turn off the power switch. Insert a finger under the funnel to release the suction and remove the breast kit from the breast. Adjust it so the nipple is in the center of the funnel. Turn the pump on and continue to increase the suction as long as it feels comfortable.

While you are pumping

• Try NOT to look at the pump or your breast while you are pumping. Try instead to think about your baby.
• Do not worry about how much milk you express each time you pump your breasts. The amount will not always be the same. For example, you may have more milk in the morning when you are rested. Many women pump more milk from one breast than the other breast.

To finish pumping

• Turn the suction to minimum and turn off the pump. Insert your finger to release the suction. Remove the breast kit from your breast.
• Take some of the breast milk and gently apply to the nipple and areola. Allow the nipple to air dry.
• Place your breast milk in the sterile bottles provided.
• Remember to leave an inch space at the top of the bottle to allow the milk to expand when freezing.
• Label your breast milk with the computer label provided and write the time and date you pumped on the bottle.
• Place your milk in the place indicated on your unit.

What is a pump log?

This is a paper to record how much milk you are making in each 24 hours over a period of time. Each time you pump your breasts, write down the amount you pump under the hour you pumped. Add up how much you pump each 24 hours. Keeping a record of your 24 hour volumes allows you to see increases and decreases in your milk volume. Ask for help when your milk volume decreases.

Download a pump log here.

How much milk should I expect to pump?

In the first few days, many women can only pump a few drops to a few teaspoons of milk per pumping session. Do not worry if you cannot pump anything in the first few days but continue to pump 7 to 8 times a day to stimulate your breast.

Breast milk increases in volume usually 2 to 4 days after the birth of your baby. You need to provide regular stimulation and emptying to keep the breasts producing breast milk. You should produce 350 cc of breast milk in 24 hours (about 12 ounces) when your baby is 7 days old and 500 cc in 24 hours (about 17 ounces) when your baby is 10 days old. Breast milk then continues to increase to about 800 cc in 24 hours at 6 months.

If you are not able to pump these amounts please speak to your nurse, doctor, or lactation consultant about ways to increase your milk supply. Remember any amount of breast milk is of benefit to your baby.

What is Power Pumping?

When you are near or holding your baby, the hormones that make breast milk increase. Many mothers can then pump more milk. There are different ways to do this.

• Kangaroo care is holding your baby against your skin, clothed only with a diaper, upright between your breasts.
• Holding your baby in your arms.
• Touching your baby while in the incubator.
• Sitting beside and looking at your baby.

After being with your baby for at least 20 minutes go and pump. You can continue to do this every 1 to 2 hours when you are in hospital with your baby. If you are pumping away from your baby, have things near you that remind you of your baby such as a photo, a sleeper, or your baby's blanket draped over your shoulders.

Pumping at home for your hospitalized baby

How do I care for my breast pump kit at home?

If you are pumping at home for your hospitalized baby, wash all the pump kit parts with hot soapy water, rinse well and place on a clean towel to dry after each pump session. Cover with a clean towel. Once a day all the pump parts need to be sterilized according to the manufacturers instructions.

How do I get my breast milk to the hospital?

Bring your milk to the hospital in a cooler. If the milk has been refrigerated add ice cubes to the cooler to keep the breast milk cold.

If the milk is frozen add a freezer pack to the cooler. Do not add ice cubes to the cooler if the breast milk is frozen as they will make the breast milk thaw faster.

How long can I keep refrigerated and frozen breast milk? How long can I keep breast milk at the bedside?

These guidelines are more strict than recommendations for healthy babies at home. We are being extra careful to protect your baby while in hospital.

Storing breast milk

• Store breast milk in sterile bottles provided at the hospital.
• Breast milk can not be stored at SickKids in plastic bags or glass bottles.
• Put your breast milk in the refrigerator or freezer right after pumping if you are not going to use it right away.
• Use breast milk that has been in the refrigerator within 48 hours after you express it. Once it is past 48 hours, throw it out.
• Use frozen milk that has been started to thaw within 24 hours. Once it is passed 24 hours throw it out.
• If you wish to freeze your breast milk, freeze it within 24 hours after pumping it.
• Breast milk can be kept at the bedside for one hour after it is warmed.
• Do not freeze breast milk that was already frozen and then thawed out.
• Never microwave breast milk as hot spots can develop and burn your baby's mouth.

What is hand expressing?

This is a method of taking milk from your breast with your hand. If you wish to learn this method, please ask your nurse to call the lactation consultant.

When are manual pumps used?

Manual pumps are recommended for occasional pumping for a baby who is breastfeeding well at the breast. They do not use electricity.

Key points

• Expressing breast milk means taking milk from your breast with your hand, or a breast pump.
• Hospital grade double electric breast pumps are recommended to build up and maintain milk a milk supply when your baby cannot breastfeed at the breast.
• Breast milk can be refrigerated or frozen and stored for your baby.