If a baby sucks properly, effectively and with sufficient frequency, lactation is maintained at a level adequate to its needs and expression of breast milk is unnecessary.
It happens that small loosening of full breasts or softening of its areola is required. However, sometimes milk expression proves to be necessary, when breast suckling is impossible.
It is common knowledge that mother’s milk is the best nutrition for both a sick and for a healthy a baby. Mother’s milk, particularly in case of preterm babies, has a therapeutic effect, supports their development and recovery. When breastfeeding is not possible, lactation must be maintained in order to provide the child with drawn milk. Properly drawn and stored milk is optimal nutrition both for a neonate, an infant and a small baby. When drawing milk for a preterm baby, special attention must be paid to hygiene at every stage, because it is important in terms of maintaining all its nutritional and immunological properties and in terms of bacteriological safety.
Indications for breast milk expression:
- child’s separation from the mother (e.g. when the baby is in an incubator, at a hospital),
- ineffective suckling by the child,
- lactation stimulation, i.e. activating the production of larger amounts of milk,
- treatment of stasis and mastitis, when a child does not empty the breast and sucks improperly,
during an episode of breast fullness, to loosen the breasts between feedings and/or before feeding in order to soften the areola for the child to be able to latch on to the breast properly.
How to express mother’s milk?
Mother’s milk can be expressed manually or with the help of various types of breast pumps (electrical or manual ones). Manual expression is a skill that should be learnt by every mum. It allows drawing milk in any conditions and in any place, irrespectively of the fact whether a full portion of milk needs to be drawn or only its small amount. Very often manual expression enables obtaining several drops of colostrum immediately after the delivery when it is impossible to put the baby to the breast as well as during a breast fullness spell.
In order to properly draw milk manually one has to remember of four key steps:
- facilitating milk flow (warm compress, gentle nipple rolling, thinking of the baby),
- proper positioning of the fingers (thumb above the areola, fingers 2-3 cm below the bottom of a nipple),
- massaging (bringing fingers close together, turning them slightly, and not moving the fingers on the skin, only slightly massaging the breast tissue held with the fingers),
- changing fingers position (according to the following schedule 6-12, 5-11, 2-8, etc.),
Manual expression is used sporadically to relieve breasts, as opposed to electric breast pumps which are intended for regular expression of larger amounts of milk.
To stimulate lactation with the aim of greater milk production, milk expression should be conducted in the manner mimicking the rhythm and length of feeding an infant, preferably with the use of an electric breast pump 8 times for at least 100 minutes per 24 hours. Drawing milk from both breasts at the same time improves the effectiveness of lactation stimulation and saves time. Maintaining a constant ritual and regularity are crucial.
Expression should be alternated between both breasts in accordance with the following pattern:
5-7 minutes from one breast, 5-7 minutes from the other one
3-5 minutes from the first breast, 3-5 minutes from the other one
2-3 minutes from the first breast, 2-3 minutes from the other one
What facilitates effective breast milk expression?
- a warm compress on the breasts or a shower several minutes before drawing milk,
- gentle massage towards the nipple, gentle breast shaking,
- gentle nipple rolling,
- comfortable position,
- a place ensuring intimacy,
- good mood, being calm,
- thinking of the baby, drawing milk in its presence or looking at an object associated with the baby (baby’s photo, a nappy, a piece of garment bearing its scent),
- breast massage or kneading is not recommended when drawing milk. Gentle breast massage, stroking towards the nipple is permitted,
- drinking of lactation tea 3 – 4 times a day can be recommended as a way of additional help along with pleasant, warm compresses put on the breasts before expression,
- if possible, it is best to practice kangaroo care as often as possible.
Mothers need to be aware that milk starts flowing after a while and not immediately after expression is started. Mothers must be warned against forcefully squeezing milk out from the breast, because it damages lactiferous alveoli and causes inflammatory conditions in the