Expressing breast milk – what no one else will tell you

When it comes to expressing breast milk, no matter what thinking, planning, dreaming and scheming women invest into predicting the need to do this and how their life as a mother generally will be, nothing can really prepare them for the truth.

Friends and family may do their best, but ultimately it’s not until we have the experience of mothering firsthand that we just “get” it. The exhaustion, the milky confusion which descends on our mind, the overwhelming sense of love and pride we have for our baby and the strange, unfamiliar changes in ourselves as we transition into parenthood. How could we possibly envision such a huge shift in our lives? And would we really believe anyone who tried to tell us it would be so?

Just let me get through the birth first

During pregnancy, so much effort is put into planning for labour and birth that baby care tends to be relegated to a section of our brains of just “deal with that later”. Fingers are crossed that everything will go smoothly with the baby’s feeding and sleeping and if they don’t? Well surely it can’t be that hard to fix. But millions of parents have quickly learned that babies have a special way exerting their own little personalities and intentions to do whatever they choose.

For some babies, sleep is almost a foreign word and they care little for what the books and experts say. Others just seem to adjust perfectly to independent life and follow regular routines of sleeping and feeding, meeting their milestones and being absolutely predictable. These are what is known as “easy to please” babies. Whether they emerge this way due to luck, genetics, individual temperament or other factors is unclear. But it is true to say that from the outset, babies are their own little people and ultimately, parents cannot control them.

Why would I want to start expressing breast milk?

You may not want to express your breast milk, but you may need to. There are all sorts of reasons for this, but some of the most common are:

• Being engorged and so full of breast milk that you need to express to relieve some pressure
• Your baby cannot cope with the rapid flow of your breast milk. You may want to express until you have “let down” and your flow of milk has slowed to the point where your baby can suck more efficiently
• You would like your partner to feed your baby your expressed breast milk (EBM) from a bottle. This can be done to share your baby’s cares, if you would like to have a rest/sleep or your nipples are cracked or tender and you are having a temporary break from breastfeeding
• You are going out, returning to work or will be away from your baby for a period of time
• To build a storage bank of breast milk for those “just in case” occasions
• If you are donating your breast milk to a milk bank
• To boost your supply if you feel it is decreasing
• If you need to take medication which is contraindicated with breastfeeding. By expressing breast milk and discarding it if you need to and then when you have stopped taking the medication, reintroduce breastfeeding
• If your baby is sick and in hospital
• If your baby was premature and unable to suck or you have been advised by your healthcare professional that you should be expressing breast milk

How can I express?

You have a choice of using a pump or expressing your milk by hand. Some women find it impossible to express by hand; they find it awkward and can’t get the hang of what’s involved. And others say they prefer hand expressing to using a pump which may cause them some discomfort. But using a pump should not cause pain and instead, feel like it is providing relief.

Pumps come with a variety of options - manual, single electric and twin electric. Depending on your individual needs, there is a suitable pump for you to use. Some women find hand expressing is fine to do sometimes but use a pump at other times. Depending on how full you are may also determine what method of expressing you use. Expressing both breasts at the same time can result in more milk being obtained and is more time efficient. Manual pumps are ideal when there is no power source available and are very portable. Because of this, they are often used by women who are expressing breast milk at work.

There are no hard and fast rules when it comes to expressing – it’s all about what works for you and is the most hassle free way to collect your breast milk into a bottle, rather than directly breastfeeding your baby.

Put your positive hat on

The other important issue with expressing breast milk is to have a positive mind set. If you feel you are trying to channel a dairy cow and just look at expressing in a purely biological way, then you may find this affects your supply. But if you view expressing as a loving and nurturing act and something only you can do for your baby, then this will help you to feel more positive about expressing.

What does expressing feel like?

In a strange way, it feels like you imagine it would. The pump creates a gentle and rhythmic pressure on the nipple and surrounding areola and is similar in sensation to the baby sucking. Visually of course, it is a different matter entirely.

Some babies have such a strong suck that in comparison with a breast pump, expressing could be described as being very gentle. But for women whose baby has not directly breastfed, because of prematurity or illness, the sucking action of a breast pump can be quite strange, especially at first.

Expressing shouldn’t cause you pain or to feel anxious that it’s going to. Expressing is dependent on a mother being relaxed and comfortable; so if you don’t feel this way, check the pump is correctly assembled and all the connections are tight.

Also, remember to start pumping gently and build up to the number of depressions on the lever (of a manual pump) to the point where you have a letdown and your milk is flowing. With an electric pump, you will be able to adjust both the sucking pressure and the duration of the sucking/pause cycles. This means that you will be able to replicate your own baby’s sucking action.

• If your breasts are very full of milk and you are engorged, expressing should come as a relief, especially when you let down
• When the pump funnel is first placed on the nipple/s, it can feel cold until your skin warms it up
• Some women describe feelings of sexual pleasure when they are expressing. Others find this comparison almost laughable. Each woman and her own experience of expressing are unique
• If you have very tender nipples, you may experience some nipple pain initially but this should settle in less than a minute. Make sure you are completely covering the nipple with the pump funnel and have positioned it centrally over your nipple without pinching or compression
• If the funnel and cushion of the pump are not firmly against your breast and air is escaping, the suction will be affected. This means it will not feel as if it is creating sufficient pressure to eject the milk from your breast
• Letting down itself can be almost painful, as the hormone oxytocin causes the milk to eject from the nipples there can be a stinging, sharp feeling in both nipples. This is a separate sensation to that which is created by the pump itself
• Expressing is not silent. The pump may make a low volume noise and when your milk is flowing into the bottle, there can be some sound from this as well
• Find a comfortable chair, get yourself a drink and if possible, have your baby near you
• You can try expressing one breast whilst your baby is feeding on the other
• Be patient when you are expressing breast milk for the first few times. It can take practice to become used to expressing and the mechanics of it can be a little tricky to start with

What does express breast milk look like?

Mature milk looks very different to milk produced by mothers in the early newborn period. Early milk is called colostrum and although not very much volume is produced, it is a powerhouse of antibodies, fat and specific nutrients perfectly designed for a newborn’s gut.

Mature milk can appear quite watery and with a bluish green colour. When left for a period of time, the fat settles to the top and the milk sitting underneath the yellow/creamy coloured milk can appear almost like water. This can lead mothers to thinking their milk is not strong enough for their baby to grow, but breast milk is always perfect in terms of nutrient composition.