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Unicef UK Baby Friendly Initiative | Hand expression

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Unicef UK Baby Friendly Initiative | Hand expression

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Click on the link below for post birth feeding information

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Click on the link below for post birth feeding information

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Click on the link if your baby is on or may go to the Neonatal Unit or Transitional Care Ward

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Click on the link if your baby is on or may go to the Neonatal Unit or Transitional Care Ward

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More  information to help you prepare to meet your baby

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More  information to help you prepare to meet your baby

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How to Fit Your Medela Breast Shield Size

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How to Fit Your Medela Breast Shield Size

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Instructions for use Medela Symphony breastpump (English - UK)

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Instructions for use Medela Symphony breastpump (English - UK)

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Breastshell Sizing: All You Need to Know

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Breastshell Sizing: All You Need to Know

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How to clean your Symphony® Breast Pump and Set

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How to clean your Symphony® Breast Pump and Set

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HOW TO Disassemble and Clean Ardo Pumpsets

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HOW TO Disassemble and Clean Ardo Pumpsets

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How to use the Ardo Calypso electronic breastpump

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How can breast massage help you on your breastfeeding journey? IBCLC, Ilayda talks us through it!

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How can breast massage help you on your breastfeeding journey? IBCLC, Ilayda talks us through it!

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How to Express Breastmilk – Breastfeeding Series

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How to Express Breastmilk – Breastfeeding Series

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Birmingham Community Based Feeding Support 

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Birmingham Community Based Feeding 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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Expressing Your Milk - La Leche League GB

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Expressing your milk by hand or with a pump helps you establish and maintain your milk production if you're separated from your baby or if he isn't breastfeeding well. And if your milk production is low, expressing can help increase it whilst also providing extra milk to give to your baby.

When a baby can't breastfeed
Return to work or separation
Making more milk
Storing breastmilk
Pumps
Tips for expressing
Expressing when out and about
Support and Encouragement
Feeding your baby your milk

When a baby can't breastfeed

Breastmilk is especially important for babies who are unwell. And if your baby can't breastfeed because of prematurity he will benefit from every drop of breastmilk you can give him. Some babies have conditions which mean they can't feed at the breast, they can still have your milk. If your full term baby is taking a while to learn to breastfeed, expressing protects your milk production and gives you both time to practice.

The prospect of expressing might seem daunting at first but giving your milk is something you can do that will make a real difference to your baby's short and long term health.

Return to work or separation

When you can't be with your baby, expressing maintains your milk production and helps you avoid engorged breasts during the separation. It also means your baby can continue to have his familiar milk when you're away.

See Working and breastfeeding, and When mum can't be there.

Making more milk

You teach your breasts to make more milk by removing milk. Full breasts signal to your body to slow down milk production, so don't wait for your breasts to 'fill up' before expressing, as this will mean a lower milk supply over time. The more thoroughly and frequently you remove milk from your breasts, especially in the early days and weeks, the more milk you will make and the greater the benefit for your long term supply. If you're expressing to establish milk production, making extra milk in the early days can make it easier to produce more milk later on to keep up with your baby's needs. Milk can always be frozen and used later.

If you are expressing to increase milk production remember a well-attached baby is far more effective than any pump, so do seek help to improve positioning and attachment so your baby can feed more effectively when at the breast.

See How to increase your milk supply.

Storing breastmilk

Breastmilk's antibacterial properties help it stay fresh so it can be safely stored at room temperature for up to 4 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.

Pumps

You can simply use your hands to express, or you can buy or rent a pump. Your choice of pump will depend on your reasons for expressing and your circumstances.

If your baby can't yet feed directly from the breast, or if you need to greatly increase your milk production then consider a hospital-grade double electric pump. Such a pump lets you adjust the suction and pumping speed (cycling) and is designed for long-term use. Many hospitals have these pumps available for use on the ward. Some have pumps that you can hire and take home for use during the night, or you could rent from a pump manufacturer.
Even if you rent a hospital-grade pump you may also find a smaller, portable pump useful for when you are out and about.

For expressing while out at work mini electric pumps are a popular choice. These usually come in a carry case for portability.

For occasional pumping a smaller electric or hand pump may be sufficient. Or you could just hand express.

Double pump set: hire pumps and some mini electric pumps come with two pump sets. Double pumping (expressing from both breasts at once) improves milk flow and saves time.

Check fit: check that your pump flange and nipple tunnel fits you comfortably. If too much of your areola is pulled into the tunnel during pumping it can cause rubbing and soreness. If the tunnel is too tight it can inhibit milk flow. Size varies between different makes and models, with some available in a choice of sizes. You may need a different size for each breast.

Suction and cycling controls: look for a pump with separate controls for suction and cycling (speed) so you can vary these to suit yourself.
Cleaning the equipment:
Always wash your hands before expressing milk.
If you're expressing for a premature or sick baby who is still in hospital then you'll need to follow the hospital procedures for cleaning and sterilizing the pump parts.
If your baby is healthy, pump manufacturers generally recommend washing with hot soapy water. Just like your milk, pumping equipment can safely be left at room temperature for short periods and refrigerated in a clean container or bag for longer periods, giving you more time for your baby.

Tips for Expressing

Relax!
Successful expressing has a lot to do with your emotions and how you are feeling. The hormone oxytocin causes the milk in your breasts to be released (let-down). Oxytocin is released when you feel happy and relaxed. It can be difficult to relax if your baby is very ill and in hospital, or if you feel rushed or under pressure. Make a conscious effort to put your mind at ease and use your senses to help trigger milk release. Hold or sit near your baby, or look at a picture or video of him, listen to a sound recording or hold and smell an item of his clothing. Relax your shoulders and take a deep breath to calm yourself before you begin. Try not to think about how much milk you are producing-instead, try distracting yourself by reading, listening to music or a relaxation CD, watching TV or even chatting on the phone. Some mothers who express long term build up a pre-expressing ritual that 'prompts' their breasts to release milk.

Use your hands
When hand expressing, the skin-to-skin contact helps stimulate the let-down reflex. And your hands can remove milk from parts of your breast which the pump can't. It's also perfect for the first few days after birth when the small droplets of precious colostrum you make can be collected on a clean teaspoon.

Combine hand expression with pumping
This can help you remove milk more thoroughly than with pumping alone.
Each time you express start with hand expression to stimulate a let-down. Then alternate pumping (double pumping if possible) and massage/hand expression until the flow slows. Finish by hand expressing into the pump flange, or single pumping with intensive breast compressions, switching between breasts until you feel that no more milk can be removed.

Suction and cycling speed
When using a pump, set its suction strength so it feels comfortable. Aim for the lowest suction strength which effectively produces milk for you; higher settings can hurt and won't necessarily produce more milk. Encourage multiple milk releases by mimicking a baby's natural sucking pattern. Increase the cycling speed when milk flow slows and use a slower speed as flow increases again. Aim for at least 3-5 milk releases during the session. If single pumping, switching between breasts several times can help trigger milk releases.

How often?

If you need to establish milk production without breastfeeding your newborn baby, aim to express 8-12 times per 24 hours including at least once during the night to mimic a baby's natural breastfeeding pattern. It might help to plan when to express during the day (e.g. on waking, after breakfast, mid-morning, after lunch, mid afternoon, early evening, twice during the evening and once at night).

Once your milk supply is well established, you may find that you can maintain your milk production with fewer expressing sessions.

You don't need to express at evenly spaced intervals-little and often can be more effective than long sessions.

Express until milk flow stops, then have a short break and come back to it-even a few extra drops of milk or expressing for a few minutes here and there make a difference.

Expressing several times (cluster pumping) during the evening can help you increase the number of times you remove milk per day, so increasing your milk production.

If you're expressing to increase milk production, or because your baby isn't yet feeding well at the breast, do it after or between feeds to ensure your breasts stay well drained. This will stimulate them to make milk faster.

If you are expressing at work or for a short term separation from your baby see our page Workday Practicalities for useful suggestions.

Expressing when out and about

You can breastfeed your baby very discreetly but you may feel much more exposed when expressing. In a public place you can use a lockable baby change facility or ask to use a changing room in a clothes shop. A battery or hand pump can be useful in these situations. Some mothers express in the car, creating privacy with shades on the windows and/ or with a cardigan or scarf. When visiting people you may feel more comfortable and relaxed in a separate room. At home it helps if you can get used to expressing with family around, as retreating to a separate room may reduce how often you do it. But some women just find it easier in a private place.

Support and encouragement

Expressing milk is sometimes challenging but it's always worthwhile, whether you are establishing breastfeeding, producing milk for a baby who is unable to breastfeed, increasing your milk or returning to work. Seek support from people who understand and value what you are doing and ignore comments from those who don't. Your local LLL Leader and Group will be able to give you encouragement and support. To find them take a look at our website.

Feeding your baby your milk

See Further Reading and resources below for information on ways to feed your baby your expressed milk.

Written by mothers of LLLGB. Photos courtesy of Lois Rowlands and Rae Vacher Lowe.

Further Reading

How to increase your milk supply
Engorged Breasts - Avoiding & Treating
Hand Expression of Breastmilk
My Baby Needs More Milk
My Baby Won't Breastfeed
When Mum Can't Be There
Comfortable Breastfeeding
Sleepy Baby - Why and What to Do
Storing Your Milk
Bottles and other tools

Other websites
Hand expressing:

Maximizing milk production when expressing:

Books
The Womanly Art of Breastfeeding. LLLI. London: Pinter & Martin, 2010.
Breastfeeding Solutions. Mohrbacher, N. New Harbinger Publications, Inc. 2013.
Exclusively Pumping Breastmilk, Second edition. Casemore, S. Gray Lion Publishing, 2014

References:
Breastfeeding Answers Made Simple. Mohrbacher, N. Amarillo, TX: Hale Publishing, 2010.

This information is available to buy in printed form from our shop.

Copyright LLLGB 2016

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Expressing Your Milk - La Leche League GB

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Expressing your milk by hand or with a pump helps you establish and maintain your milk production if you're separated from your baby or if he isn't breastfeeding well. And if your milk production is low, expressing can help increase it whilst also providing extra milk to give to your baby.

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Https://bit.ly/birminghambreastfeeding

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Birmingham Breastfeeding Support - Google My Maps

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A map of FREE breastfeeding support groups in the area. Always try finding their website, phone number or social media to check for the most up to date information. All groups listed are free and run by trained and insured organisations/peer supporters. Hospital infant feeding teams are black in colour/ read the description for contact details.

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Increasing Low Milk Supply * KellyMom.com

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By Kelly Bonyata, BS, IBCLC

Is your milk supply really low?

First of all, is your milk supply really low? Often, mothers think that their milk supply is low when it really isn't. If your baby is gaining weight well on breastmilk alone, then you do not have a problem with milk supply.
It's important to note that the feel of the breast, the behavior of your baby, the frequency of nursing, the sensation of let-down, or the amount you pump are not valid ways to determine if you have enough milk for your baby.
What if you're not quite sure about baby's current weight gain (perhaps baby hasn't had a weight check lately)? If baby is having an adequate number of wet and dirty diapers then the following things do NOT mean that you have a low milk supply:

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Your baby nurses frequently. Breastmilk is digested quickly (usually in 1.5-2 hours), so breastfed babies need to eat more often than formula-fed babies. Many babies have a strong need to suck. Also, babies often need continuous contact with mom in order to feel secure. All these things are normal, and you cannot spoil your baby by meeting these needs.

Your baby suddenly increases the frequency and/or length of nursings. This is often a growth spurt. The baby nurses more (this usually lasts a few days to a week), which increases your milk supply. Don't offer baby supplements when this happens: supplementing will inform your body that the baby doesn't need the extra milk, and your supply will drop.

Your baby nurses more often and is fussy in the evening.

Your baby doesn't nurse as long as she did previously. As babies get older and better at nursing, they become more efficient at extracting milk.

Your baby is fussy. Many babies have a fussy time of day - often in the evening. Some babies are fussy much of the time. This can have many reasons, and sometimes the fussiness goes away before you find the reason.

Your baby guzzles down a bottle of formula or expressed milk after nursing. Many babies will willingly take a bottle even after they have a full feeding at the breast. Read more here from board-certified lactation consultant Kathy Kuhn about why baby may do this and how this can affect milk supply. Of course, if you regularly supplement baby after nursing, your milk supply will drop (see below).

Your breasts don't leak milk, or only leak a little, or stop leaking. Leaking has nothing to do with your milk supply. It often stops after your milk supply has adjusted to your baby's needs.

Your breasts suddenly seem softer. Again, this normally happens after your milk supply has adjusted to your baby's needs.

You never feel a let-down sensation, or it doesn't seem as strong as before. Some women never feel a let-down. This has nothing to do with milk supply.

You get very little or no milk when you pump. The amount of milk that you can pump is not an accurate measure of your milk supply. A baby with a healthy suck milks your breast much more efficiently than any pump. Also, pumping is an acquired skill (different than nursing), and can be very dependent on the type of pump. Some women who have abundant milk supplies are unable to get any milk when they pump. In addition, it is very common and normal for pumping output to decrease over time.

See also Is my baby getting enough milk?

Who to contact if you suspect low milk supply

If you're concerned about your milk supply, it will be very helpful to get in touch with a trained breastfeeding counselor or a board certified lactation consultant. If your baby is not gaining weight or is losing weight, you need to keep in close contact with her doctor, since it's possible that a medical condition can cause this. Supplementing may be medically necessary for babies who are losing weight until your milk supply increases. If supplementing is medically necessary, the best thing to supplement your baby with is your own pumped milk.

Potential causes of low milk supply

These things can cause or contribute to a low milk supply:

Supplementing. Nursing is a supply & demand process. Milk is produced as your baby nurses, and the amount that she nurses lets your body know how much milk is required. Every bottle (of formula, juice or water) that your baby gets means that your body gets the signal to produce that much less milk.

Bottle preference. A bottle requires a different type of sucking than nursing, and it is easier for your baby to extract milk from a bottle. As a result, giving a bottle can either cause your baby to have problems sucking properly at the breast, or can result in baby preferring the constant faster flow of the bottle.

Pacifiers. Pacifiers can affect baby's latch. They can also significantly reduce the amount of time your baby spends at the breast, which may cause your milk supply to drop.

Nipple shields can be a useful tool in some cases, but they can also reduce the stimulation to your nipple or interfere with milk transfer, which can interfere with the supply-demand cycle.

Scheduled feedings interfere with the supply & demand cycle of milk production and can lead to a reduced supply, sometimes several months later rather than immediately. Nurse your baby whenever she is hungry.

Sleepy baby. For the first few weeks, some babies are very sleepy and only ask to nurse infrequently and for short periods. Until baby wakes up and begins to breastfeed well, nurse baby at least every two hours during the day and at least every 4 hours at night to establish your milk supply.

Cutting short the length of nursings. Stopping a feeding before your baby ends the feeding herself can interfere with the supply-demand cycle. Also, your milk increases in fat content later into a feeding, which helps baby gain weight and last longer between feedings.

Offering only one breast per feeding. This is fine if your milk supply is well-established and your baby is gaining weight well. If you're trying to increase your milk supply, let baby finish the first side, then offer the second side.

Health or anatomical problems with baby (including, jaundice, tongue-tie, etc.) can prevent baby from removing milk adequately from the breast, thus decreasing milk supply.

Mom's health (uncontrolled anemia or hypothyroidism, retained placenta, postpartum hemorrhage...), previous breast surgery/injury, hormonal problems (e.g. PCOS), anatomical problems, medications she is taking (hormonal birth control, sudafed...), or smoking also have the potential to affect milk supply.

Increasing your milk supply

Milk production is a demand & supply process. If you need to increase milk supply, it's important to understand how milk is made - understanding this will help you to do the right things to increase production.

To speed milk production and increase overall milk supply, the key is to remove more milk from the breast and to do this frequently, so that less milk accumulates in the breast between feedings.

OK, now on to things that can help increase your milk supply:

Make sure that baby is nursing efficiently. This is the "remove more milk" part of increasing milk production. If milk is not effectively removed from the breast, then mom's milk supply decreases. If positioning and latch are "off" then baby is probably not transferring milk efficiently. A sleepy baby, use of nipple shields or various health or anatomical problems in baby can also interfere with baby's ability to transfer milk. For a baby who is not nursing efficiently, trying to adequately empty milk from the breast is like trying to empty a swimming pool through a drinking straw - it can take forever. Inefficient milk transfer can lead to baby not getting enough milk or needing to nurse almost constantly to get enough milk. If baby is not transferring milk well, then it is important for mom to express milk after and/or between nursings to maintain milk supply while the breastfeeding problems are being addressed.

Nurse frequently, and for as long as your baby is actively nursing. Remember - you want to remove more milk from the breasts and do this frequently. If baby is having weight gain problems, aim to nurse at least every 1.5-2 hours during the day and at least every 3 hours at night.

Take a nursing vacation. Take baby to bed with you for 2-3 days, and do nothing but nurse (frequently!) and rest (well, you can eat too!).

Offer both sides at each feeding. Let baby finish the first side, then offer the second side.

Switch nurse. Switch sides 3 or more times during each feeding, every time that baby falls asleep, switches to "comfort" sucking, or loses interest. Use each side at least twice per feeding. Use breast compression to keep baby feeding longer. For good instructions on how to do this, see Dr. Jack Newman's Protocol to manage breastmilk intake. This can be particularly helpful for sleepy or distractible babies.

Avoid pacifiers and bottles when possible. All of baby's sucking needs should be met at the breast (see above). If a temporary supplement is medically required, it can be given with a nursing supplementer or by spoon, cup or dropper (see Alternative Feeding Methods).

Give baby only breastmilk. Avoid all solids, water, and formula if baby is younger than six months, and consider decreasing solids if baby is older. If you are using more than a few ounces of formula per day, wean from the supplements gradually to "challenge" your breasts to produce more milk.

Take care of mom. Rest. Sleep when baby sleeps. Relax. Drink liquids to thirst (don't force liquids - drinking extra water does not increase supply), and eat a reasonably well-balanced diet.

Consider pumping. Adding pumping sessions after or between nursing sessions can be very helpful - pumping is very important when baby is not nursing efficiently or frequently enough, and can speed things up in all situations. Your aim in pumping is to remove more milk from the breasts and/or to increase frequency of breast emptying. When pumping to increase milk supply, to ensure that the pump removes an optimum amount of milk from the breast, keep pumping for 2-5 minutes after the last drops of milk. However, adding even a short pumping session (increasing frequency but perhaps not removing milk thoroughly) is helpful.

Consider a galactagogue. A substance (herb, prescription medication, etc.) that increases milk supply is called a galactagogue. See What is a galactagogue? Do I need one? for more information.

Additional information

@

@ other websites

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Increasing Low Milk Supply * KellyMom.com

# data[].attributes.attachment_link.description
First of all, is your milk supply really low? Often, mothers think that their milk supply is low when it really isn't. If your baby is gaining weight well on breastmilk alone, then you do not have a problem with milk supply.

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National Breastfeeding Helpline - Helpline

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National Breastfeeding Helpline - Helpline

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Is your milk supply really low?

New mothers who are learning to breastfeed often worry that they might not be making enough milk for their baby. Their breasts might stop feeling full and their baby might sometimes be unsettled, or not want to be put down between feeds. There are many reasons for babies to be unsettled and breasts usually get softer after the first few weeks - these are not proof of low milk supply. If your baby is growing as expected (at least 20-30g a day, on average, during the first three months) just on your milk, then your milk supply is fine. If your baby does not grow well on your milk alone, then you may be making less milk than your baby needs.

The most common reason for genuine low milk supply is a slow start with breastfeeding, when not enough milk was removed from your breasts in the early days after birth. It may be possible to turn this around, with prompt action. Some other causes of low milk supply, such as previous breast surgery and some hormonal conditions, may mean that there is a limit to how much milk you can produce. Many nursing parents can make more milk than they are making, and you never know what you can do until you try!

Increasing low milk supply is hard work. It takes time, energy and commitment. It is important to be realistic from the start about your goal and how much time and energy you are able to invest. It works best when you have lots of practical and emotional support, so you can concentrate on your baby and your milk supply. Remember that this won't be forever - it is a short-term investment for long-term gain. Set yourself short-term goals, e.g. 48-72 hours, then review your progress. If you are not able to increase your milk supply as much as you would like, or decide that it is not realistic to try, you can still have a close, happy feeding relationship with your baby.

While you are working on your milk supply:

Find skilled feeding support. LLL is here to help! You can find information about ways we can support you here. We can also help you connect with other women who have experienced low milk supply.

Track how you are doing. Keep a record of how much milk you express and the amount of formula or donated breastmilk your baby takes (if relevant) and how many wet and dirty nappies your baby produces. Tracking changes over time is useful to show how well your plan is working and can help you decide what to do next.

Monitor your baby's health and growth. Your baby needs to be weighed regularly while you are working on your milk supply. Your midwifery or health visiting team will usually do this. For more complex feeding issues, you may be referred to a local specialist infant feeding team or clinic. Any baby who is not growing as expected should be under the care of a doctor. This is because occasionally, slow growth can be caused by underlying health issues in the baby, rather than low milk supply.

How milk production works

Milk production starts in the middle trimester of pregnancy. After birth, milk continues to be made in the breasts in response to milk being removed. The most common reason for low milk production is a slow start with breastfeeding - not enough milk being removed from the breasts in the early days after birth.

Milk supply usually reaches its peak around four weeks after birth, with most of the increase happening in the first two weeks. If not enough milk is removed during this time, your breasts may end up making less milk than your baby needs. It may be possible to increase milk production, by removing more milk from your breasts. The earlier you start this, and the more energy you put into it, the higher your chances of making more milk. Even if more time has passed, it may still be possible to increase your milk production to some extent, but unfortunately there is no guarantee of being able to make a full milk supply.
Any amount of milk you are able to produce is valuable to your baby. Breastfeeding is about much more than just milk and you can enjoy nurturing your baby at the breast, however much milk you are making.
For more detailed information about how milk production works see How Milk Production Works.

Risk factors for low milk supply

These include:

Previous breast surgery (especially reduction) or radiation

Retained placenta

Unusually small/thin/unequally sized/widely spaced breasts

A history of infertility with hormonal cause

Hormonal conditions like thyroid problems or polycystic ovary syndrome (PCOS).

If you have any risk factors for low milk supply, you may be referred to an infant feeding specialist. Some of these conditions are treatable. Even if you have underlying factors that can't be treated, you may still be able to make more milk than you are currently making.

Effective attachment

A baby who isn't deeply attached at the breast may not be able to get enough milk, and feeding may also be uncomfortable for you. Squashed ("new lipstick") nipples after a feed, skin damage and pain that lasts throughout feeds are all signs of shallow attachment. You can read more about positioning and attachment here.

Face to face help (including via video call) is usually best when working on attachment. If feeding doesn't become more comfortable and/or effective even with skilled help, your baby may be referred for an oral assessment (a thorough examination of their mouth) to check for tongue tie, which is a problem for a small number of babies and can be treated. You can read more about this here and here.

Hold your baby skin to skin

This helps your milk-making hormones to work well, keeps your baby calm and happy, helps you and your baby feel connected and encourages interest in feeding. You can read more about holding your baby skin to skin here.

How often and when to feed

While you are working to increase your milk supply, you will want to encourage your baby to feed as often as possible. Signs of interest in feeding include your baby turning their head and opening their mouth (rooting), licking lips, mouthing hands, restlessness and making small sounds. Try to offer a feed when your baby is first interested, before they become upset. If your breasts are feeling full or you just feel like feeding your baby, you can offer your baby a feed, even if they are not asking.

You may want to avoid using a dummy, a baby swing, or swaddling your baby, as these can make it difficult to tell if your baby is interested in feeding.

Don't give your baby water, tea or any other non-milk drinks.

Breastfeeds don't have to be regular (e.g. every 2-3 hours). Your baby just needs to have enough feeds in 24 hours, whenever they are awake enough and interested. Most young babies need at least 8-12 feeds in 24 hours. Don't watch the clock - watch your baby and count feeds.

Keep your baby feeding actively when they are at the breast

Knowing when your baby is feeding actively at the breast, with deep sucks and swallowing after every one-two sucks, can be very helpful. While you are working to increase your milk supply, you will want to make sure that milk is removed from your breasts as effectively as possible. If your baby is mostly doing light, fluttery sucks with very little swallowing (three or more sucks per swallow), they are not removing much milk. If your goal is to increase the amount of milk removed from your breasts, you may want to end the feed and use a breast pump instead to maximise efficient milk removal.

Breast compressions and switching sides can help to keep your baby actively feeding for longer. Start compressing your breast as soon as your baby stops actively feeding. You can read about how to do compressions here. When your baby is no longer actively feeding even with compressions, repeat on the other side. Offer as many breasts as your baby will take - it can be more than two!

Some babies seem to want to feed all the time and protest when you take them off the breast. If they are not growing well, it may be because they are not yet breastfeeding effectively. To increase your milk supply, you may temporarily need to limit their time at the breast, to give you more time to express your milk.

Increasing breast stimulation by expressing your milk

If the steps above do not result in increased milk supply, the next step is to increase stimulation of your breasts by expressing your milk:

An LLL Leader and/or your local infant feeding specialist will agree with you how many times in 24 hours to aim for at first. For more impact, you can increase the number of sessions. For maximum effect, you would aim to express 8-12 times in 24 hours (this is the number of times most babies need to feed).

A double electric breast pump, preferably a large "hospital grade" pump, is usually the best tool for this job. Smaller single electric and manual pumps are designed for occasional expressing, not the big task of increasing milk supply.

You don't need to pump after set intervals (most babies don't feed after set intervals either), just as often as you can. The important thing is how many times you express in 24 hours - it's up to you when you do it. It's fine to take a break for a few hours to go out or to sleep! More, shorter expressions often work better than fewer, longer ones and it's fine to stop in the middle of pumping, if you need to do something. Even if you only have a few minutes, it's worth pumping. Notice the times of day or night when you can express most and aim to pump more often then. First thing in the morning and in the quiet hours of the night can work well. Experiment to see what works best.

Use your hands as well as your pump. Try massaging your breasts before and during pumping. You might want to buy or make a "hands-free pumping bra" to hold your pump in place. Some women find that they can express lots of milk by hand after they have finished pumping. You can see how to use your hands to express more milk in this video.

Try covering the collection bottle with a sock so you can't see it. Frustration about how slowly it is filling with milk can make it even slower!

Try visualisation, e.g. a flowing fountain, or milk pouring into a bottle.

Many women find that they get most milk in the first few minutes of pumping. To make the most of this, it can work well to pump very frequently for short periods, stopping and starting as many times as possible. This is sometimes called 'power pumping'.

Try pumping with a piece of your baby's clothing near enough to smell, or while looking at your baby, or holding your baby skin to skin.

You can find more tips on how to express milk here.

Balancing breastfeeding and expressing

The priority at this stage is to increase your baby's milk intake and your milk supply. This may mean limiting your baby's time at the breast, for now, to free up enough time to express. Your baby has lots of time to learn to breastfeed. Your milk supply will become more difficult to increase as time goes on, so it is important to act quickly. This might feel all wrong - you want to breastfeed, not pump! Remember that it is an investment of your time now to help your baby breastfeed later. As your milk supply increases, breastfeeding will get easier and more rewarding for your baby. When breastfeeding is going well, you will be able to let your baby feed as much as they want.

How to feed expressed milk to your baby

There are lots of options - an LLL Leader can help you choose some to try, including paced bottle feeding and more, , and at-breast supplementers (lactation aid).

Keeping the breast a happy place for your baby

If your baby is upset, try offering some extra milk before offering the breast. This helps your baby to associate the breast with feeling full and happy, rather than hungry and frustrated.

Babies enjoy ending a feed by falling asleep at the breast. You can offer expressed or formula milk between breasts, allowing your baby to finish with the second breast.

You can give milk by bottle or cup with your baby's cheek against your breast.

If a supplementer is used, your baby can drink expressed milk while breastfeeding.

Domperidone

This is a prescription medication that can help to increase milk supply in some women, whilst they are taking the tablets. It is not suitable for everyone, e.g. it is not safe for those with certain heart conditions. Because of this, doctors are currently discouraged from prescribing domperidone to anyone. However, the NHS states that domperidone may be appropriate in some cases, so if you would like to try it, it's worth discussing with your GP, and taking along some information for them to read.

The most important thing to do to increase milk supply is to remove more milk from your breasts, so don't worry if you can't or prefer not to take domperidone.

Formula milk

Some babies need extra milk for a short time or longer term if their mother is not making a full milk supply. If donated human milk is not available, the only safe alternative is infant formula milk. You can find LLLGB's information on milk sharing here.

It is never safe to suddenly stop or reduce supplements of formula or donor breastmilk. This needs to be done gradually, to allow your own milk supply time to increase. and it is very important that your baby is weighed regularly, to make sure that they continue to get enough milk. It would usually be appropriate to weigh your baby every 1-2 weeks while working on reducing supplements. You can read about how to use donor milk or formula to support breastfeeding here.

Whether or not you are producing all the milk your baby needs, you can still have a great feeding relationship with your baby. The breast can still work beautifully to calm, comfort and soothe your baby, even if your milk supply remains low. Any amount of your milk that your baby gets will be beneficial to them. Some of the immune components of milk become concentrated so that babies get the same amount, no matter how much of your milk they get each day. Whatever feeding looks like for you and your baby, we are here to support you.

Summary
Stage 1 - make sure your baby is feeding as effectively as possible

1. Consider risk factors for low milk supply.

2. Make sure that your baby is well positioned and attached at the breast. This will include checking for any reason the baby might not be able to attach and feed well (e.g. tongue tie).

3. Hold your baby skin to skin as much as possible.

4. Offer the breast as soon as your baby shows any signs of interest in feeding, at least 8-12 times in 24 hours, waking baby if necessary.

5. Switch sides and use breast compressions to increase milk flow.

Stage 2 - if milk supply has not increased enough

1. Express your milk at a frequency agreed with an LLL Leader and/or infant feeding specialist.If your baby is still not growing well, increase the number of expressions. For maximum effect, aim for at least 8 times in 24 hours. This may mean temporarily limiting your baby's time at the breast, to give you enough time to express.

2. Feed as much expressed milk as your baby wants to drink by cup, paced bottle-feeding, finger feeding or nursing supplementer.

3. Aim to keep your baby's time at the breast happy and relaxed, and to end feeds with your baby at the breast (if necessary, after giving your baby extra milk at the start or in the middle of the feed) as often as you can.

4. Consider using the medication domperidone, which may help increase your milk supply.

5. If necessary, use enough formula milk to make sure your baby grows as expected and seems satisfied.

Further reading

Getting breastfeeding back on track after a difficult start
How milk production works
My baby needs more milk
Expressing your milk
Relactation and induced lactation - bringing back milk supply after a break or bringing in a milk supply when you haven't been pregnant.

Books
Making More Milk, by Diana West & Lisa Marasco (2019)
Defining Your Own Success: Breastfeeding After Breast Reduction Surgery by Diana West (2001)
Breastfeeding Without Birthing by Alyssa Schnell - for non-gestational parents who are inducing lactation.

Written by Jayne Joyce and Emily Tammam, LLL Oxfordshire, February 2021

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How to increase your milk supply - La Leche League GB

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Is your milk supply really low? New mothers who are learning to breastfeed often worry that they might not be making enough milk for their baby. Their breasts might stop feeling full and their baby might sometimes be unsettled, or not want to be put down between feeds.

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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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Do you have any breastfeeding questions? Get NHS trusted advice from the Breastfeeding Friend available on Google Home. Find out more

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Do you have any breastfeeding questions? Get NHS trusted advice from the Breastfeeding Friend available on Google Home. Find out more

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Do you need breastfeeding support & advice? There is a lot of help available - including the Breastfeeding Friend from Start for Life on Google Home. Click to find out more.