Expression, Collection And Storage Of Breastmilk

GENERAL INFORMATION:

How do breasts make milk?

• Your breasts change during pregnancy in preparation for making milk. Your breasts contain milk glands and milk ducts that increase in number, causing your breasts to get larger. Milk is made in small sacs called milk glands or mammary glands. The milk glands are arranged side by side in small grape-like clusters. The milk glands connect to milk ducts, which are pathways for milk to travel through before reaching your nipples. These small ducts join other ducts and form bigger ducts as they get closer to the nipple. Breast milk flows from the ducts into the sinus (collection area) behind the nipple. It then comes out through 15 to 20 small openings on your nipples.
  
  
• During the later part of your pregnancy, your breasts start to make and store colostrum. Colostrum (KO-lah-strum) is a yellow, creamy fluid made by the breasts before they start making milk. It contains protein, vitamins and minerals, and sugar. Your baby will receive colostrum during breastfeeding before your breasts start making milk. This yellow, creamy substance may be in your milk for up to two weeks after your baby is born. Your breasts start making regular milk 2 to 4 days after your baby's birth. Your milk glands make milk continuously while you breastfeed and removing more milk increases how much you make. Milk is removed from your breast during feeding when your baby suckles it or by expression (milk removal by hand or pumping).

Why is breastfeeding important?

• Breastfeeding offers many good effects for both your baby and you. Your breast milk is available at no cost, requires no preparation, and is always clean, fresh, and at the right temperature. Human breast milk has the best combination of nutrients for your baby. Nutrients include all the protein, fat, sugar, vitamins, and minerals your baby needs for his body and brain to grow. Breastfeeding helps protect your baby from infections. It may also decrease your baby's risk of getting allergies and certain diseases. These diseases include sudden infant death syndrome (SIDS), asthma, diabetes (high blood sugar), lymphoma (lymph node cancer), and leukemia (blood cancer) . Breastfeeding also strengthens the bond between you and your baby.
  
  
• Breastfeeding helps stop bleeding from your uterus (womb) right after giving birth. It also helps you lose the extra weight and fat you put on during pregnancy. Breastfeeding without giving any formula to your baby can delay the return of your menstrual cycles. It can help control or decrease the amount of sugar in your blood. Breastfeeding can help make your bones stronger and decreases your risk of getting osteoporosis. It also helps protect you against breast, ovarian, and uterine cancer. You may need to learn and practice breastfeeding methods so your baby gets all the milk that he needs.

What is expression of breast milk and how soon can it be done?

• Expression of breast milk is getting milk from your breast without your baby suckling on it. Your breast milk can be expressed using your hands. This is called "hand expression" or "manual expression." You can also use a breast pump to express milk from your breasts. You can start expressing milk right after your baby is born. At that time, the amount of breast milk will be small. Six hours after having your baby, you should be able to pump more milk out of your breasts.
  
  
• At first, your breast milk will be colostrum (KO-lah-strum). This is a thick, yellow fluid that contains protein, minerals, vitamins, and sugar, plus antibodies (substances that protect against infection). Your regular breast milk will come in usually 2 to 4 days after your baby's birth. Colostrum has important nutrients and substances in it that your baby needs when he is born.

Why might I need to express my breast milk?

• You and your baby are going to be separated.
  
  
  • One time or infrequent events: You may need to be separated from your baby for a time to have a procedure or surgery done.
    
    
  • Ongoing or regular separations: You will be away from your baby for work, travel, or for other reasons.
  
  
• Your baby is very sick. Your baby may be in the hospital if he was born earlier than expected or was ill at birth and. When he is premature or ill, he may not be able to be breastfed often or at all.
  
  
• Your baby's feeding is off-schedule. Your baby missed or skipped a feeding.
  
  
• You have breast problems. Your breasts are engorged (too full with breast milk), or your milk ducts are plugged.
  
  
• You have a short term use of certain substances. You may be taking certain medicines. Some medicines, such as lithium, are passed through your breast milk to your baby and can be harmful to him. Illegal (street) drugs are also harmful to a baby. Do not breastfeed if you use street drugs. Express your breast milk and throw it away.
  
  
• You want to donate some of your milk. Some breastfeeding women choose to donate some of their milk to a local breast milk bank. The milk goes to sick babies and children whose own mothers are not able to provide breast milk to them. Ask your caregiver for more information about breast milk donation and milk banks.

Why is milk let-down important, and what can I do to make my milk let-down?

• Your breast milk stays in the milk glands until it is released into the milk ducts. The process of this release is called let-down. The "let-down reflex." at first is triggered when the nerves in your nipple and areola (dark circular area) feel your baby suckling. This reflex is also known as the "milk-ejection reflex" When your baby suckles milk from your breast, hormones (special substances) in your body are released. You may have a warm, tingling feeling in your breasts when this happens. When you get ready to feed your baby, milk may drip or spray from your nipples when your let-down happens. You may feel breast fullness 30 to 60 seconds after your baby is correctly attached to the breast. Multiple let-downs happen during every feeding.
  
  
• Your body responds with let-down more easily to your baby than when you use a pump or do manual (hand) expression. When pumping or expressing milk, you will need to trigger your milk let-down without your baby's sucking. Being relaxed, free from distractions, and in a place where you feel comfortable can help your milk let-down. Seeing pictures of your baby, or smelling and feeling his clothing may also help. You can also record and listen to his voice. Placing warm cloths on your breasts may also help. Ask your caregiver for more information about pumping and manual expression.

How do I express my breast milk by hand? Hand expression is a natural way of getting milk from the breast. It may take 20 to 30 minutes to empty your breasts of milk. To hand express your milk, do the following:

• Always wash your hands before starting. Pat them dry.
  
  
• Position your thumb and first two fingers 1 to 1 and a half inches behind your nipple without cupping your breast.
  
  
• Push straight into your chest while rolling your thumb and fingers forward. The rolling motion will help empty your milk from the breast without damaging breast tissues. Do not slide your fingers along your breasts, or squeeze or pull your nipples.
  
  
• Repeat this, expressing breast milk at a regular and steady rate.
  
  
• Change the position of your thumb and fingers to different areas of your breast. Keep expressing your milk until there is no more milk coming out.

What should I use to collect my breast milk in? You can use plastic or glass bottles for collection and storage of your breast milk. Wash reusable milk containers in the dishwasher, or with warm, soapy water, rinsing them with hot water. You may want to use screw-top glass or plastic bottles that be attached to a store-bought nipple. Disposable plastic bags made for storing breast milk may also be used. Babies less than six months old often drink between 3 and 5 ounces at a feeding. You may want to pump and store small amounts of milk, such as four ounces, in one container. If you do this, you can thaw or prepare close the right amount for your baby to drink at a feeding.

How do I use a breast pump?

• Always wash your hands first.
  
  
• Put the pump attachment pieces together as directed. Connect these to the pump.
  
  
• Put the breast shield pump attachment piece over the nipple and areola (dark area around the nipple) of your breast. Your nipple should fit well within this attachment piece without rubbing.
  
  
• If you use a hand-powered pump, pump until all of your milk is expressed from one or both breasts. If you chose an electric or battery-powered pump, turn it on until all of your milk is expressed from one or both breasts.
  
  
• Turn the pump off, and then remove it from your breast when you have no more milk coming out.
  
  
• Store the milk, or feed it to your baby.
  
  
• Wash the reusable milk containers and pump attachments in a dishwasher. You can also wash them with warm, soapy water and rinse them with hot water.

What type of breast pump is best for me?

• There are many types of breast pumps to choose from. They can be small, medium, or large in size, and quiet or noisy. They can be manual (hand pump), battery-powered, or electric (need to be plugged in). Some electric pumps can also be run by battery or by hand. Some electric pumps have a car battery attachment so you can pump while away from home. Some pumps have the suction rate and pressure set to stay the same. On other pumps, these factors can be changed. Small light pumps can be easily carried, and some fit easily into a purse or even a bra.
  
  
• Factors to consider when choosing a breast pump are how long you may use it, and the cost and ease of using it. If your baby has to stay in the hospital, you will probably use the pump there. You may also be supplied with a portable one you can use at home. If your baby is at home, you can buy or rent a breast pump. Hospital-grade electric pumps are most often rented, as they are costly to buy. Check with your medical insurance company about whether you have benefits that cover breast pump rental or purchase. Select a breast pump that is comfortable and easy for you to use. Ask caregivers for help selecting the breast pump and attachments that are best for you.

What else should I know about expressing breast milk?

• Do not rush through expressing your milk. Use 20 minutes or longer if possible to relax and pump your breast milk out. Hand expressing can take 30 minutes. Using a breast pump that pumps both breasts at the same time may only take 10 minutes to do.
  
  
• Follow your baby's feeding times, and express your milk often. Doing this helps prevent plugged milk ducts and mastitis. Pump between feeding sessions if your baby is breastfeeding. This will empty your breasts often and help your body make more milk. Pump the rest of your milk out after your baby is done with a feeding. This will help empty your breasts completely. Save the milk that comes out last for your baby to drink later. Completely emptying your breasts each time you pump will help your body make more milk.
  
  
• When you start pumping for the first time, use the lowest setting for the pump. As you pump more often, you can use the higher setting. This will help prevent discomfort while pumping, and may avoid damaging your breast tissue.
  
  
• Your milk will be watery as it first comes out, and will look thicker while you are expressing it. Breast milk may also look blue or yellow, depending on what you eat. Your breast milk may also smell soapy at times. This is all normal for breast milk. If you have stored the milk correctly, it is OK to feed it to your baby.
  
  
• You may make more milk in the morning hours than later in the day. You may also be able to pump more milk from one breast than you can from the other. The amount of milk that you pump each time may change. This is normal.

How should I store the expressed milk? After collecting breast milk using the pump, remove the collection container and cover it for storage. You will also need to do the following:

• Label your milk: It is important to label the container with the date and time the milk was expressed. This lets you identify the oldest milk to be used first, so that none is wasted. If your baby is in the hospital or daycare, also write your baby's name on the label.
  
  
• Select the storage location: Breast milk contains substances that slow the growth of germs in it, compared to formula or cow's milk. Expressed milk may be safely stored in any of the following ways:
  
  
  • Room temperature: For 4 to 8 hours. Cover the container and keep it as cool as possible.
    
    
  • Insulated cooler with ice packs: For up to 24 hours. Try not to open the cooler except to take out or add more milk. Keep the milk next to the ice packs.
    
    
  • Refrigerator: For up to 8 days. Store the milk in the back or body of the refrigerator where the temperature is coldest. Do not place the milk in the door of the refrigerator.
    
    
  • Freezer:
    
    
    • Refrigerator freezer compartment: For up to 6 months if the freezer section has its own outer door. For up to 2 weeks if freezer door is inside of the refrigerator.
      
      
    • Deep freezer: For up to 12 months.
  
  
• Other storage safety practices:
  
  
  • Do not add fresh milk to a breast milk container that is already in the refrigerator or freezer.
    
    
  • Throw away any breast milk that is past the time limit of safety.

How do I use stored breast milk?

• Check the date and use the oldest milk first. Read the labels carefully. The sooner stored breast milk is used, the less chance of it having germs.
  
  
• Milk separation is normal. Breast milk separates when it is stored, with fat floating on the top. This is not a sign of that it is spoiled. Shake the milk before giving it to your baby to mix it again.
  
  
• Thaw or warm it safely. You can thaw frozen stored milk slowly in the refrigerator, or by placing it in a bowl of warm water. You may also let the milk defrost at room temperature. Never use a microwave oven to warm milk or to thaw frozen milk. Doing so can destroy important substances in the milk and make the milk too hot for your baby.
  
  
  • Warmed to room temperature: Once stored breast milk reaches room temperature, is should be used it within 4 hours.
    
    
  • Thawed in the refrigerator: Use it within 24 hours if thawed in the refrigerator.
  
  
• Use or discard it once it is warm. Never refreeze milk once it has been thawed or warmed. Never put stored milk that has then been warmed to at least room temperature back in the refrigerator.
  
  
• No second feeding with the same bottle. Never do a second feeding using the same bottle and milk from a previous feeding. Germs from your baby's mouth can get into the milk during the first feeding and spoil the milk.

When should I call my caregiver? Call your caregiver if:

• The amount of milk that you are able to express is decreasing over time.
  
  
• You have nipple pain that seems to get worse during or after milk expression.
  
  
• Your breasts do not feel full before expressing your milk, and soft after.
  
  
• Your breasts are hard, painful, or swollen, and your milk is not coming out.
  
  
• You have questions or concerns about expressing, collecting, and storing breast milk.

Where can I find support and more information? Ask for information about breastfeeding and make sure caregivers know that breastfeeding is important to you. Take a breastfeeding class, or join a group with other breastfeeding mothers. Ask your caregiver for the name of a Lactation Consultant. This person is specially trained to help women breastfeed their babies. Contact the following:

• Centers for Disease Control and Prevention, Breastfeeding
  1600 Clifton Rd
  Atlanta, GA 30333
  Phone: 1-800-232-4636
  Web Address: http://www.cdc.gov/breastfeeding/recommendations/index.htm
  

• La Leche League International
  1400 N. Meacham Rd
  Schaumburg, IL 60173-4808
  Phone: 1-847-519-7730
  Web Address: http://www.lalecheleague.org
  

• Human Milk Banking Association of North America
  1500 Sunday Dr., Suite 102
  Raleigh, NC 27607
  Phone: 1-919-861-4530
  Web Address: http://www.hmbana.org
  

CARE AGREEMENT:

You have the right to plan how you are going to feed your baby. To help with this plan, you must learn as much as you can about breastfeeding. Ask your caregiver questions about breast expression, collection and storage of breast milk. You can talk with him about the best way for you to feed your baby even if you are away.

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