Expressing breast milk for a premature baby

The first milk you produce after your baby is born is called colostrum. If you need to express milk at this stage it is best done by hand. During the first week, as your breasts feel fuller, you may choose to continue expressing by hand or to use a pump. Your midwife can show you how to express breast milk.


The number of times you will need to express per day will depend on your circumstances. For example, if your newborn baby is not feeding from the breast at all, then you need to express frequently (8 to 10 times in a 24-hour period) to establish and maintain your supply. Once your supply is established you may be able to reduce the number of times you express.

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Hand expressing

Always wash your hands before you start to express. To begin, gently massage your breasts for a short time and stimulate your nipples to encourage the let-down or flow of milk, then follow these steps:

  1. With your hand under your breast, place your thumb and index finger on either side of your areola, well back from the nipple.
  2. Gently press your thumb and forefinger back into your breast and as you do this, press them towards each other behind the nipple. Press for about two seconds, then release.
  3. Continue to compress and release and your milk will begin to appear.
  4. When the flow stops move your fingers to another position, around the edge of the areola, and start again.
  5. When the flow slows to drops of milk change to the other breast.
  6. Massage both breasts again and repeat steps 1 to 5.
  7. It is important not to cause pain or friction while expressing.

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Breast pumps

Hospital-grade electric breast pumps are recommended for mothers with premature babies. Hand pumps (those that aren’t battery or electrically powered) are not generally recommended for mothers with premature or sick babies. They are designed for less frequent use (one to two times per day).

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 you spend expressing. However, some mothers will feel that the single pump is best for them. Speak with your nurse, midwife or the lactation consultant about what will suit you best.

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How long does expressing take?

Expressing will take between 25 and 30 minutes in total. If using a double pump kit then it will normally take about 15 minutes.

Express one breast until the flow slows to drips and then switch to the other breast and repeat. If you are expressing because your supply is low, switch back to the first breast again. Switching back and forth, expressing each breast two or three times will increase your supply over time. This is sometimes called switch pumping/expressing.

Using breast compression will speed up the process as well as increase the amount of milk you get. 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.

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How often should I express?

For most women it is recommended to express at least 8 to 10 times in 24 hours with at least one expression overnight. You are trying to imitate breastfeeding a newborn baby. For mothers of twins it is recommended you express at least 10 times in 24 hours.

Frequent expressing gives a message to your breasts to make milk for your baby. 

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How much milk should I 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 to 70 mls at each expression by about day four or five. Milk volumes vary from mother to mother and from expression to expression. By about two weeks, you may produce around 600 to 800mls (2.5 to 3.5 cups) and about 1000mls (4 cups) for women with twins, over a 24-hour period.

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

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Things to remember

  • If your baby is not able to breastfeed, expressing should begin as soon as possible after the birth, ideally within the first six hours.
  • Hand expressing should be used for the first few days (before the milk comes in), but can be used at any time.
  • 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 (also called let-down reflex).
  • Expressing frequently throughout a 24-hour period (including overnight) is more effective in stimulating your milk supply than expressing for a long period of time at one sitting.
  • In the first few days after birth the amount of colostrum expressed may vary from a few drops to a few mls. As colostrum changes to more mature milk the volume will gradually increase.
  • When your baby is able to feed, if your breasts become very full, hand express a little milk just before the feed to help your baby to latch on well.
  • If your nipples are damaged and sore, hand expression is the gentlest way of expressing breast milk. Electric pumps can also be used carefully if they can be set on a low suction level.
  • 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 skin-to-skin contact with your baby just before and even during expressing helps to increase your milk supply.

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Storing and transporting breast milk

  • Expressed breast milk needs to be placed in sterile containers or syringes – write the amount and date on the container. If the milk is being taken into a neonatal intensive care unit, they will have their own requirements about how the container is marked. Usually you will also need the baby’s identification number and the date and time of expression.
  • 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.
  • If you are transporting expressed breast milk, it must be kept chilled in an esky-like container with ice or freezing blocks.

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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

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The Women’s does not accept any liability to any person for the information or advice (or use of such information or advice) which is provided on the Website or incorporated into it by reference. The Women’s 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.

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