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IBCLC, Ilayda shows us how to use the Ardo Calypso Double breast pump!

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Unicef UK Baby Friendly Initiative | Hand expression

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Breast feeding network community support: up to date information 

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Breast feeding network community support: up to date information 

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This information is about introducing your premature baby to more solid foods, and the steps you can follow as your baby moves from milk to eventually only eating solids. This is called weaning.

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The Breastfeeding Friend, a digital tool from Start for Life, offers practical information and advice on breastfeeding.

Get answers to questions asked by new mums, and tips on things like sore nipples and what to do if your baby cries during feeds.

Think of it like your health visitor but, because it's a digital tool, it's available whenever you need it - all day and all night.

The Breastfeeding Friend is available on Amazon Alexa and Facebook Messenger.

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Find out how to get NHS trusted advice from the Start for Life Breastfeeding Friend, available on Amazon Alexa and Facebook Messenger.

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Details

PersonalFit™ PLUS reusable rental pump set

Designed for pumping mothers to use easily and comfortably at home, PersonalFit™ PLUS rental pump sets for Symphony® are also proven to yield more milk in the same time, when compared to standard pump sets.
At a glance

Same pump set design as used in hospitals

Tested and proven in clinical studies

Double and single pump sets available

Single-user product designed for home use

Quick and easy to assemble, clean and sanitise

Offers more comfortable, efficient milk removal

For just £49 (less than £1.70 a day!)
The Symphony Breast Pump, which is despatched in a hard-grey moulded protective carry case is supplied with 2 Pump Sets, included in the price, which allows you to single or double express your milk.

£49 for first 14 days (to cover carriage charges and the two pump sets)

£49 charged on the 15th day for another 30 days thereafter (£49 every 30 days rolling - cancel at any time)

The Symphony PLUS includes the initiate and maintain pumping program 2 x Pump sets with 24 mm breastshields. The 24 mm breastshield is our standard size which is suitable for the majority of women. Other shield sizes are available to purchase from www.medela.co.uk.

Orders placed before 3pm Monday to Friday are dispatched the same day for next working day delivery, excluding weekends and bank holidays. However this is not guaranteed due to incidents that may occur beyond our control.

If you require a weekday delivery before 10.30am there is a supplement of £20 or a weekday delivery before 12pm a £15 supplement. If you require a Saturday delivery then please select the Saturday Delivery Shipping Option when you check out. Orders must be received by 3pm on Friday in order to receive delivery by 1pm on Saturday, and are subject to a £35 supplement.

For any deliveries to Northern Ireland there is a £20 supplement, please select this option at the checkout. We do not deliver direct to Southern Ireland.

Please note we require the address to be residential or a place of work, we cannot deliver to a hospital address. Additional charges will apply to deliveries outside mainland UK.

If you need any further assistance, please contact our customer service team on 0161 776 0400.
Instructions for PersonalFit PumpSet:
Available online: view document

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Hire a Symphony Double Breast Pump | Hospital Grade

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The Hospital Grade Medela Symphony Plus breast pump is the number one choice for midwives and UK hospitals. Rent from less than £1.50 a day today!

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Rent a Breast Pump - Ardo is here to support you in making your decision about whether to buy or hire an Ardo breast pump

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Breastfeeding - Transitioning To Oral Feeding

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In this video, Maria Douglass (Neonatal Infant Feeding Lead) takes you through transitioning to Oral Feeding. Maria discusses Feeding Cues, Modified Responsi…

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HOW TO Disassemble and Clean Ardo Pumpsets

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Rent a Breast Pump - Ardo is here to support you in making your decision about whether to buy or hire an Ardo breast pump

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Symphony PLUS Rental with PersonalFit PLUS MEDNICU 2020

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Details

PersonalFit™ PLUS reusable rental pump set

Designed for pumping mothers to use easily and comfortably at home, PersonalFit™ PLUS rental pump sets for Symphony® are also proven to yield more milk in the same time, when compared to standard pump sets.
At a glance

Same pump set design as used in hospitals

Tested and proven in clinical studies

Double and single pump sets available

Single-user product designed for home use

Quick and easy to assemble, clean and sanitise

Offers more comfortable, efficient milk removal

For just £49 (less than £1.70 a day!)
The Symphony Breast Pump, which is despatched in a hard-grey moulded protective carry case is supplied with 2 Pump Sets, included in the price, which allows you to single or double express your milk.

£49 for first 14 days (to cover carriage charges and the two pump sets)

£49 charged on the 15th day for another 30 days thereafter (£49 every 30 days rolling - cancel at any time)

The Symphony PLUS includes the initiate and maintain pumping program 2 x Pump sets with 24 mm breastshields. The 24 mm breastshield is our standard size which is suitable for the majority of women. Other shield sizes are available to purchase from www.medela.co.uk.

Orders placed before 3pm Monday to Friday are dispatched the same day for next working day delivery, excluding weekends and bank holidays. However this is not guaranteed due to incidents that may occur beyond our control.

If you require a weekday delivery before 10.30am there is a supplement of £20 or a weekday delivery before 12pm a £15 supplement. If you require a Saturday delivery then please select the Saturday Delivery Shipping Option when you check out. Orders must be received by 3pm on Friday in order to receive delivery by 1pm on Saturday, and are subject to a £35 supplement.

For any deliveries to Northern Ireland there is a £20 supplement, please select this option at the checkout. We do not deliver direct to Southern Ireland.

Please note we require the address to be residential or a place of work, we cannot deliver to a hospital address. Additional charges will apply to deliveries outside mainland UK.

If you need any further assistance, please contact our customer service team on 0161 776 0400.
Instructions for PersonalFit PumpSet:
Available online: view document

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Hire a Symphony Double Breast Pump | Hospital Grade

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The Hospital Grade Medela Symphony Plus breast pump is the number one choice for midwives and UK hospitals. Rent from less than £1.50 a day today!

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LINK: Cracked Nipples and Moist Wound healing

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LINK: Cracked Nipples and Moist Wound healing

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LINK: Breast feeding Network Alcohol and Breast feeding

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LINK: Breast feeding Network Alcohol and Breast feeding

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Advice on drinking alcohol while breastfeeding, including how to manage social occasions and the risks of binge drinking.

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Other languages resources - Baby Friendly Initiative

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Using straightforward language and simple illustrations to aid understanding, these infosheets on breastfeeding and bottle feeding are available in multiple languages and can be used to support parents with the basics of feeding and responding to their baby.

The infosheets are free to download and print, and are currently available in:
Please note: Following feedback, these translations were updated in 2019 to ensure the language used was as straightforward as possible.
The English versions of these resources are available below for reference:

Breastfeeding guidance: English (for reference)

Bottle feeding guidance: English (for reference)

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Foreign language resources - Baby Friendly Initiative

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These infosheets are available in multiple languages and can be used to support parents with feeding and responding to their baby.

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LINK: Breast feeding support in the community

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LINK: Breast feeding support in the community

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Are you pregnant or breastfeeding?

Birmingham Forward Steps ‘Breastfeeding Lounges’ are available Monday – Friday for new and expectant mothers in Birmingham.

Breastfeeding sessions are open to ALL mothers in the city; face-to-face and virtual sessions are both available.

We provide information during pregnancy and once baby is born you will have continued direct access to the groups for on-going support and encouragement  breastfeed your baby for as long as you wish.

The Breastfeeding Lounges are run by Antenatal Infant Feeding Workers across the city, and you can access your local lounge or any listed below for continued support.

So come along and meet other mothers, share experiences and support each other in a safe space.

Birmingham Babies Love to Breastfeed – so we look forward to seeing you at a group soon.

To join a lounge on a day that suits you, please contact one of the phone numbers below:

MONDAY  1.30pm

Please Contact

Vic: 07974 255957

Or

Kitts Green Children’s Centre:

0121 752 1280

THURSDAY 11am

Please Contact

Anjali 07519 294569

Becki 07874 800383

Julie  07749 436442

TUESDAY 1.30pm

Please Contact

Becki: 07874 800383

Diane: 07761 503191

Surjit: 07738 119692

Samina: 07715 233852

FRIDAY 11am

Please Contact

Rukhsana: 07958 206120

Hasmita:  07701 303921

Languages spoken: English, Urdu, Punjabi, Hindi and Gujarati (Bengali and Arabic if requested in advance)

You can download this poster HERE

I f you wish to access antenatal courses, breastfeeding groups, 1 to 1 breastfeeding support and more, please contact your local Children’s Centre. You can find your nearest centre by using the postcode checker on our home page here: https://www.bhamforwardsteps.co.uk/

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Virtual Breastfeeding Lounge – Birmingham Forward Steps

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How to use the Ardo Calypso electronic breastpump

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Milk supply.....are you doing all of these.......

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Milk supply.....are you doing all of these.......

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LINK: Galactagogues- Increasing milk supply

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LINK: Galactagogues- Increasing milk supply

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This information can also be viewed as a PDF by clicking here.
The information provided is taken from various reference sources. It is provided as a guideline. No responsibility can be taken by the author or the Breastfeeding Network for the way in which the information is used. Clinical decisions remain the responsibility of medical and breastfeeding practitioners. The data presented here is intended to provide some immediate information but cannot replace input from professionals.
Galactagogues are substances that aid the initiation and maintenance of milk supply at a level which meets the needs of the baby. The production of milk is controlled by the hormone prolactin. Nipple stimulation controls the release of prolactin whilst oxytocin controls the release of the milk, experienced as the letdown.

Poor milk supply can result from:

Less than perfect positioning and attachment of the baby at the breast resulting in incomplete breast drainage

Infrequent, restricted, limited feeds

Reduction in milk supply is frequently noted after premature delivery with milk supply maintained only by expression over a period of weeks (DaSilva 2004 and Wan 2008). Smoking is associated with decreased milk production and smokers are more likely to wean earlier because of low milk supply or to notice inhibition of letdown (Vio 1991 and Hopkinson 1992).

Many cultures have their own remedies to increase milk supply (Riordan and Auerbach 1998). In the past Guinness and Vitamin B supplements have been advocated widely. There is limited research evidence to support its effectiveness. However if a mother believes it will help her, the positive effect may be apparent - whether due to placebo or genuine effect is unknown.

Medicinal products which have been shown to increase milk supply produce their effect by dopamine antagonism, generally as a side effect, whilst having other therapeutic effects. Use of these medicines as galactagogues is outside of the licence application and prescribers are required to take ultimate responsibility for their use.

Many women perceive that their milk production is inadequate and it is the commonest reported reason given for cessation of breastfeeding earlier than the mother had intended. Medication should not be advocated as a solution to unfounded concerns or where additional support and encouragement as well as consistency of information are the prime need. Expert assessment of the latch and the effectiveness of feeding is essential.

This drug is used as an anti-nauseant. Clinical studies have shown that it increases prolactin levels and consequentially milk supply at a dose of 10milligrammes three times daily. However it can produce extra-pyramidal side effects including tremor and slow, shuffling movements as well as precipitating depression (Ingram 2011, BNF)

This drug is used to speed gastric emptying and is used for dyspepsia after meals, reflux oesophagitis and vomiting (BNF). It is available as an over the counter medicine to treat bloating after meals. The normal dose is 10milligrammes three times a day. Reports of higher doses have been published (reported in Gabay 2002) but care should be taken if mother or chid have a history of cardiac problems or are on interacting medication. Reported side effects are unusual but can include headache, diarrhoea, mood swings and feeling dizzy. The drug has been evaluated as a randomised double blind; placebo controlled trial although this only involved 20 women (reported in Gabay 2002). Warnings issued by the FDA in June 2004 reported concerns over IV use, which are not applicable in these circumstances (Hale 2014). Further concerns on use and limitations on dose and indication were published by MHRA and EMC in May 2014.

-please see separate sheet on Domperidone use in breastfeeding www.breastfeedingnetwork.org.uk/domperidone/

Sulpiride and Chlorpromazine have been noted to have galactagogue properties but side effects limit their effectiveness. (Hale 2014, Jones 2013, BNF)

If no increase in milk supply is noted after seven days of taking medication, consideration should be given to removing the medication rather than continuing to expose mother and child.

This is a herbal spice, which is a member of the pea family whose seeds are used amongst other things as the artificial flavour in maple syrup. Anecdotal reports of its effectiveness go back to 1945 (reported in Gabay 2002) but no formal studies have been located. Its mechanism of action has been theorised as stimulation of sweat production (the breast is a specialised sweat gland). The recommended dose is 2-3 capsules three times a day (Newman 2009). Since herbal remedies are not standardised the exact amount of fenugreek may vary. Reported adverse events are rare and include maple syrup like odour of the sweat and urine, diarrhoea and aggravation of the symptoms of asthma (Lawrence 1998) although it has also been suggested as a remedy for asthma. Fenugreek can also interact with insulin and warfarin and anyone taking medication is advised to seek advice from a medical practitioner or herbalist. It also stimulates the uterus and should not be used in pregnancy. Hypoglycaemic effects (low blood sugar levels) have also been reported Vijayakumar (2005). Milk production is said to increase within 24-72 hours (Humphrey 2003).

It is important to note that natural products can vary in strength. The fact that they are natural products does not imply their use is without risk. Other natural remedies said to increase milk supply include anise, basil, blessed thistle, caraway, chasteberry and fennel but evidence is anecdotal rather than scientific. (Kellymom 2011, Humphrey 2003, Lawrence 1998)

In a paper by Shawahna 2018 it is suggested that all mothers recommended to take fenugreek should have a risk:benefit discussion so that they are fully informed.

Not all practitioners said that they would discuss the full list;
Fenugreek has anticoagulant effects

Breastfeeding women who have a history of any clotting related disorder need to be warned not to take fenugreek

Breastfeeding women who have a history of vaginal bleeding disorder need to be warned not to take fenugreek

Breastfeeding women who are at risk of any bleeding disorder need to be warned not to take fenugreek

Breastfeeding women need to be warned that fenugreek might be associated with menstrual breakthrough bleeding

Breastfeeding women who are on anticoagulants need to be warned not to take fenugreek

Breastfeeding women who are on non-steroidal anti-inflammatory drugs (NSAIDs) need to be warned not to take fenugreek

Fenugreek might be associated with abortion

Women planning to become pregnant need to be warned that fenugreek is a potential utero-stimulant and might cause spontaneous abortion

Women with a history of previous miscarriage need to be warned not to take fenugreek

Women planning to become pregnant need to be warned that fenugreek might impair fetal development

Risks associated with using fenugreek on other co-morbidities

Breastfeeding women need to be warned that fenugreek might cause nausea and vomiting

Breastfeeding women need to be warned that fenugreek might cause diarrhea in the mother and her breastfed infant

Breastfeeding women with a history of asthma need to be warned that fenugreek might worsen the symptoms of their asthma

Breastfeeding women need to be warned that fenugreek might cause dehydration

Fenugreek could be associated with hypotension

Breastfeeding women with a history of or at risk of hypotension need to be warned not to take fenugreek

Breastfeeding women with a history of or at risk of dizziness need to be warned not to take fenugreek

Breastfeeding women who are on anti-hypertensive medications need to be warned not to take fenugreek

Fenugreek could be associated with hypoglycemia

Breastfeeding women with a history of or at risk of hypoglycemia need to be warned not to take fenugreek

Diabetic breastfeeding women whose disease is controlled by medications or insulin need to be warned not to take fenugreek

Other adverse effects

Breastfeeding women need to be warned that fenugreek might cause fever

Breastfeeding women need to be warned that fenugreek might cause excessive sweating

Breastfeeding women taking diuretics, laxatives, mineralocorticoids, and/or other hypokalemic agents need to be warned that fenugreek may worsen hypokalemia

Nursing supplementer (SNS) devices may prove effective in aiding additional nipple stimulation through suckling. Breast compression may also stimulate milk flow and encourage the baby to suckle.

Amir LHm Donath SM. Does maternal smoking have a negative physiological effect on breastfeeding? The epidemiological evidence. Breastfeed Rev. 2003 Jul;11(2):19-29

British National Formulary

da Silva OP, Knoppert D C. Domperidone for lactating Women. Can Med Assoc J 2004;171:725-6

European Medicines Committee. May 2014 www.ema.europa.eu/ema/index.jsp?curl=pages/news_and_events/news/2014/04/news_detail_00 2083.jsp&mid=WC0b01ac058004d5c1

Gabay MP. Galactogogues -Medication that Induces Lactation, J.Hum.Lact. 2002;18(3) :274-9

Hale T. Medications and Mothers Milk

Hale T.1999. Clinical Therapy in Breastfeeding Patients(1stEd) Hale Publishing

Hopkinson JM, Schanler RJ, Fraley JK, Garza C. Milk production by mothers of premature infants: influence of cigarette smoking. Pediatrics. 1992;90:934-8. PMID: 1437437

Humphrey S. 2003. The Nursing Mothers Herbal. Fairview Press (Minneapolis)

Ingram J, Taylor H, Churchill C, Pike A, Greenwood R, Metoclopramide or domperidone for increasing maternal breast milk output: a randomised controlled trial Arch Dis Child Fetal Neonatal Ed F2 of 5(2011). doi:10.1136/archdischild-2011-300601

Ingram J, Taylor H, Churchill C, Pike A, Greenwood R, Metoclopramide or domperidone for increasing maternal breast milk output: a randomised controlled trial Arch Dis Child Fetal Neonatal Ed F2 of 5(2011). doi:10.1136/archdischild- 2011-300601

Jones W Breastfeeding and Medication 2018 Routledge

KellyMom - what is a galactogogue? Do I need one? http://kellymom.com/bf/can-i-breastfeed/herbs/herbal_galactagogue/

Lactmed website http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT

Lawrence R. 1998 .Breastfeeding a guide for the medical profession (5th Ed) Mosby

Newman J. Protocol to Manage Breastmilk Intake http://www.breastfeedinginc.ca/content.php?pagename=doc%20PMBI

Riordan J, Auerbach KG.1998.Breastfeeding and Human Lactation.(2nd Ed) Jones & Bartlett

Shawahna R, Qiblawi S and Haifa Ghanayem H. Which Benefits and Harms of Using Fenugreek as a Galactogogue Need to Be Discussed during Clinical Consultations? A Delphi Study among Breastfeeding Women, Gynecologists, Pediatricians, Family Physicians, Lactation Consultants, and Pharmacists. Evidence-Based Complementary and Alternative Medicine. 2018. www.hindawi.com/journals/ecam/2018/2418673/

Vijayakumar MV1, Singh S, Chhipa RR, Bhat MK The hypoglycaemic activity of fenugreek seed extract is mediated through the stimulation of an insulin signalling pathway. Br J Pharmacol. 2005 Sep;146(1):41-8.

Vio F, Salazar G, Infante C. Smoking during pregnancy and lactation and its effects on breast-milk volume. Am J Clin Nutr. 1991;54:1011-6.

Wan W W-X, Davey K, Page-Sharp M et al. Dose-effect study of domperidone as a galactagogue in preterm mothers with insufficient milk supply, and its transfer into milk. Br J Clin Pharmacol 2008;66:283-289

©Dr Wendy Jones MBE, MRPharmS and the Breastfeeding Network Sept 2019

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Increasing Milk Supply - use of Galactagogues - The Breastfeeding Network

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This information can also be viewed as a PDF by clicking here. The information provided is taken from various reference sources. It is provided as a guideline. No responsibility can be taken by the author or the Breastfeeding Network for the way in which the information is used.

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LINK: Skin to skin with your preterm baby

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LINK: Skin to skin with your preterm baby

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VIDEO: Effective initiation of Breast Milk-NICU

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VIDEO: Effective initiation of Breast Milk-NICU

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Informing mums - effective initiation | Medela | Maternity & NICU Care

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LINK: Receiving Donor Expressed Breast Milk

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LINK: Receiving Donor Expressed Breast Milk

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What is tube feeding?

During tube feeding, breast milk or formula is given through a tube passed into your baby's nose or mouth to their stomach. Types of tube feeding include the following:

Nasogastric tube feeding (also called an NG tube) - This is when a baby is fed through a small soft tube, which is placed in the nose and runs down the back of the throat, through the food pipe (oesophagus) and into the stomach.

Orogastric tube feeding - This is when a baby is fed through a small soft tube, which is placed in the mouth and runs down the back of the throat, through the food pipe (oesophagus) and into the stomach.

Babies who are very premature or sick may need to be fed using parenteral nutrition (PN) at first.

Why does my baby need to be fed using tube feeding?

Tube feeding is often used to feed premature and sick babies as they can be too small and sick to breastfeed or bottle feed at first. Babies born premature or sick have a low supply of energy and nutrients, so it is important that they are able to have small nutritional feeds often, without lowering their energy levels.

In babies born premature, the coordination of sucking, swallowing and breathing needed for effective feeding is usually not fully established until about 32 to 34 weeks' gestation (although this is different for different babies). Babies born at term and sick may also take longer to co-ordinate feeding. Tube feeding will help your baby receive enough nutrition to grow and develop.

Can I be involved in caring for my baby if they are being tube fed?

Yes, you can. Staff on the neonatal unit will encourage you to be as involved as possible in the care of your baby on the neonatal unit. If you feel comfortable doing so, they should show you and your partner how to give tube feeds. Staff on the neonatal unit will explain how tube feeding works and will teach you how to:

Check the tube is in the correct position before feeding

Prepare the milk and fill the syringe that is connected to the feeding tube

Position your baby correctly for tube feeds

Give the milk slowly to support comfortable digestion

Know what to look for during a feed.

This can feel quite scary at first, but with practice you should gain confidence. You will have the time to give the milk very slowly which helps your baby to digest more comfortably.

If your baby is well enough to come out of the incubator, you and your partner can also practice skin-to-skin contact with your baby while they are tube feeding. Skin-to-skin contact has lots of benefits for you and your baby, and helps parents to feel closer to their baby and more confident in caring for them.

When can my baby stop tube feeding?

In time, you may notice your baby demonstrating feeding cues during a tube feed. For example, they may open and close their mouth, put out their tongue or suck their fingers during a tube feed. This shows that they might be ready to practise breastfeeding or bottle feeding.

If you are planning to breastfeed and your baby is well enough to come out of the incubator, giving them lots of opportunities to be close to the breast may help them to learn to breastfeed. During a tube feed may be a good time to do this. When they are more mature and interested enough, some babies will start licking milk and in time practice sucking. As your baby starts to take more breast and bottle feeds, they will not need as many top-ups of milk from the feeding tube. This will depend on your baby's energy levels and their ability to coordinate sucking, swallowing and breathing.

Some parents have concerns about their baby changing from tube feeding to breastfeeding, as it is more difficult to measure how much milk their baby is having. Your baby will show signs that they are receiving enough milk, such as feeding cues and wet and dirty nappies. The healthcare team supporting you will monitor your baby's feeding and will manage any top-ups that might be needed. Talk to a member of staff on your unit if you have any concerns.

What will happen if my baby needs to go home from the neonatal unit with a feeding tube?

If your baby is going home with a feeding tube, a member of unit staff will show you how to feed and care for the tube yourself. It may be you or your community neonatal nurse who will replace the tube when you go home. This will depend on your baby's needs, your preferences, and the support the unit provides.

Support will always be available if you do not feel comfortable with replacing the tube yourself. If you have any questions or concerns, talk to the unit staff.

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Your baby may be fed using tube feeding while on the neonatal unit. Find out why this might be and information about caring for your baby while they are being tube fed.

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We rely on the generosity of our members and supporters to fund our work. Every penny we receive goes to wherever the need is greatest.

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A nipple shield is a soft protective cover that can be worn over the nipple and areola during breastfeeding. A nipple shield is shaped like a tiny Mexican hat with a high crown and a wide brim that fits against the breast. Made of thin and flexible silicone, nipple shields have a number of holes in the tip through which a baby can receive breast milk. Some breastfeeding helpers think nipple shields can be useful sometimes and others strongly disapprove of them. Are nipple shields OK to use or not?! This article looks at the situations where nipple shields may be suggested to help keep breastfeeding going, and discusses their pros and cons.

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When might a nipple shield be used?

#1 Flat nipples, short nipples or inverted nipples

When a baby feels a firm nipple against the roof of his mouth it will usually trigger even a sleepy baby's sucking reflex and help to focus a baby's latch (the way baby attaches to the breast). It follows that if a mother has quite flat or inverted nipples, her baby may find it more difficult to latch on the breast properly if he does not feel this trigger. Locating a flatter nipple may be even more difficult for a baby who is very sleepy after a stressful or medicated birth. In this situation, a well fitted nipple shield can provide that firm touch or trigger to the baby's palate to get breastfeeding going.

Seek specialist help

Given a little time, plenty of skin-to-skin, and some skilled help with latching and positioning, many babies can breastfeed with flat or even inverted nipples without a shield. Try contacting your IBCLC lactation consultant for help and support before reaching for nipple shields and see Breastfeeding With Inverted Nipples and Flat Nipples.

Avoid shields in the first few days

Jack Newman-a Canadian paediatrician and breastfeeding specialist-cautions against the practice of using nipple shields for a baby who won't latch in the first few days before a mother's milk has come in:

Using a nipple shield before the mother's milk comes in should absolutely not be done. Once the milk comes in, the baby often latches on. If the baby is on a nipple shield, the mother may delay getting help when the milk comes in because she thinks the problem is solved. It's not, and in many cases, the milk supply decreases with time.

#2 Premature babies

Arriving in the world early can present feeding challenges for premature babies, some of whom may find it difficult to latch at first. Skin-to-skin or kangaroo care can be particularly helpful for these little babies to help stabilise their body systems and prime their instinctive feeding behaviour so they can concentrate on learning to suckle. A well fitted nipple shield is a possible tool to provide a firm sucking trigger to help a premie to maintain their latch and suck . But not all premature babies will need one, seeking good skilled help may be all that you need to get breastfeeding off to a good start.

#3 Sore nipples

If breastfeeding is very painful or a mother's nipples are sore or cracked, a well fitted nipple shield can act like a glove protecting the nipples and allowing mum some pain relief until she can get some help with the latch or while her nipples heal. Used this way, shields can help to keep breastfeeding going for mother and baby. However it's important to solve the cause of the original nipple damage and not just use the shield as a quick fix. See Why Does Breastfeeding Hurt? for ideas to solve painful feeding or find a good breastfeeding helper. If your baby continues to latch on the nipple (or tip of the shield) rather than the breast, your baby may not be able to get enough milk and breastfeeding will likely still be painful. With good positioning and a corrected deep latch, breastfeeding will be more comfortable, even with a sore or damaged nipple.

#4 Nipple confusion

If your baby has got used to bottle teats and become confused about latching to a breast, or is refusing to latch at all (sometimes called a nursing strike), a nipple shield can help to transition your baby back to the breast because the shield feels, smells and tastes more like a bottle teat. How to Get Baby Back to the Breast has more ideas to help you.

#5 As a tongue exercise

Sometimes a nipple shield can be useful as a type of training exercise for a baby who isn't using his tongue properly-for example if your baby is retracting his tongue (holding it back instead of extending it to wrap around the breast). Contact your IBCLC lactation consultant to assess your baby first; babies with high palates or a tongue-tie can have a sensitive gag reflex which may be stimulated by the shield and they may need different exercises or treatment .

Why do nipple shields get a bad press?

Nipple shields can reduce the milk available to your baby

Some nipple shields (especially the earlier thicker versions) can make it much harder for your baby to get enough milk and can reduce your milk supply. After all it is an extra layer or barrier between you and your baby. And the silicone shield is not as soft and flexible as skin-so it can be more difficult for your baby to reach all the milk with a nipple shield in place. To avoid this;

Check that your baby is latching deeply on the shield with a wide open mouth and isn't just on the tip of the shield

Make sure the shield is big enough, if it is too small it can restrict the milk available to your baby

Try breast compression during a feed to help your baby get more milk

Keep a count of your baby's dirty nappies and check their weight gain regularly to make sure he is getting enough milk

If there is a problem, try hand expressing or pumping after a feed and topping your baby up with the expressed milk. This will protect your milk supply and help to keep your baby well fed. There are more ideas for making more milk in How to Make More Breast Milk.

A difficult habit to break

Once a baby has got used to using a shield it can sometimes be difficult to stop using them. To avoid the extra complications that nipple shields bring it's worth trying to get problems sorted out early by getting expert help from an experienced IBCLC lactation consultant.

Where can I get nipple shields?

Most baby stores will sell nipple shields or you can also find them online (e.g. Amazon). Different brands have slightly different shapes and usually come in several sizes. For example:

Mamivac sell conical shaped small (18mm), medium (20mm) and large (28mm) or cherry shaped small (18mm) or medium (22mm)

Ardo's Tulip shields are available as medium (20mm) and large (24mm)

Medela sell shields that are small (16mm), medium (20mm) or large (24mm)

Check reviews on nipple shield brands carefully before buying and avoid any with consistently bad reviews. Some nipple shields are poorly designed and can rub a mother's nipple, for example some even have raised ridges on the inside of the shield.

Which size or shape do I need?

It can be trial and error to find the right shape and size that works for you and your baby. A baby's individual mouth size and mother's nipple and breast size will need to be taken into account. To accommodate nipple variations, a mother may need different sizes for each breast.

Choose the largest size that works well for you and your baby

Avoid a shield that is too small which can rub your nipple and restrict milk flow, there needs to be enough room for your nipple to stretch during feeding.

Rounded nipple tip or dome shaped

Some nipple shields have more of a rounded nipple tip than popular brands Medela, Mamivac or Ardo which have a dome shape. As above, choose a style that allows enough room for your nipple to stretch during the feed, otherwise it may be uncomfortable and slow milk flow.

Larger nipples

The largest shield that I am aware of is the 28mm Mamivac shield.

Cut away shields

While some shields make a full circle shape around the nipple, others are more of a half-circle shape so that an area of silicone is cut away. Most manufacturer's recommend that this cut away area be lined up with baby's nose so they are able to smell the breast-helping their feeding instincts. However, some lactation consultants prefer to turn the shield around so that the cut away area is alongside baby's chin/lower jaw allowing some skin-to-skin contact between the tongue and breast. There is no right or wrong way if one works better than another. Some cut away styles styles may be harder to keep in place on the breast, it is worth trying different brands.

Latching with a nipple shield

A baby is latched well to the breast when they have a big mouthful of breast tissue as well as the nipple in what is often called a deep latch. The same deep latch is desirable with a nipple shield. A baby can still have a wide open mouth with plenty of breast tissue as well as the nipple inside their mouth with a nipple shield in place. See Latching Tips for general latching help.

Applying a shield

Tips for using a nipple shield include:

Warm the shield first in hot water to make it more flexible (optional)

A little breast milk, water or lanolin under the flat part or brim of the shield can help the shield stay in place on the breast and prevent chaffing

Expressing a little milk into the tip of the shield and initiating the let down before latching can encourage your baby with an instant reward of milk

Turn the shield partly inside out before placing centrally over the nipple and then smooth down the edges so that the nipple is drawn into the shield

Manufacturers recommend the cut away part of the shield should line up with baby's nose once they are latched, but some mothers find having the cut away area against the baby's chin works well

Ensure baby takes the shield deeply into their mouth so they are not just latched onto the crown (tip) of the shield

Your nipple should not be rubbed or feel sore during the feed and after feeding your nipple should not look flattened or distorted.

Step by step instructions for applying a shield can be found in Nipple Shields, by the Australian Breastfeeding Association, 2016.

Cleaning the nipple shield

Medela recommend shields be rinsed in cool water to remove breast milk, then washed in hot soapy water and rinsed well with clear water after each use. Shields can be sterilised once a day if required e.g. by boiling in water for ten minutes or follow manufacturers' individual recommendations.

Not all bad

In a Breastfeeding Today article Nancy Mohrbacher explains that modern shields are much thinner and less detrimental to breastfeeding than previous shields and when used correctly may preserve the breastfeeding relationship for short or even longer term use.

Excerpt From

New Insights on Nipple Shields, Breastfeeding Today, LLLI, Nancy Mohrbacher, 2010

A mother can feel at ease about using the shield as long as it helps the baby breastfeed more effectively. In general, as the baby matures, his coordination increases, and as he develops more practice and positive associations at the breast, the easier it will be to wean him from the shield. A baby may need the shield for one feeding, a few feedings, a few days, a few weeks, or very rarely, a few months. If the baby is unable or unwilling to breastfeed without the shield, chances are the problem that caused the baby to need the nipple shield in the first place is not yet completely resolved. A mother who wants to wean from the shield should take her cues from her baby but keep trying to offer the breast without the shield every few days.

Weaning from a nipple shield

Some babies switch happily between breast and bottle and some will switch easily from a nipple shield back to a breast. However some babies develop a preference for the familiar feel of the nipple shield. If your baby refuses to latch without the nipple shield after a period of using one, see our article Weaning From A Nipple Shield.

Summary

Nipple shields can be helpful to keep breastfeeding going sometimes. It's not the end of the world if you have to use one but it might be an early end to your milk supply if they are not used correctly. If you are wondering whether to use them, or whether your problems could be solved another way, seek out an experienced breastfeeding helper such as an IBCLC lactation consultant for help and support.

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A nipple shield is a soft protective cover that can be worn over the nipple and areola during breastfeeding. A nipple shield is shaped like a tiny Mexican hat with a high crown and a wide brim that fits against the breast.

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Positive touch is a way of communicating your love and reassurance to your baby and hearing your baby's needs in return. Babies do communicate, and by watching and listening to your baby you can learn what kind of touch to use and when it is appropriate, safe and pleasurable for your baby.

It's harder for your baby to communicate when exposed to too much noise, too much light, too much cool air, or an uncomfortable lying position. See whether the environment can be calmed down first. In time, you will get to know your baby's individual ways and you may find your baby responding more often and for longer.

Comfort holding

Comfort holding is one of many ways for you and your baby to get to know each other. Your baby may be more comfortable lying in the incubator than being held. In this case, the staff may suggest that you try comfort holding if they think your baby is well enough. Comfort holding is 'still touch'. Cradling your baby with still, resting hands can be more comforting than stroking or massage, which are more stimulating.

Comfort holding can:

soothe your baby during uncomfortable procedures.

settle a restless baby.

help your baby to get back to sleep after feeds and care.

encourage your baby to be quietly awake and responsive.

Comfort holding is a way to experience loving touch when your baby is not ready to be held.

Talk to your baby's nurse about comfort holding. Together you can watch for signs from your baby that will guide you as to when and how to do it.

Be careful to:

Remove watches and jewellery, pull your sleeves up to the elbows, and wash your hands and lower arms. This reduces the risk of infection inside the incubator.

Always make sure that your hands are warm before touching your baby.

If your baby has difficulty keeping warm, make sure there is a layer of fabric (a hat, vest or blanket) between you.

Speak to your baby before touching, so that they are aware of your presence before you start.

Cradle one or both hands around your baby's feet, head or body, and keep them still. Your baby may also like to grasp one of your fingers.

Wait and watch for signs that tell you that your baby is relaxed.

You can continue for as long as you are both comfortable. When you finish comfort holding, move your hands away from your baby very slowly.

Kangaroo Care

Kangaroo Care is skin-to-skin contact when a baby is placed against the parent's chest. Benefits include improvements with lactation and with establishing breastfeeding, and better weight gain for the baby. In the longer term, it helps parents to feel closer to their babies and more confident in caring for them. Kangaroo Care can be used with babies with high medical needs, but this will require careful planning and collaboration with the neonatal staff.

Talk to staff and plan a good time and comfortable place for you to try Kangaroo Care.

While Kangaroo Care is based on direct skin-to-skin contact, removing your baby's clothes is not vital if this is upsetting for him or her. A hat and a blanket for extra warmth might be necessary for very small babies.

Hold your baby chest-to-chest tucked inside your clothes, enclosing him/her to keep his/her temperature stable. Check that the head is well supported and if you can't see your baby easily, try using a hand mirror.

Explore what you both like to enjoy together. Some babies like to have their eyes shielded, others like to be sung to softly or while having a tube feed. Allow time for your baby to settle and get the full benefit.

If you baby is happy, you can cuddle for as long as you are both comfortable. Lie back, relax and enjoy.

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Premature and sick babies undergo many medical procedures that can cause them some discomfort. As your baby's parents, you are the best people to balance this with a positive, reassuring touch.

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When babies cannot feed at the breast comfortably and effectively, and breastfeeding support is hard to find or not able to help, mothers may choose to use a breast pump to express all the milk their baby needs, and then feed via a bottle or feeding tube. This is known as exclusive pumping. While this is often a temporary solution to protect milk supply until the baby is able to nurse directly at the breast, some mothers may find themselves exclusively pumping long term. Some mothers may also actively choose to exclusively pump and some mothers may be unable to feed their baby directly at the breast because their baby is poorly or has medical difficulties.

The decision to exclusively express breastmilk usually stems from an awareness of the irreplaceable qualities of breastmilk. Mothers also find that providing their babies with breastmilk can help with the grief from not being able to nurse directly at the breast. If their baby has medical difficulties, many mothers feel strongly that providing human milk will give their child the best possible start, particularly if their baby is in hospital. Yet, exclusive pumping is a significant undertaking which requires dedication, information and support.

You might find the decision to exclusively express feels difficult, and that you don't feel you fit with breastfeeding mothers or with those using formula. Please be sure that you will receive a warm welcome and support at LLL meetings and from your local Leader, and that we understand the lengths you're going to, to make sure your baby has your milk.

This page concentrates on the practicalities of how and when to express your milk and feed it to your baby, to establish exclusive expressing as your feeding method. Sometimes it can help to focus on all these practicalities and, once you have a workable plan, to give yourself time too to process how you're feeling about it, as you settle into life with your new baby. If you have a partner or supporter at home with you, all the things that are useful in supporting a breastfeeding mother will apply to you too!

Getting Started

If you have recently given birth and your mature milk has not yet come in, hand expressing is the most effective way of collecting colostrum to feed to your baby. It is important to start expressing colostrum within six hours (ideally after one hour, if possible) of giving birth, though if this doesn't happen for you, it is still possible to get started.

A newborn would expect to feed 8-12 times in 24 hours, and the feeds might not be evenly spread over that time, though they do need to include some feeds in the night; it is important to try to express breastmilk just as frequently in order to lay the groundwork for a robust milk supply later on. If you can have skin to skin contact with your baby while you're expressing, it can really help, and a photo or something that smells of your baby can be a substitute. You can collect your colostrum in a syringe, a small clean cup or a spoon. See our article on Hand Expression of Breastmilk for more information on hand expressing, and you might also find this video on hands-on pumping helpful. This technique can be tricky to get the hang of, so please do ask your midwife or other breastfeeding supporter to help. It's very common to need an extra pair of hands to collect the drops of colostrum.

Equipment

As your milk starts to transition, you will probably notice it start to change colour and spray out as you are expressing; this is a good time to introduce a breast pump. Although some women respond better to hand expressing, using a hospital grade double electric pump is the most effective way of removing breastmilk when a baby isn't latching or is not nursing adequately. If you are planning on exclusively expressing for your baby long term, then it will be worth investing in a hospital grade double pump. If you would like to try one before deciding whether or not to buy it, your hospital or midwife may be able to provide you with one on a short-term loan. Alternatively, you can hire a pump, although it may turn out to be rather expensive if you are exclusively expressing long term.

A breast pump usually comes with a collection set and the part that sits over your nipple/areola, which is called a flange. As women's nipples and skin elasticity differ, flanges are available in different sizes. It's important to ensure you have the right size for your nipples, as flanges that are too large or too small may cause pain or nipple damage and reduce the amount of milk you are able to express. Finding the right flange size may be a bit of a trial and error process; you may want to start by trying the standard size that comes with the pump (which varies for different pump brands) and see how you respond. If the standard flange sucks in too much areola, or if your nipple is at the back of the pump, you may need to go down a size. If, instead, you are left with a white ring around your nipple, you may need to go up a size.

Many mums find being able to express handsfree invaluable in terms of allowing them to fit regular pumping sessions into their day. There are a small variety of pumps that provide milk collection cups that sit inside your bra, freeing you up to cuddle your baby without fear of spilling your milk. However, they tend to have a limited range of flange sizes. Alternatively, you can buy special bras designed to hold your pump flanges against your breasts, or you can even DIY your own by cutting holes in a stretchy bra that line up with your nipples.

There are several other things to consider when choosing which hospital grade double pump to purchase or hire:

- How often will you use it? If you are planning to exclusively pump long term, you may need to consider motor life, to make sure the pump you purchase will live up to its use.

- How portable is it? If it uses a battery, then it can be carried around the house or out and about with you. Some pumps have built-in rechargeable batteries, while others offer the option to purchase a power pack or a car charger. Some pumps use removable batteries which are easy to replace if you unexpectedly run out of charge while away from a plug socket. However, using removable batteries may end up being rather expensive long term. You might find you end up using two different pumps - an efficient hospital grade one when you're at home and a hand pump or battery pump when you're out and about.

- Can you purchase spare collection sets? Having a spare collection set or two can come in handy, as most mothers find that it is easier to stick to their pumping schedule if their pump is set up and ready to go at a moment's notice, especially at nighttime.

Setting your schedule

For the first three-four months, you will need to express regularly to build a robust milk supply, ideally 8-12 times in 24 hours. Although you do not always need to pump at regular intervals, it is best not to go more than two to three hours between pumping sessions, with one longer stretch of four-five hours at night if you can take this break without damaging your milk supply. You will need to have at least one pumping session overnight, ideally between 2am and 5am when prolactin levels are highest. If you are able to pump when your baby wakes up for a feed, you may find it easier to do so than setting an alarm. If you need to set an alarm, but are having difficulty waking up, it may be worth experimenting with setting it for different times to try and coincide with the periods in your sleep cycle where you are in a lighter sleep. Many mothers find that they are able to express the most milk first thing in the morning, and less as the day goes on. You will notice your own patterns. It's also common for one breast to produce more milk or have a faster flow than the other side.

Working out ways to fit pumping sessions into your routine is key to long-term success. Some mothers will express while cooking, or holding a sleeping baby, or while travelling; sometimes before they feed their baby, sometimes afterwards. Experiment to find out what works best for your family and your daily rhythms.

In the early days, you may find that you are producing more milk than your baby needs; this is common and it will settle down in a few weeks. It can be useful to freeze any excess milk in small portions for later on, should your baby suddenly require more milk, such as during a growth spurt or period of illness.

Once your supply has established, usually between three and four months, you may decide to slowly reduce your number of daily pumping sessions. If you are planning to exclusively express long term, however, you may decide not to make any changes to your pumping schedule. If you start to reduce your expressing sessions, you may like to keep a record of your daily pumping outputs so that you can monitor what effect it has on your overall milk supply. You could start by increasing the intervals between your overnight pumping sessions, although it will still be important to express once at night. After doing this for about three-four weeks, you may consider dropping one daytime session. This may require you to adjust the time of all your other pumping sessions, in order to avoid leaving a big gap in between them, which could make you vulnerable to experiencing blocked ducts or mastitis.

Once your baby starts eating solids reliably, around eight-nine months, you may start to notice a change in their milk requirements and can adjust your pumping schedule and milk supply accordingly. However, many mothers find that introducing solids does not affect milk intake for a lot longer (in some cases, 18 months). When your baby is sat in a highchair, it can be a good time to express your milk without them pulling on the pump tubes.

How long is an expressing session?

The length of each expressing session will vary for each mother, based on her breast storage capacity and the type of pump she uses. If you are able to express milk from both breasts at once, then you will find it much faster.

While some experts recommend pumping for about 15-20 minutes, others believe that specifying the duration of a pumping session may not be helpful, as some mothers may take up to 45 minutes. In her book Exclusively Pumping Breastmilk, Stephanie Casemore suggests spending two hours over the course of 24 hours expressing. However, this total pumping time may need to be adjusted for mothers who need long individual expressing sessions. Also, other experts believe the total number of separate sessions to be more important than total pumping duration, with shorter, more frequent expressing sessions usually being more effective than fewer, longer sessions.

As a general rule of thumb, you can express until your milk stops spraying, and then for an additional five minutes to stimulate another let-down. If you need to increase your supply, you can pump for 10 more minutes and use hand expression right after to remove as much milk as possible. Breast compressions and massage during sessions ( hands-on pumping) also help to stimulate let-downs and maximise milk output. Some mothers find that it helps to experiment with "power pumping", where they pump frequently for short periods, to mimic cluster feeding. This might be something to use on occasion rather than as part of a daily routine as it can be quite time-intensive.

If, on the other hand, you need to decrease your supply, then slowly reduce the length of time you are expressing for. In both cases, many of the techniques discussed in our articles " My baby needs more milk" and " Too Much Milk and Oversupply " can be adapted for use with a breast pump.

If you are worried that you do not have enough time to do a full session, then it is better to pump less time and have a longer session later, than to miss one entirely.

Over time, as you reduce the number of pumping sessions, you may find that you will need to express for longer to obtain the same amount of milk. Many women find that if they cycle through their pump settings again, they can trigger a second or even a third let-down over a period of 30-45 minutes.

The importance of Oxytocin

Oxytocin is the hormone that triggers your letdown (milk ejection reflex). It is especially important to be mindful of this when expressing, as even mildly stressful situations of feeling rushed can make it difficult to trigger a letdown when using a breast pump. Many mothers find looking at their baby - or at pictures of their baby if they are separated - while expressing helpful. Gently massaging your breasts before and during your pumping session, as well as applying warm compresses or taking a warm shower before expressing can also trigger a let-down. Other ways to boost your oxytocin might include listening to music, watching a comedy on TV, reading a book, or browsing social media on your phone.

If you are able to cuddle your baby while expressing, you may see an increase in your normal milk output! It is even possible to express while carrying your baby in a sling or baby carrier. As your baby gets older and more mobile, you may find it easier to remove yourself to a different room where you can relax without worrying about them pulling on your tubes, or getting into things they shouldn't.

It can feel disheartening if you are watching your collection bottles and feel that they are not filling up quickly enough. Covering the bottles with socks, or distracting yourself so that you are not watching, can be helpful. If you are struggling to get a let-down, it is ok to put your pump away and come back to it 10-20 minutes later and try again. If it is a persistent problem at certain times of day, try to remember that the stimulation you are giving your breast still has a valuable purpose.

How to pump

In order to keep pumping comfortable and avoid nipple damage, you may want to consider using lubrication, such as lanolin or olive oil, inside the pump flange to reduce friction. The flange needs to make a comfortable seal around the breast.

Pumps have different suction and cycles settings. You may want to start with a low suction and high number of cycles to stimulate your let-down. Once your milk starts flowing, you can decrease the number of cycles and increase suction. In order to avoid getting sore, it is a good idea not to use the same suction setting for long periods of time. Switching between low and high suction also helps to trigger more let-downs.

Once you are done pumping, you can massage both breasts and hand express to make sure your breasts are completely drained.

How much milk to pump

As breastmilk is highly digestible, breastfed babies tend to feed little and often. When babies nurse directly at the breast, milk intake varies from feeding to feeding, so the amount of breastmilk taken per bottle may also vary throughout the day. On average, babies need 750-1035ml of breastmilk per day between one and six months of age. You may want to pump slightly more than this to make sure you have enough milk when your baby goes through a grow spurt.

Feeding your breastmilk

Babies drink from a bottle and nurse from the breast in a completely different way. When drinking from a bottle, babies cannot control the flow of milk, which can be uncomfortable for them and can lead to overfeeding. In order to minimise this problem, you may want to feed your baby your expressed milk in a way that is as close as possible to nursing. This is often referred to as paced bottle feeding.

Rather than feeding your baby bottles of expressed milk according to a strict schedule, you may want to feed on demand, as you would if they were nursing at the breast, being aware of early hunger cues. Holding your baby upright and keeping the bottle in a horizontal position allows the baby to suck actively, as he would at the breast, and to control the flow of milk, taking a break whenever he needs to. Offering the bottle teat gently, letting the baby draw it into their mouth, and feeding to satiation also allow the baby to be more in control of his feed. You can find more information on how to feed your baby your expressed milk in our article ' Bottles and other tools '.

It's important to remember that breastmilk should not be warmed up in a microwave or in a pan on the hob, in order to avoid damaging its nutrients. Shaking breastmilk is also not necessary.

Storing your breastmilk

Breastmilk's antibacterial properties help it stay fresh, so it can be safely stored at room temperature for four-six hours and in the fridge for up to a week. If away from home, you could use a cool bag with ice packs. Our page Storing Your Milk has comprehensive details on safe periods for storing expressed milk for healthy babies. If your baby is unwell or premature, then follow hospital guidelines. Your baby will benefit more from fresh than frozen breastmilk because its living properties will help him fight off possible infections, however all human milk is beneficial for you baby.

You may well see that your expressed milk is not always the same colour, and that it separates into layers when it has been stored for a while. Neither of these is a cause for concern, and a gentle swirl of the container before you feed your milk to your baby should make the layers mix again.

If you find that you are producing more milk than your baby needs, you might like to consider donating your milk by registering as a donor for your local breastmilk bank.

Stopping exclusively pumping

When you feel ready to stop expressing milk for your baby, it's important not to rush into dropping pumping sessions, in order to avoid the risk of experiencing blocked ducts or mastitis. Your breasts need time to adjust, so it's best to adopt a gradual approach. You could try to reduce the length of your pumping sessions by a few minutes over a few weeks, or you could try slowly increasing the intervals between sessions.

Exclusive pumping, while also doing the day to day work of looking after your baby, can be exhausting, and sometimes mothers and parents wrestle with feeling guilty about having stopped "too soon". By taking on the work of exclusive pumping, though, you gave your baby a wonderful gift.

Written by Nicola Sheldon (LLL Berkshire and Oxfordshire) and Eva Williams (LLL Oxfordshire), May 2020.
Thanks to Harriet Valentino for her input and to Lois Rowlands, Rae Vacher Lowe and Laura Loasby for the photos.

Further reading

https://www.laleche.org.uk/hand-expression-of-breastmilk/
https://www.laleche.org.uk/my-baby-needs-more-milk/
https://www.laleche.org.uk/too-much-milk-and-oversupply/
https://www.laleche.org.uk/bottles-and-other-tools/
https://www.laleche.org.uk/expressing-your-milk/#Pumps
https://www.laleche.org.uk/storing-your-milk/
A mother's story from our members magazine breastfeeding matters
https://kellymom.com/category/bf/pumpingmoms/pumping/
Exclusively Pumping Breastmilk, Second edition. Casemore, S. Gray Lion Publishing, 2014

i Exclusively Pumping Breastmilk. Second edition. Casemore, S. Gray Lion Publishing, 2014

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Exclusively Expressing Breastmilk for Your Baby - La Leche League GB

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When babies cannot feed at the breast comfortably and effectively, and breastfeeding support is hard to find or not able to help, mothers may choose to use a breast pump to express all the milk their baby needs, and then feed via a bottle or feeding tube. This is known as exclusive pumping.

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 LINK: Breast feeding feeding your premature baby

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 LINK: Breast feeding feeding your premature baby

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Breastfeeding has lots of benefits for you and your baby. As well as the health benefits of breast milk for your baby, breastfeeding is a good way to have skin-to-skin contact with your baby, which can help you and your baby to get to know each other.

Your baby may not be ready to breastfeed as soon as they are born. They may not be well enough or strong enough to breastfeed. Some babies who are born at term and sick may find it more difficult to breastfeed because of surgery or difficulties swallowing. Some babies with breathing or heart problems may also have difficulties coordinating breathing and feeding.

If your baby is very premature or sick, they may have to be fed using parenteral nutrition (PN) and/or tube feeding before they are well enough to breastfeed. We have more information about the signs a baby being tube fed may show if they are ready for breast or bottle feeding.

You can still provide breast milk for your baby if they are unable to breastfeed by using a technique called expressing. We have more information about expressing.

Sometimes premature babies need more nutrients than you can provide in your breast milk. If this is the case, your baby's doctor may prescribe a breast milk fortifier (which is usually a powder made from cow's milk) which can be added to breast milk. This can help with growth and bone development.

Some parents may feed their baby through a combination of breastfeeding and bottle feeding. This is often known as mixed or combination feeding. It is recommended that your baby, if possible, establishes breastfeeding before introducing another type of feeding. Combination feeding may be used if there are problems with breastfeeding, such as there not being enough breastmilk, or for other reasons. If you are thinking about mixed or combination feeding, talk to your neonatal team, feeding specialist, midwife, health visitor or GP.

Staff on the neonatal unit may recommend that your baby is fed your breast milk using cup feeding. They might suggest this if your baby is looking to feed but cannot latch onto the breast or is separated from the mother for any reason. If you are unsure, speak to the staff on the neonatal unit.

If you decide not to breastfeed your baby, it is very important that you are given information about the other options that are available. Your baby can still get many benefits of breastmilk if you express. Talk to your midwife, neonatal nurse or health visitor about how you are feeling and how they can support you.

The let-down reflex

Each time you breastfeed your baby, you may notice tingling or prickling in your breasts and nipples, or a feeling as if the milk is rushing in to fill them. This is called the let-down reflex (it is sometimes called the milk ejection reflex). During the let-down reflex, a hormone called oxytocin is released, which helps with milk flow. At first, this takes a few minutes to be released, but later it will happen within a few seconds.

The let-down reflex feels different to different women. Some women describe a slight pain and some have no sensations at all. Your body may respond to certain things you do, which can trigger your let-down reflex. For example, it is normal for the let-down reflex to happen in response to having a warm bath or shower, or to breast massage. It can also happen in response to being close to your baby, hearing your baby cry or having a picture or something close by that smells of them.

Staying as relaxed as possible and having skin-to-skin contact with your baby can all help to trigger the let-down reflex. Taking some deep breaths and concentrating on your breathing can also help.

How do I start to breastfeed my baby?

You may not know where to start with breastfeeding your baby, especially if your baby has previously been tube fed. A nurse, midwife or feeding specialist (such as an infant feeding coordinator) on the neonatal unit will be able to support you.

Both parents can be involved in breastfeeding, and other people close to you can also provide encouragement and support, such as grandparents. Having as much support as possible can help ensure that you continue to breastfeed when you go home from the neonatal unit. It might be helpful to talk about how you are going to approach breastfeeding with your partner, and how they can best support you. The NHS website has more information about how dads and partners can support breastfeeding, and signposts to more support that is available.

It is important to recognise the signs that your baby is hungry (feeding cues) before breastfeeding. Early feeding cues might include putting their fingers into their mouth, making sucking motions (rooting) and becoming restless.

What breastfeeding positions should I try?

When you are on the neonatal unit, a healthcare professional such as a neonatal nurse or midwife should support you to try to breastfeed your baby. They will help you to find feeding positions that are most comfortable for you. There are positions that may be more suitable for mothers who have had surgery, or whose baby was born premature or sick. Unit staff may recommend that you use pillows to support your arms or back.

If you have twins or multiples, you may also need more support with pillows when feeding, so that you are more comfortable and your babies are supported. Some mothers benefit from a hard pillow that ties at the back or a sling. It can be daunting at first to hold multiple babies at once, but staff in the neonatal unit will help with this. Twins Trust have some more information about breastfeeding multiples that you may find useful.

I am having difficulties getting my baby to breastfeed and latch on. Why is this?

As with all newborn babies, some find breastfeeding easier than others. This can depend on factors such as your baby's age, maturity and any medical conditions they have. It is normal for babies who are born premature or sick to take slightly longer to establish breastfeeding than babies born at term. Every baby is different, and it is important to ask for help and support, especially when you start.

There are some common problems that parents experience when starting breastfeeding. Some babies born premature can be too sleepy to feed effectively, and it can be difficult to get the right position for feeding when your baby is so small. We have a page that lists common problems you may have when breastfeeding or expressing milk for your baby and what can help.

For some mothers, it can take a while to gain confidence in breastfeeding. This is normal, even if you have breastfed before. Having a baby born premature or sick is a unique experience and it is okay to find things difficult at times. Having plenty of support around you can help you build up confidence. We have more information about support you can get with breastfeeding below.

Where can I get help and support with breastfeeding?

Many parents find breastfeeding a rewarding, empowering experience. But establishing breastfeeding can be challenging at times. It can be tiring, especially when you are travelling to and from the unit, and some mothers experience discomfort when they are starting to breastfeed. There are many places where you can get help and support.

Most parents find that having lots of support helps them to get started and to continue to breastfeed. Support can come from your partner, family and friends, and from medical professionals on the unit and at home.

Support on the unit could come from your unit's feeding specialist, a neonatal nurse, or your midwife. Some neonatal units also have a lactation consultant or feeding specialist, who are trained to help parents who are having problems with breastfeeding and expressing.

If you are at home, support with breastfeeding could come from your health visitor, a community neonatal nurse, if you have one, or your GP. You can talk to your health visitor for more information about any breastfeeding support groups in your area. It is always important to speak up and ask if you need more help and support, or if you have questions.

There are also helplines and organisations that can help:

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Find more information about breastfeeding your premature or sick baby here, including how to get started and how to find support.

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Expressing milk can take time to learn. Find out how to express in neonatal care and how to look after yourself while expressing.

Expressing means collecting breast milk which you can store and feed to your baby later. You can express milk by hand or with a breast pump, which can be electric or manual.

Expressing can be helpful:

If your baby is not well enough or strong enough to feed from the breast straight away

So that both partners or others are able to share feeding

If you are too sick to feed your baby from the breast

If you cannot be near your baby and want to establish a good milk supply

If your baby has difficulty latching on to the breast, but you still want to give them your breast milk.

If your baby is not able to breastfeed straight away, the staff at the hospital will help you to express (collect) your breast milk as soon as possible after your baby is born. This means that your baby will still get the benefits of breast milk until they are ready to feed from the breast or bottle, as it can be given to them by a feeding tube.
It is important to express in the way that is most comfortable and convenient for you.
A small amount of milk is produced in the first few days after a baby is born. This milk is called colostrum, and is often thicker and more yellow in colour than breastmilk. Colostrum is really important for your baby. It helps to boost your baby's immune system, protect them from infections and helps them grow.

Some parents are worried that they are not producing enough milk in these first few days. This is normal - most parents start by expressing less than 1ml of milk at a time. This will increase gradually the more times you express. Around two to four days after giving birth, you will notice your milk becoming more white and your breasts might feel fuller. This is often referred to as your milk 'coming in'.

Later on, the amount of milk you express may change depending on the time of day and how you feel.

After expressing your milk, the milk can be kept in the fridge or be frozen and stored until your baby is ready to have feeds. We have some more information about how to store breast milk at the bottom of this page.

Your milk is best suited to your baby's needs, but sometimes premature or sick babies need more nutrients than are provided in breastmilk alone. If this is the case for your baby, your baby's doctor may prescribe a preterm fortifier (which is usually a powder made from cow's milk) to go in your milk. This will provide more nutrients that will help with your baby's growth and bone health.

Many parents tell us that expressing can feel like a big pressure. It is important not to be too hard on yourself if you are not able to express a lot of milk in the early stages. No matter how much or how little you can express, your baby will benefit.

Many parents find comfort in expressing as it is something positive and important they can do for their baby. Try not to compare the amount you are expressing with others, as they may have faced different challenges or situations to you.

Expressing breast milk can also take time to learn. The staff looking after your baby will give you support and practical help with this. Speak to your neonatal nurse, feeding specialist or midwife for more support.

In this section, we have more specific information about:

If you have any questions about expressing or are not sure what to do, you should always ask questions or seek more support. Most units will provide specific support with expressing, and your neonatal nurse will be happy to help with any questions that you have.

How often should I be expressing milk for my baby?

It is important to start expressing milk as soon as possible after your baby is born - ideally within two hours. It is recommended you express frequently to keep your milk supply up. To begin with, this is around eight to ten times in 24 hours, including at least once at night. This is because breast milk is produced on a demand and supply system, so you are likely to produce less milk overall if long periods of time are left between expressing.

In time you will find what works best for you. You may find that your milk flow responds to a fixed routine and will trigger a let-down reflex (see below), which will make it easier to express. This might include actions when you prepare to express, such as removing equipment from the steriliser, or putting the pump together.

The let-down reflex

When you express milk, you may notice tingling or prickling in your breasts and nipples, or a feeling as if the milk is rushing in to fill them. This is called the let-down reflex (it is sometimes called the milk ejection reflex). During the let-down reflex, a hormone called oxytocin is released, which helps with milk flow. This takes a few minutes to appear at first, but later it will happen in a few seconds.

The let-down reflex feels different to different women. Some mothers describe a slight pain and some mothers have no sensations at all. Your body may respond to certain things you do, which can trigger your let-down reflex. For example, it is normal for the let-down reflex to happen in response to having a warm bath or shower, or to breast massage (see below). It can also happen in response to being close to your baby, hearing your baby cry or having a picture or something close by that smells of them.

Staying as relaxed as possible and having skin-to-skin contact with your baby can all help to trigger the let-down reflex. Taking some deep breaths and concentrating on your breathing can help with this. It will also help to express at your baby's cotside if this is possible, so you can be close to your baby. Speak to the staff looking after your baby about this.

Gentle breast massage

Breast massage before expressing can help to trigger the let-down reflex and stimulate your milk flow. You can do this by gently stroking, rolling, kneading, and tapping your breasts with warm hands before hand expressing and/or using a breast pump. You should do this for at least two minutes. Breast massage during expressing can help to drain your breasts.

Looking after yourself when expressing

Expressing milk for your baby can be a great way for parents to feel more empowered and in control of their baby's care. Many mothers also tell us how difficult and exhausting it can be to express, especially at night. This can be a particularly difficult experience if their baby is not with them.

It can be a very stressful time, but it is important that you try to stay as relaxed as possible when expressing, as this helps with the let-down reflex and milk flow. Some research has shown that higher stress levels may contribute to the delay of milk production. Some parents find that having a photograph or something that smells of their baby nearby when expressing helps. It may also help to distract yourself by doing something like reading a book or watching TV when you express. Listening to soothing music, meditation or taking time to focus on your breathing may also help you to relax.

Partners can help with expressing. For example, they can offer encouragement, help you to relax, or get equipment ready.

It is not unusual to find feeding your baby a difficult experience. In our survey of over 100 parents, over 60% said that their mental health got slightly or significantly worse during the experience of feeding their premature or sick baby. It is okay to find the experience difficult, no matter your situation. Every parent will have a very different experience of neonatal care.

It is important to talk to someone if feeding your baby is having an impact on your mental health. This could come from your feeding specialist, neonatal nurse, midwife, doctor, partner, or friends and family. We have lots of information about the impact having a premature or sick baby can have on your mental health, and where you can get support.

How to store expressed milk safely

You can store milk if your baby is unable to drink it at the time it is expressed. It is very important that expressed milk is stored safely. This is something that partners can be involved with. On the neonatal unit, breast milk is stored in fridges and freezers that only store infant milk.

Many units supply sterile disposable bottles and labels for you to use. You should label each container with your baby's name, the date and time of collection.

If you will be using your breast milk within 48 hours of expressing, you should refrigerate it. If you are at home, breast milk that has recently been expressed will keep in a refrigerator for 48 hours (24 hours if it is defrosted). The breast milk should be stored at the back of the fridge and not in the fridge door. This is because the temperature in the door compartments goes up and down when the fridge is opened and closed.

If you will not be using your breast milk within 48 hours of expressing, it should be frozen. Milk can be frozen for up to 6 months in a home freezer. If you are freezing your milk, always leave at least one centimetre of free space at the top of the milk container. This is because milk will expand when frozen.

If you are on the neonatal unit, ask the unit staff about the best way to safely refrigerate and freeze milk. Different units may have different guidelines.

Once your milk is defrosted, it will need to be used within 24 hours. Try to use small containers to freeze your milk so that no milk is wasted. Defrosted milk may have a slightly soapy or sour smell, but this will not be harmful to your baby.

Fortified b reast milk that has been supplemented with addi tives should be used with the following one to two feeds. It is not suitable f or freezing and defrosting.

Talk to the hospital staff looking after your baby for more guidance on storing and defrosting breast milk.

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Expressing milk can take time to learn. Find out how to express in neonatal care and how to look after yourself while expressing. Expressing means collecting breast milk which you can store and feed to your baby later. You can express milk by hand or with a breast pump, which can be electric or manual.

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