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how to establish a good milk supply

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The fourth film from the Small Wonders DVD shows how mothers can express breast milk for their baby within a few hours of giving birth (if at all possible mothers should express milk within the first 6 hours after giving birth). Starting to express breast milk early and expressing milk often will help your body produce plenty of milk for the weeks and months to come.

The Small Wonders DVD was created by child health charity Best Beginnings to support families on the journey with their sick and premature baby. The Small Wonders DVD, with all 12 films on, is available for free for families and staff in neonatal units in England thanks to funding from the Department of Health. It will soon be available in neonatal units in Scotland and Northern Ireland thanks to funding from these nations.

If you are not in a neonatal unit where the Small Wonders DVD is given out, you can purchase a copy of the DVD at bestbeginnings.org.uk/Shop/small-wonders-dvd

We would really value your feedback on the Small Wonders films at smallwonders@bestbeginnings.org.uk

Next film:
sw5.bestbeginnings.org.uk/

Previous film:
sw3.bestbeginnings.org.uk/

04-2-Establishing a good milk supply

The fourth film from the Small Wonders DVD shows how mothers can express breast milk for their baby within a few hours of giving birth (if at all possible mothers should express milk within the first 6 hours after giving birth). Starting to express breast milk early and expressing milk often will help your body produce plenty of milk for the weeks and months to come.

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Small Wonders Film 4 - 04-2-Establishing a good milk supply

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The fourth film from the Small Wonders DVD shows how mothers can express breast milk for their baby within a few hours of giving birth (if at all possible mothers should express milk within the first 6 hours after giving birth).

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When should I feed my baby?

As a rough guide, babies need to feed at least eight to 12 times (sometimes more) over 24 hours during the first few weeks (NHS, 2019a; UNICEF, 2010). That means they'll probably need to feed every two to three hours.

Watch our video for tips on how often and how long to breastfeed your baby for.

It's best to feed babies responsively or in a baby-led way rather than sticking to a feeding schedule (WHO, 2009; Entwistle, 2013; Fallon et al, 2016). Letting your baby feed when they want will help them get the milk they need. It will also stimulate your milk supply (Infant and Young Child Feeding, 2009).

What if I'm struggling or worried about the number of feeds?

We know from the experiences of new mums that breastfeeding responsively can feel emotionally and physically challenging (Fallon et al, 2016).

A baby that breastfeeds frequently can give parents a sense of reassurance but it can also cause worry. Some people may think frequent feeding is a sign of insufficient milk, or that baby isn't getting enough breastmilk during feeds. This sometimes leads to women supplementing feeds with formula milk or deciding to stop breastfeeding (Leurer, 2015).

Try and keep in mind that a newborn baby's stomach is really small. They need to feed little and often (NHS, 2020). It's really common for babies to have a good feed and then appear to be hungry again quite quickly. This doesn't mean something is wrong or that they're not getting enough milk. It's just the way newborn babies feed (Kent et al, 2012).

All of this also means that newborn feeding is frequent. In fact, much of the time, it's not really a question of clearly-defined 'feeds' with clear beginnings and endings (WHO 1998).

Your baby knows your voice, your smell and your taste but they are much less familiar with the 'world' outside your womb. Staying close to you gives them a vital sense of safety and reassurance. This builds their confidence that they are loved and cared for (Crenshaw, 2007).

If you're worried, it can really help to talk through your concerns with a breastfeeding counsellor. So call our Infant Feeding Support line on 0300 330 0700.

Will I produce enough milk?

The more you breastfeed your baby, the more milk you will produce (Daly & Hartmann, 1995). If your baby is attached properly, and you're both comfortable and feeding them when they ask for it, you will make enough milk for them (Kent et al, 2012; WHO 2019).

How do I know when to feed my baby?

When your baby is hungry they may give you little signals, known as early feeding cues (NHS, 2019a,b). They might:

* get restless

* suck their fist or fingers

* make murmuring sounds

* turn their head and open their mouth (rooting).

Looking out for and responding to these cues is important. It can help prevent your baby from becoming upset and frustrated, which will make it more difficult to feed them (WHO, 2009). Here's what you might see...

How long should each feed last?

Every baby is different and they will go through different patterns of feeding as they grow (Kent et al, 2012). How much milk a baby needs per breastfeeding session will vary. It's best to be guided by your child (Kent et al, 2012).

Some feeds will seem to last a long time, with your baby dozing for short periods before wanting more. And more. And still more! It's normal for a young baby to be on the breast many times a day and night. 12-15 'visits' to the breast is well within a normal range (Entwistle, 2013).

As a general rule, babies who are feeding well will feed for between five and 40 minutes at each feed (UNICEF, 2010). Your baby will let you know when they've had enough milk. They will usually come off the breast themselves, look sleepy or calm, and look around (UNICEF, 2010).

During each breastfeed, your milk changes slightly. So the milk at the end of the feed is more creamy and filling than the milk at the beginning of the feed (Ballard and Morrow, 2013). Offer one breast and let your baby feed until they stop drinking. If they still appear hungry, offer the second breast - allowing them to drink as much as they want (NICE, 2015).

Should I wake my baby up to feed?

In most cases, healthy, thriving newborns will wake up for feeds and, provided they are well latched on, get all the milk they need (Australian Breastfeeding Association, 2017). But there might be reasons why a newborn might be more sleepy and therefore need to be woken up for feeds.

This includes medical reasons, such as jaundice, infection or a heart problem, or perhaps because the pain relief used during birth is still affecting them (Australian Breastfeeding Association, 2017). If you're worried your baby might be sleeping too much and this is affecting their feeding, talk to your health visitor or call our Infant Feeding Support line on 0300 330 0700.
This page was last reviewed in March 2021
Further information

We support all parents, however they feed their child. If you have questions, concerns or need support, you can speak to a breastfeeding counsellor by calling our helpline on 0300 330 0700, whether you are exclusively breastfeeding or using formula milk. Breastfeeding counsellors have had extensive training, will listen without judging or criticising and will offer relevant information and suggestions. You can also find more useful articles here.

National Breastfeeding Line (government funded): 0300 100 0212.

Australian Breastfeeding Association. (2017) Do I need to wake my baby for feeds? Available at: https://www.breastfeeding.asn.au/bfinfo/do-i-need-wake-my-baby-feeds [Accessed 20 March 2021].

Ballard O, Morrow AL. (2013) Human milk composition: nutrients and bioactive factors. Pediatric Clinics of North America. 60(1):49-74. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3586783/ [Accessed 20 March 2021].

Crenshaw J. Care practice #6: No separation of mother and baby, with unlimited opportunities for breastfeeding. Journal of Perinatal Education2007;16(3):39-43. Available at: doi:  10.1624/105812407X217147 (Accessed 26 Apr 21)

Daly SEJ, Hartmann PE (1995). Infant Demand and Milk Supply. Part 1: Infant Demand and Milk Production in Lactating Women. Journal of Human Lactation. 11(1):21-26. doi:10.1177/089033449501100119 Available at https://journals.sagepub.com/doi/10.1177/089033449501100119 [Accessed 13 April 2021]

Entwistle FM. (2013) The evidence and rationale for the UNICEF UK Baby Friendly Initiative standards. UNICEF UK. Available at: https://www.unicef.org.uk/babyfriendly/about/evidence-and-rationale-for-the-baby-friendly-standards/ [Accessed 20 March 2021].

Fallon A, Van der Putten D, Dring C, Moylett EH, Fealy G, Devane D. (2016) Baby-led compared with scheduled (or mixed) breastfeeding for successful breastfeeding. Cochrane Database of Systematic Reviews. (9):CD009067. Available at: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD009067.pub3/full [Accessed 20 March 2021].

Kent JC, Prime DK, Garbin CP. (2012) Principles for maintaining or increasing breast milk production. Journal of Obstetric, Gynecologic, and Neonatal Nursing. 41(1):114-121. Available at: https://onlinelibrary.wiley.com/doi/full/10.1111/j.1552-6909.2011.01313.x [Accessed 20 March 2021].

Leurer MD, Misskey E. (2015) "Be positive as well as realistic": a qualitative description analysis of information gaps experienced by breastfeeding mothers. International Breastfeeding Journal. 10(10):2-11. Available at: https://internationalbreastfeedingjournal.biomedcentral.com/articles/10.1186/s13006-015-0036-7 [Accessed 20th March 2021].

NHS. (2019a) Breastfeeding: the first few days. Available at: http://www.nhs.uk/Conditions/pregnancy-and-baby/Pages/breastfeeding-first-days.aspx#building [Accessed 20 March 2021].

NHS. (2019b) Breastfeeding: is my baby getting enough milk? Available at: http://www.nhs.uk/Conditions/pregnancy-and-baby/Pages/breastfeeding-is-baby-getting-enough-milk.aspx [Accessed 20 March 2021].

NHS. (2020) Your breastfeeding questions answered. Available at: http://www.nhs.uk/Conditions/pregnancy-and-baby/Pages/your-breastfeeding-questions.aspx [Accessed 20 March 2021].

NICE (2015) Postnatal care up to 8 weeks after birth. CG37. Available at: https://www.nice.org.uk/guidance/cg37 [Accessed 20 March 2021].

UNICEF. (2010) Baby Friendly Initiative. Breastfeeding checklist for mothers - How can I tell that breastfeeding is going well? Available at: https://www.unicef.org.uk/babyfriendly/wp-content/uploads/sites/2/2016/10/mothers_breastfeeding_checklist.pdf [Accessed 20 March 2021].

World Health Organization. (1998) Evidence for the Ten Steps to Successful Breastfeeding. Geneva: World Health Organization.

World Health Organization. (2009) Session 2 The physiological basis of breastfeeding. In: Infant and Young Child Feeding. Model Chapter for Textbooks for Medical Students and Allied Health Professionals. Available at: https://www.ncbi.nlm.nih.gov/books/NBK148970/ [Accessed 20th March 2021].
Further reading
Hoddinott P, Craig, LCA, Britten J, McInnes RJ. (2012) A serial qualitative interview study of infant feeding experiences: idealism meets realism. BMJ Open 2:1-14. Available at: https://bmjopen.bmj.com/content/2/2/e000504 [Accessed 20 March 2021].

Martin CR, Ling PR, Blackburn GL. (2016) Review of infant feeding: key features of breast milk and infant formula. Nutrients, 8(5):279. Available at:   https://www.mdpi.com/2072-6643/8/5/279 [Accessed 20th March 2021].

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How often should I breastfeed my baby? | Baby & toddler, Feeding articles & support | NCT

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Read our tips on when to breastfeed your baby and how much milk they need.

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For healthy babies born at term the current recommended practice is to introduce solids foods from six months of age. Parents should not be encouraged, or feel pressured, to introduce solids before this time. In some cases premature, low birth weight or sick babies may need specialised feeding before this age.

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19 Nov 2015. InZwang - Bevallen presentation. More details (pdf)

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Why breastfeed? Benefits of breastfeeding | NCT

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Why breastfeed? Benefits of breastfeeding | NCT

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1. You know when a friend makes you a cup of coffee exactly how you like it? Breast milk is like that for your baby. It changes over time to make sure it's just right (Victora et al, 2016; NHS, 2017).

2. Breast milk can help to reduce the risk of your baby getting infections and diseases by breastfeeding (NHS, 2017).

3. Breastfeeding can be really handy and you can do it anywhere (NHS, 2017).

4. Breastfeeding is a way of bonding with your baby - giving you time together (NHS, 2017).

5. Breastmilk fact: breast milk is a bioactive fluid (Martin et al, 2016). It contains proteins, fats, vitamins and minerals plus antibodies to fight germs. It also contains hormones that help your baby's development (Victora et al, 2016).

6. If you can breastfeed your baby, they have a lower risk of ear, respiratory and gastro-intestinal infections and diarrhoea (Victora et al, 2016; Bowatte et al, 2015). Meaning a healthier baby and fewer trips to the hospital for you both (NHS, 2017).

7. Breastfeeding reduces the risk of sudden infant death syndrome (Victora et al, 2016).

8. Premature babies who can drink their mum's breastmilk have a lower risk of necrotising enterocolitis (Colaizy et al, 2016; NHS 2016), a potentially dangerous bowel disorder.

9. It's not all about the baby: breastfeeding reduces your risk of obesity and of type 2 diabetes (Horta et al, 2015; Victora et al, 2016).

10. Major plus: fewer children who had breastmilk as babies develop childhood leukemia.

11. Random one but babies who receive breastmilk have a lower risk of dental malocclusions. This is where the upper teeth bite over the lower ones (and in some cases the jaw too), it can cause tooth decay (Victora et al, 2016).

12. Breastfeeding may reduce the risk of childhood asthma and allergic rhinitis, an inflammation inside the nose caused by allergens (Lodge et al, 2015).

13. Breastfeeding could help your baby enjoy more foods. The flavour of breastmilk changes, while formula remains constant so by the time it comes to weaning, your baby could be more used to different flavours.

14. When your six month plus baby is ill, they might be comforted by a breastfeed, which then means they'll probably recover more quickly.

15. You can battle food allergies with breastfeeding. Continuing to breastfeed your baby after they've started solids may protect them from being allergic to certain foods (Baby Centre 2017).

16. If your baby gets a cold, you'll then get the cold virus from them but your immune system will make antibodies to fight the virus. Then through your milk, those antibodies will help your baby fight the infection themselves (Baby Centre 2017).

17. Breastfeeding is free. Let's not underestimate the importance of this one.

18. Breastmilk contains long-chain polyunsaturated fatty acids. They help your baby's all-important brain to develop (Baby Centre 2017).

19. Your own risk of ovarian or breast cancer reduces if you can breastfeed your baby (Victora et al, 2016; NHS, 2017).

20. While there's no evidence breastfeeding will help you shed weight anywhere else, it will help your uterus return to its normal size.

21. Breastfeeding reduces the risk of your baby wheezing and developing severe eczema (Baby Centre 2017).

22. Mums who can breastfeed won't see the return of their periods quite so soon. This can be handy as it may assist with birth spacing (Victora et al, 2016).

23. With no packaging or plastic, breastfeeding doesn't have an impact on the environment (Kent, 2015).

Further information

NCT supports all parents, however they feed their baby. If you have questions, concerns or need support, you can speak to a breastfeeding counsellor by calling our support line on 0300 330 0700, whether you are exclusively breastfeeding or using formula milk. Breastfeeding counsellors have had extensive training, will listen without judging or criticising and will offer relevant information and suggestions. You can also find more useful articles here.

Our support line offers practical and emotional support in many areas of pregnancy, birth and early parenthood: 0300 330 0700.

You might find attending one of our groups helpful as they give you the opportunity to explore different approaches to important parenting issues with a qualified group leader and other new parents in your area.

Make friends with other parents-to-be and new parents in your local area for support and friendship by seeing what NCT activities are happening nearby.

National Breastfeeding Line (government funded): 0300 100 021.

Bowatte, G. et al (2015). Breastfeeding and childhood acute otitis media: a systematic review and meta-analysis. Acta Paediatrica, Special Issue: Impact of Breastfeeding on Maternal and Child Health. Volume 104, Issue Supplement S467, pages 85-95

Chowdhury, R. et al (2015). Breastfeeding and maternal health outcomes: a systematic review and meta-analysis. Acta Paediatrica, Special Issue: Impact of Breastfeeding on Maternal and Child Health. Volume 104, Issue Supplement S467, pages 96-113.

Colaizy, T, et al (2016), Impact of optimised breastfeeding on the costs of necrotizing enterocolitis in extremely low birthweight infants, Journal of Pediatrics, doi: 10.1016/j.jpeds.2016.03.040

GOSH (Great Ormond Street Hospital for Children NHS Foundation Trust) (2016) Necrotising enterocolitis. Available at: https://www.gosh.nhs.uk/medical-information/search-medical-conditions/necrotising-enterocolitis

Horta, B.L. et al (2015). Long-term consequences of breastfeeding on cholesterol, obesity, systolic blood pressure and type 2 diabetes: a systematic review and meta-analysis. Acta Paediatrica, Special Issue: Impact of Breastfeeding on Maternal and Child Health. Volume 104, Issue Supplement S467, pages 30-37.

Kent, G. (2015). Global infant formula: monitoring and regulating the impacts to protect human health. International Breastfeeding Journal, 10, 6. http://doi.org/10.1186/s13006-014-0020-7. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4362817/

Kramer MS, Kakuma R. (2012) Optimal duration of exclusive breastfeeding. Cochrane Database of Systematic Reviews, Issue 8. Art. No.: CD003517. DOI: 10.1002/14651858.CD003517.pub2. Available at: http://www.cochrane.org/CD003517/PREG_optimal-duration-of-exclusive-breastfeeding

Lodge, C.J. et al (2015) Breastfeeding and asthma and allergies: a systematic review and meta-analysis. Acta Paediatrica, Special Issue: Impact of Breastfeeding on Maternal and Child Health. Volume 104, Issue Supplement S467, pages 38-53.

Martin, C. R., Ling, P.-R., & Blackburn, G. L. (2016). Review of Infant Feeding: Key Features of Breast Milk and Infant Formula. Nutrients, 8(5), 279. http://doi.org/10.3390/nu8050279.

NHS (2017a) Benefits of breastfeeding. Available at: http://www.nhs.uk/Conditions/pregnancy-and-baby/Pages/benefits-breastfeeding.aspx

NHS (2017b) Premature labour and birth. Available at: https://www.nhs.uk/conditions/pregnancy-and-baby/premature-early-labour/

Peters, s et al (2017) Breastfeeding and the Risk of Maternal Cardiovascular Disease: A Prospective Study of 300 000 Chinese Women. Journal of the American Heart Association. Available at: http://jaha.ahajournals.org/content/6/6/e006081

Sankar, M. J. et al (2015). Optimal breastfeeding practices and infant and child mortality: a systematic review and meta-analysis. Acta Paediatrica, Special Issue: Impact of Breastfeeding on Maternal and Child Health. Volume 104, Issue Supplement S467, pages 3-13

Victora, Cesar G et al (2016) Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. The Lancet, Volume 387 , Issue 10017 , 475 - 490. Available at: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)01024-7/fulltext

World Health Organisation (WHO) (2017) Breastfeeding. Available at: http://www.who.int/topics/breastfeeding/en/

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1. You know when a friend makes you a cup of coffee exactly how you like it? Breast milk is like that for your baby. It changes over time to make sure it's just right (Victora et al, 2016; NHS, 2017). 2.

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How do my breasts produce milk?

As soon as you're pregnant, your body starts to change to support milk-making. You may notice some of these changes in your breasts, like a slight tenderness and maybe a darkening of your nipples and areola. These changes are among the early signs of pregnancy (NHS Choices, 2016b).

Mammary glands

These glands are in your breasts and produce breastmilk. Each mammary gland contains the following parts that help you to make breastmilk (MIDIRS, 2011).

Alveoli

These are small clusters of sacs that develop when you are pregnant and produce your breastmilk (Sternlicht et al, 2006). Muscles that squeeze the milk into ductules surround these sacs.

Ductules

These are small channels carrying milk from the alveoli to the milk ducts.

Milk ducts

These are the network of channels delivering milk from the alveoli and ductules to your baby. When you're pregnant, these ducts grow larger and there will be more of them. The average breast has about nine milk ducts ready for breastfeeding (Geddes, 2007).

When will I start making milk?

During pregnancy your breasts increase in size as the mammary glands grow to support milk production. Sometime during the second trimester your body is ready to produce milk. You might notice a little milk leaking from your breasts in the final weeks of pregnancy (WHO, 2009).

Once your baby is born and you pass the placenta, your body releases the hormone prolactin. This tells your body to produce milk (WHO, 2009).

"You can start to feed your baby immediately after birth as soon as you're both ready."

Skin-to-skin contac t can help to stimulate your milk flow and your baby's natural feeding responses (NHS Choices, 2016b).

What is colostrum?

Colostrum is the first milk your breasts produce in the few days following birth. It is thick and golden yellow in colour (NHS Choices, 2016b). Colostrum is very concentrated and full of vitamins and antibodies. All of this helps your baby grow and fight off infections (NHS Choices, 2016b). It also helps expel meconium - the black, sticky poo babies are born with (NHS Choices, 2016b).

Your baby will only need about a teaspoonful at each feed because colostrum is so concentrated. To begin with your baby may want to feed often, perhaps every hour. They'll begin to have fewer, longer feeds after a few days. The more you breastfeed, the more your baby's sucking will stimulate your supply and the more milk you'll make.

After a few days the colostrum will be replaced by more mature milk, which is more liquid and greater in volume (WHO, 2009). Approximately two to four days after birth you may notice your breasts are warmer and fuller feeling; this is known as your milk coming in (NHS Choices, 2016b).

The let-down reflex

When your baby starts sucking at your breast, this releases the hormone oxytocin, causing the tiny muscle cells around the alveoli to contract and squeeze out breastmilk. This squeezing is known as the let-down reflex (WHO, 2009; NHS Choices, 2016b). Some women get a tingling feeling, which can be quite strong, while others don't feel anything. Both are normal.

You may notice your baby respond when your milk 'lets down'. Their quick sucks will change to deep rhythmic swallows as the milk begins to flow. Babies often pause after the initial quick sucks, while they wait for more milk to arrive (NHS Choices, 2016b). There may be a number of let downs every time you breastfeed, which you may or may not be aware of.

You may also feel some contractions in your belly during the first few days of breastfeeding your baby. These are known as afterpains and feel like mild labour contractions. They are caused by oxytocin shrinking your uterus (womb) back to its pre-pregnancy size (WHO, 2009; NHS Choices, 2016b).

Breastfeeding frequency

Mums start producing mature milk as soon as their baby is born. This happens whether their baby is ever placed at their breast or not. You may notice this surge in production as your milk coming in around two to four days after the birth. Your breasts may look and feel fuller than before (NHS Choices, 2016b).

After this, you continue to make milk as a result of milk being removed from your breasts. This happens either as your baby drinks the milk or by you expressing it with your hands or a breast pump (WHO, 2009).

When breastfeeding is going well, this is what drives the milk supply. As milk is removed, your body gets the signal to make more. Your baby will never fully empty your breasts. If your baby feeds a lot, your body increases the milk supply in response (NHS Choices, 2016b).

Young babies typically feed frequently, at least eight times in 24 hours (or more), often in clusters of feeds with small gaps in between. Counting the feeds is not realistic, as you might not know whether your baby is starting a new feed or ending a previous one (NHS Choices, 2016c).

Changes in your breast milk

The fat content of your milk gradually increases as the milk is removed. So when breasts are less full, the fat content is proportionately higher (Martin et al, 2016). Healthy, effectively feeding babies usually get the right milk intake and type of milk for them (Martin et al, 2016).

When your baby seems to have had sufficient on one breast, you can switch sides and offer the other breast. Your baby may show they've had enough of one breast by coming off it or slowing right down. Not all babies take both sides each time. Some are happy with one, while other babies show they want three, four or more sides at a session (NHS Choices, 2016c; NHS Choices, 2017).

"Breastmilk constantly changes to meet your baby's needs. It is responsive to changes in the mother's diet, bacteria and viruses in the environment and the baby's feeding behaviours."

Breastmilk content also varies according to the time of day. Evening milk contains more components that relax and aid babies sleep, while daytime milk contains different elements that stimulate activity (Sanchez et al, 2009).

Breastmilk can also change in response to the baby or mother's illness, with an increase immune cell levels to aid recovery (Riskin et al, 2012). After your child's first year in the world, the fat and energy content of breastmilk increases to meet their growing needs (Mandel et al, 2005).

Support to help you breastfeed

It can take time for you and your baby to get the hang of breastfeeding. Plenty of help and support is available to help you overcome any challenges. Getting breastfeeding support makes a huge, positive difference.

Contact your local NCT branch or call our Infant Feeding Line on 0300 330 0700 to find out what breastfeeding support is available locally. We have local NCT Breastfeeding Counsellors who can offer a call, virtual visit, or home visit, depending on their availability. You may also have a local drop-in NCT breastfeeding support group. Our breastfeeding support groups are a great place to meet other mums with babies of a similar age. Peer support is really beneficial to new mums.

NCT supports all parents, however they feed their baby. If you have questions, concerns or need support, you can speak to a breastfeeding counsellor by calling our helpline on 0300 330 0700, whether you are exclusively breastfeeding or using formula milk. Breastfeeding counsellors have had extensive training, will listen without judging or criticising and will offer relevant information and suggestions. You can also find more useful articles here.

You might find attending one of our groups helpful as they give you the opportunity to explore different approaches to important parenting issues with a qualified group leader and other new parents in your area.

Make friends with other parents-to-be and new parents in your local area for support and friendship by seeing what NCT activities are happening nearby.

Visit our breastfeeding support contacts page.

NHS Choices breastfeeding information.

National Breastfeeding Line (government funded): 0300 100 021.

Geddes DT. (2007) Inside the lactating breast: the latest anatomy research. J Mid Women's Health 52(6):556-63. Available From: http://breastnbabylactation.com/pdf/11_inside_lactating_breast.pdf [Accessed January 2018].

Mandel D, Lubetzky R, Dollberg S, Barak S, Mimouni FB. (2005) Fat and Energy Contents of Expressed Human Breast Milk in Prolonged Lactation. Pediatrics. 116(3):e432-e435. Available From: http://pediatrics.aappublications.org/content/116/3/e432 [Accessed 1st January 2018].

Martin CR, Ling PR, Blackburn GL. (2016) Review of Infant Feeding: Key features of breast milk and infant formula. Nutrients. 8(5): 279. Available From: http://doi.org/10.3390/nu8050279. [Accessed 1st January 2018].

NHS Choices. (2016) Signs and Symptoms of Pregnancy. Available from: http://www.nhs.uk/conditions/pregnancy-and-baby/pages/signs-and-symptoms-pregnancy.aspx [Accessed 1st January 2018].

NHS Choices. (2016) Breastfeeding the first few days. Available from: http://www.nhs.uk/Conditions/pregnancy-and-baby/pages/breastfeeding-first-days.aspx?tabname=Your%20newborn [Accessed 1st January 2018].

NHS Choices. (2016) Breastfeeding: is my baby getting enough milk? Available from: http://www.nhs.uk/Conditions/pregnancy-and-baby/Pages/breastfeeding-is-baby-getting-enough-milk.aspx [Accessed 1st January 2018].

NHS Choices. (2017) Your breastfeeding questions answered. Available from: http://www.nhs.uk/Conditions/pregnancy-and-baby/Pages/your-breastfeeding-questions.aspx [Accessed 1st January 2018].

Riskin A, Almog M, Peri R, Halasz K, Srugo I, Kessel A. (2012) Changes in immunomodulatory constituents of human milk in response to active infection in the nursing infant. Pediatr Res. 71(2): 220-225. DOI: 10.1038. Available from: https://www.ncbi.nlm.nih.gov/pubmed/22258136 [Accessed 1st January 2018].

Sánchez CL, Cubero J, Sánchez J, Chanclón B, Rivero M, Rodríguez AB, Barriga C. (2009) The possible role of human milk nucleotides as sleep inducers. Nutritional Neuroscience. 12 (1):2 DOI: 10.1179/147683009X388922. Available from: https://www.ncbi.nlm.nih.gov/pubmed/19178785 [Accessed 1st January 2018].

Sternlicht MD, Kouros-Mehr H, Lu P, Werb Z. (2006). Hormonal and local control of mammary branching morphogenesis. Differentiation 74(7):365-381. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2580831/ [Accessed 1st January 2018].

WHO. (2009) Infant and Young Child Feeding: Model Chapter for Textbooks for Medical Students and Allied Health Professionals. Geneva: World Health Organization; 2009. SESSION 2, The physiological basis of breastfeeding. Available from: https://www.ncbi.nlm.nih.gov/books/NBK148970/ [Accessed 1st January 2018].

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As soon as you're pregnant, your body starts to change to support milk-making. You may notice some of these changes in your breasts, like a slight tenderness and maybe a darkening of your nipples and areola. These changes are among the early signs of pregnancy (NHS Choices, 2016b).

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https://worc.rl.talis.com/link?url=http%3A%2F%2Fglobalhealthmedia.org%2Fportfolio-items%2Fattaching-your-baby-at-the-breast%2F%3FportfolioID%3D5623&sig=ec6890cca328cfa7b35478963b9e79b789fb0938881327d802c4b86eb6d88075

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How to guide: expressing breast milk by hand | NCT

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How to guide: expressing breast milk by hand | NCT

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There are plenty of reasons why, if you choose to do it, expressing milk is a useful skill to have for your new baby. It can help in medical situations that mean your baby or you is struggling to breastfeed (Becker et al, 2016).

When you're away from your baby expressing milk will keep up your supply (Becker et al, 2016). It can even be a good trick to boost your supply if it's low (Becker et al, 2016).

Another plus of expressing is that babies learn to take a bottle or cup. This gives you more freedom to go to work, appointments or even an evening out with friends. It also allows your partner or other members of your family to become more involved in the early months (Becker et al, 2016). Here are the ways that you can start expressing your milk.

Watch our video for tips on expressing breastmilk.

Electric breast pumps

Breast pumps are useful when you need or want to give your baby milk in a bottle or cup but want to continue breastfeeding. You have two options when it comes to using a pump to express your breast milk: manual or electric.

Electric pumps use mains electricity, batteries or sometimes both. They are more expensive than hand pumps but they are usually less exhausting - a big bonus in the early newborn weeks. Electric pumps are also great if you need to express often for a baby who is in special care.

If one type of electric pump doesn't work for you, try another one to explore the options. You could do this either by returning it for a refund or hiring a pump instead of buying from an NCT breastfeeding counsellor.

It's good to check the fit - no-one's nipples are the same and you may need a different-sized funnel (Becker et al, 2016). If you're keen on efficiency you could consider 'double pumping'. This uses a double electric breast pump so you can express from both breasts at once.

Top tip: If there are different suction settings on your pump, start on a low one. You won't win any prizes - especially not from your painful nipples - by going straight for the hardest level. So build it up gradually.

Manual breast pumps

For some women, hand-operated pumps can seem less intimidating than electric pumps. That might in turn mean you're more relaxed using them. If you're more relaxed you'll produce more milk (Becker et al, 2016). Most pumps have flanges that go over your nipple and areola (the coloured skin around the nipple) and fit the breast. This helps draw the milk out by suction as you collect it in a bottle-shaped container.

Use them when your breasts are full and you should hold your baby while you pump if possible. This helps because skin-to-skin contact makes you produce the hormones that will bring on the milk (UNICEF, 2015).

Top tip: Make sure you sterilise all parts of the pump and whatever you're using to store your milk before you start expressing (NHS, 2016a).

Hand expressing

Your milk reaches the nipple through many different ducts. So as you press and release the breast tissue, your fingers mimic the action of your baby's tongue and mouth, squeezing milk from these ducts. That's how hand expressing works.

You can also use hand expressing to ease engorgement. It's handy if you're out somewhere without your breast pump, like a private office at work. Here's how to do it:

Massage your breasts or put a warm flannel on them first.

Position your hands under your breast with your thumbs upwards. The exact position will differ between women and you may or may not be touching your areola. The idea is to put pressure on the milk ducts. You may need to experiment to feel where they are.

Try pushing in towards your ribcage before rolling your fingers inwards. Move around so you affect different areas.

As you start to squeeze, milk will appear. Work around each breast, releasing the milk from all parts.

Express from one breast until the milk flow slows down and then start massaging the other. You can switch from breast to breast until the milk flow stops.

At first you may not be able to produce much but usually the more you express the easier it becomes.

Ask your midwife, health visitor or nurse to show you how to hand express your milk (NICE, 2014; NHS Choices, 2016a).

Top Tip: Find a container like a jug that has a wide rim for catching your milk and make sure it's sterilised (NHS Choices, 2016b). Make sure you have some sterile storage containers for storing your milk, like bags, bottles or containers with lids (Breastfeeding Network, 2009).

This page was last reviewed in October 2017
Further information

Our helpline offers practical and emotional support in many areas of pregnancy, birth and early parenthood: 0300 330 0700.

You might find attending one of our Early Days groups helpful as they give you the opportunity to explore different approaches to important parenting issues with a qualified group leader and other new parents in your area.

Make friends with other parents-to-be and new parents in your local area for support and friendship by seeing what NCT activities are happening nearby.

National Breastfeeding Line (government funded): 0300 100 021.

UK Association of Milk Banking has information on its network of milk banks across the UK.

Best Beginnings: view video footage online from 'bump to breastfeeding'.

Healthtalkonline.org provides a comprehensive library of face-to-face interviews where parents share their experiences about breastfeeding, birth, parenting and many other issues.

American Academy of Pediatrics. (2011) Practical bottle feeding tips. Available from: https://www.healthychildren.org/English/ages-stages/baby/feeding-nutrition/Pages/Practical-Bottle-Feeding-Tips.aspx [Accessed 1st October 2017].

Becker GE, Smith HA, Cooney F (2016) Methods of milk expression for lactating women. Cochrane Database Syst Rev 29:9. doi: 10.1002/14651858. Available from: http://cochranelibrary-wiley.com/doi/10.1002/14651858.CD006170.pub5/full [Accessed 1st October 2017].

Breastfeeding Network. (2009) Expressing and storing breastmilk. Available from: https://www.breastfeedingnetwork.org.uk/wp-content/pdfs/BFNExpressing_and_Storing.pdf [Accessed 1st October 2017].

Healthy Children. (2011) Practical bottle feeding tips. Available from: https://www.healthychildren.org/English/ages-stages/baby/feeding-nutrition/Pages/Practical-Bottle-Feeding-Tips.aspx [Accessed 1st October 2017].

NHS Choices. (2016a) Expressing and storing breast milk. Available from: https://www.nhs.uk/conditions/pregnancy-and-baby/expressing-storing-breast-milk/ [Accessed 1st October 2017].

NHS Choices. (2016b) Sterilising bottles. Available from: https://www.nhs.uk/conditions/pregnancy-and-baby/sterilising-bottles/ [Accessed 1st October 2017].

NICE. (2014) Breastfeeding recommendations. Available from: https://www.nice.org.uk/guidance/PH11/chapter/4-Recommendations#breastfeeding-3 [Accessed 1st October 2017].

UNICEF. (2015) Guide to bottle feeding. Available from: https://www.unicef.org.uk/babyfriendly/wp-content/uploads/sites/2/2008/02/start4life_guide_to_bottle_-feeding.pdf [Accessed 1st October 2017].

UNICEF. (2018) Skin to skin contact. Available from: https://www.unicef.org.uk/babyfriendly/baby-friendly-resources/guidance-for-health-professionals/implementing-the-baby-friendly-standards/further-guidance-on-implementing-the-standards/skin-to-skin-contact/ [Accessed 1st October 2017].
Further reading
NHS. (2009) Breast milk ingredients and sleep. Available from: http://www.nhs.uk/news/2009/10October/Pages/Breast-milk-ingredients-and-sleep.aspx [Accessed 1st October 2017].

NHS Choices. (2017) Benefits of breastfeeding. Available from: https://www.nhs.uk/conditions/pregnancy-and-baby/benefits-breastfeeding/ [Accessed 1st October 2017].

NHS Choices. (2018) How to bottle feed your baby. Available from: https://www.nhs.uk/conditions/pregnancy-and-baby/bottle-feeding-advice/#how-to-bottle-feed-your-baby [Accessed 1st October 2017].

Peila C, Coscia A, Bertino E, Li Volti G, Galvano F, Barbagallo I, Gazzolo D (2017) Human milk adrenomedullin is unstable during cold storage at 4°C. Breastfeed Med. 12(9):561-565. doi: 10.1089/bfm.2017.0072. Available from https://www.ncbi.nlm.nih.gov/pubmed/28956619 [Accessed 1st October 2017].

Science News. (2015) Backwash from nursing babies may trigger infection fighters. Available from: https://www.sciencenews.org/blog/growth-curve/backwash-nursing-babies-may-trigger-infection-fighters [Accessed 1st October 2017].

University Hospital Southampton NHS Trust. (2014) Syringe and cup feeding your baby. Available from: http://www.uhs.nhs.uk/Media/Controlleddocuments/Patientinformation/Pregnancyandbirth/Syringe-and-cup-feeding-your-baby-patient-information.pdf [Accessed 1st October 2017].

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Expressing milk: Which method is best? | Baby & toddler, Feeding articles & support | NCT

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You might have decided to express milk for your baby but are unsure which method is right for you. Here's what you need to know...

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