Providing expressed breast milk

Breastfeeding can be challenging for mothers of preterm, sick or low birthweight babies, because they may not be ready to drink directly from the breast. Therefore, expression of milk is the best solution to offer mother’s own milk to a baby until breastfeeding is possible.

Frequent expression of mother’s own milk shortly after delivery maximises lactation and supports the development of colostrum into transitional and mature milk. However, takes time for the lactation to build up. Continuous stimulation of the breast and pumping milk regularly is important. Even though the amount of milk produced may seem small at the beginning, every drop is important for the newborn and the quantity will increase over time.

Colostrum can be obtained directly after birth by massaging the breast or with the help of a milk pump. Milk should be expressed regularly every 2 to 3 hours and for at least 15 minutes in the days and weeks following delivery to stimulate milk production. Practising kangaroo care before or during milk expression can increase the amount of lactation. If skin-to-skin contact is not possible, even looking at the baby or a photo might stimulate the milk flow.

There are different options for mothers to express breast milk.

Hand expression
can be taught by a lactation specialist. Milk can be effectively expressed, collected in a clean container and stored afterwards. There is no need for a pump or electricity, so that mothers can collect their milk at any time and place (even though it might take some time).

Manual milk pumps
can be used without electricity just by effort e.g. by pressing a lever. Manual pumps are lightweight and portable. Nevertheless, pumping can be quite tiring if a mother needs to express her milk on a daily basis.

Electric milk pumps
can be used as single or double pumps. Research has shown that using a double pump is more effective for stimulating lactation and that milk expressed by double pumping provides a higher fat level compared to milk collected by a single pump. Furthermore, it is less time consuming as it is used on both breasts simultaneously.

For optimal storage and transport of expressed breast milk, hygienic aspects should be considered. Pumps should be used with sterile expressing sets and bottles, which are provided by hospitals. Transferring milk from one container to another increases the risk of contamination. Parents should ask a lactation specialist or other health professional for the latest guidelines on storing human milk in refrigerators. Cooling bags with cooling elements between the bottles are the best option for transporting expressed milk and for ensuring the continuous cold chain.

When feeding the milk to a baby, it should be as fresh as possible and must not be left at room temperature for more than 4 hours. Furthermore, personal hygiene, such as washing hands before expression or showering regularly, is necessary for clean breast milk.

Health professionals or lactation specialists at hospitals can help determine the best solution for parents to provide mother’s own milk for their baby.