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Expressing breast milk for sick or preterm babies

Breastfeeding: Expressing breast milk for sick or preterm babies

Benefits of breast milk for preterm babies


Your breast milk has important health benefits for your premature or sick baby. Breast milk is easier for babies to digest, (especially for your preterm baby), helps baby’s own immune system, and has special qualities designed for preterm babies. Even the smallest amount is of benefit to your baby. As health professionals we recognise how special your breast milk is for your baby.

Starting expressing


No matter how preterm or sick your baby is you should be able to express your breasts and give your baby some breast milk. When your baby is born, colostrum, (the first milk) will be produced in your breasts. After your baby is born it may be a stressful time but it will be important to start expressing soon after the birth, i.e. within a few hours. This will help your body start to produce milk for your baby - even if your baby isn’t ready to feed.

When you start to express your breast milk, hand expressing is recommended and the midwives will be able to show you how to do it. Once your breasts feel fuller it will be best to commence using a hospital type pump. If your baby is not feeding from the breast at all then you will need to express frequently to establish and maintain your milk supply (8-10 times a day), but once your supply is established you may be able to reduce the number of times you express. It would be best to talk to your midwife or nurse before reducing expressing.

For information on how to express breast milk see: Breastfeeding: expressing breast milk fact sheet

What type of breast pump?


Hand pumps (those that aren’t battery or electrically powered) are not generally recommended for mothers with preterm or sick babies. They are designed for less frequent use such as 1-2 times per day.

Hospital grade electric breast pumps are recommended for mothers with preterm babies to ensure that they establish and maintain a good milk supply.

For mothers with a baby born at less than 34 weeks gestation it may be best to buy a double pump kit. This type of pump is the most effective in stimulating release of the milk making hormone, prolactin. Using a double pump also reduces the amount of time that is spent expressing. However some mothers will feel that the single pump is best for them, so please talk with your nurse, midwife or the lactation consultant.

See the fact sheet Breastfeeding: Using a breast pump for information about:
  • Expressing with single or double electric pump kits
  • Cleaning the pump kits

Pumps are available for hire and purchase from:
  • Australian Breastfeeding Association
  • Royal Children’s Hospital (Equipment and Distribution Centre) (03) 9345 5325
  • Some pharmacies
  • Some private companies

How long should you spend expressing your breast milk?


It will probably take between 25 and 30 minutes in total. If using a double pump kit then it will normally take about 15 minutes. The important thing is to express one side until the flow slows to drips and then switch to the other side and repeat. If you are expressing because your supply is low, switch back to the first side again. Switching back and forth, expressing each side 2 or 3 times will increase your supply over time. This is sometimes called switch pumping /expressing. Using “breast compression” to help drain your breasts will speed up the process as well as increase the amount you obtain. Breast compression means squeezing your breast gently (squeeze where the breasts meet the ribs, with your fingers on one side and thumb on the other) while expressing.

How often should you express your milk?


For most women it is recommended to express at least 8 times in 24 hrs with one expression overnight. You are trying to imitate breastfeeding a newborn baby. For mothers of twins it is recommended to express at least 10 times in 24 hours. Frequent expressing gives a message to your breasts to make milk for your baby. More frequent expressing makes more milk.

How much milk should you get?


In the first few days after the birth, between a few drops and a few mls of colostrum may be expressed each time. As colostrum changes to more mature milk, the amount increases to around 50–70 mls at each expression by about day 4 or 5. Milk volumes vary from mother to mother and from expression to expression. By about 2 weeks, you may produce around 600 – 800mls (sometimes more!) and about 1000mls for women with twins, over a 24-hour period.

If you feel your milk supply is not enough for your baby please speak with your midwife, nurse or lactation consultant.

Important points:


  • Expressing should be done gently, to avoid pain and discomfort
  • The use of gentle breast massage and nipple stimulation will help to encourage the milk flow (let-down reflex), see Getting Started fact sheet
  • Using relaxation techniques or thinking about your baby while expressing may also be helpful. Express your milk while sitting with your baby or have a picture of your baby with you.
  • Kangaroo care - having a cuddle with your baby skin to skin just before expressing helps to increase your milk supply.
  • Expressing frequently throughout a 24 hour period, (including overnight), rather than for a long period of time at one sitting, is more effective in stimulating your milk supply

Guidelines for storage and transport of breast milk if your baby is in Newborn Intensive and Special Care


  • Expressed breast milk is to be placed in sterile containers or syringes and clearly labelled with the baby’s identification label and date and time of expression.
  • Containers of colostrum/ breast milk need to be labelled 1-30 in order of expression using the fluorescent dot stickers given to each mother. Following the first 30 expressions, breast milk from several expressions may be combined in the one container after it has been chilled in the refrigerator.
  • Expressed breast milk transported to the hospital must be kept chilled in an esky like container with ice or freezing blocks.
  • For women in regional areas that are sending milk to the Women's please talk with your nurse about how to safely send your breast milk to your baby.

Breast milk status
Room temperature
(26°C or lower)
Refrigerator
(4°C or lower)
Freezer
Freshly expressed into container
4 hours
48 hours

Place in refrigerator within 1 hour of expression

Store at back where it is coldest
2 weeks in freezer compartment inside refrigerator

3 months in freezer section of refrigerator with separate door

12 months in deep freeze (-18°C or lower)

Place in freezer within 24 hours of expression
Previously frozen thawed in refrigerator but not warmed
4 hours
48 hours from time removed from freezer
Do not refreeze
Thawed outside refrigerator in warm water
For completion of feeding
Do not return to refrigerator
Do not refreeze

For more information and advice about expressing and breast pumps


Breastfeeding Service
Royal Women's Hospital
Level 4
Cnr Grattan St & Flemington Rd
Parkville VIC 3052
Tel: (03) 8345 2400

Your local Maternal & Child Health Nurse

Maternal and Child Health Line
Tel: : 13 22 29 (24 hours)

Australian Breastfeeding Association
Tel: 1800 mum 2 mum (1800 686 2 686) Breastfeeding Helpline
Web: http://www.breastfeeding.asn.au

The Australian Breastfeeding Association has a booklet available titled Breastfeeding your Premature Baby which is an excellent source of breastfeeding and expressing information for parents with a preterm baby.

Disclaimer


The Royal Women’s Hospital does not accept any liability to any person for the information or advice (or use of such information or advice) which is provided in this fact sheet or incorporated into it by reference. We provide this information on the understanding that all persons accessing it take responsibility for assessing its relevance and accuracy. Women are encouraged to discuss their health needs with a health practitioner. If you have concerns about your health, you should seek advice from your health care provider or if you require urgent care you should go to the nearest Emergency Dept.

Published: July 2008. Updated: March 2010