Most nursing mothers want or need to express milk at some point, for different reasons. Then comes the question: how do you optimize manual milk expression?
I will try to answer these questions by giving you tools to make your milk extraction more efficient. This article is not intended to be exhaustive on the subject, but I hope it will help you in your breastfeeding.
Several situations can lead a mother to express milk, by choice or by necessity. But be careful, this is not an obligatory stage of breastfeeding. Not all women who breastfeed need to express milk, and not all women who express milk need a breast pump. Indeed, it is possible to express your milk by hand and this technique (the Marmet method, see reference) is sometimes more effective than a breast pump. No breast pump is as effective as baby's sucking. So results are not guaranteed with a breast pump. Also, what you manage to extract is, at no time, an indicator of your production.
The first thing to do before expressing milk is to wash your hands to avoid any risk of contamination. Then, to facilitate the extraction, it is recommended to massage the breasts by hand to stimulate the ejection reflex. This massage can continue during the extraction to increase the amount of milk collected. Along with the massage, you can also compress the breast.
The timing of pumping can be important. If you want to store milk for special occasions, you may find it easier and more efficient to pump in the morning when milk production is at its peak or at night when prolactin is most secreted. In the evening, the amount pumped is likely to be leaner. Also, we often wonder if we should pump before or after a feed.
Before a feed, this involves stimulating your let-down reflex, which can be difficult for some women. Also, it means that the flow will be slower for your baby who drinks afterwards, which can make him unsatisfied. Pumping after a feed may be easier because the reflex has been stimulated by your baby, but this leaves you with less milk to pump from your reserves. So depending on how often you pump or as needed, it might be a good idea to choose one or the other. If you pump after a feed, do it immediately afterwards so as not to affect the flow of the next feed.
But be careful, when you express milk, you are not depriving your child. As long as there is suction exerted, by your baby or by a breast pump, there is milk being produced. Only throughput is affected. If you want to pump on a daily basis, always do it at the same time, around the same time, to ensure that your production adjusts to this new demand and allows you to pump a little more each time. What is important is to choose a time when you are relaxed, rested and when you can think about your baby. Do not hesitate to look at your baby, or his photo, as this will facilitate the ejection reflex.
In general, the more often you need to express milk, the more of an efficient breast pump you will need, knowing that the most efficient is the one found in the hospital (double breast pump) or in a pharmacy, for rent.
The flange must be adjusted to the size of your nipple (in the box of your breast pump, you have a standard one, 24mm in general). The flange should leave a space of 1-2 mm around the nipple because it expands in length and width during extraction. It is important to pay attention to this point to avoid any injury due to the friction of the breast pump on the nipple. If you feel any discomfort, change flanges. If it is too large, the suction will be less effective. To make this more effective, you can moisten the breast with your milk before placing the dome.
Turn your breast pump to the lowest speed that allows you to pump milk, not the fastest you can tolerate. Expressing milk should never be painful. If so, check it out. Ideally, you should try to reproduce the baby's sucking rhythm, i.e. 30-60 sucks/minute and a sucking force between 50 and 155 mm Hg for a maximum of 220 mm Hg (see breast pump adjustment).
Pumping both breasts at the same time rather than one at a time can increase the amount of milk pumped and reduce the time spent pumping. You can use the “power pumping” technique: pumping for 10-12 minutes , then stop for 10-12 minutes and repeat the steps for about 1 hour, 1 to 2 times a day. This method is used to increase milk production.
If you express colostrum (milk from the baby's first days of life), use your hands instead and collect it in the container that will be used to give it to the baby to avoid losses (syringe, cup, spoon). Remember that colostrum is rare and comes out in small quantities. Every drop is precious for the newborn. It is normal that there are not large quantities.
If you express milk because your baby is not breastfeeding, the ideal is to express milk to reach 8-12 feedings per day (baby + breast pump) with less than 3 hours of intervals between each extraction or feeding , so 1 or 2 times a night if baby is not nursing. Extraction at night is important especially during the first 6 weeks to stimulate milk production as much as possible because this is the period when prolactin is most secreted.
The majority of the milk extracted will be extracted during the first 2 let-down reflexes, i.e. in about ten minutes. So you can pump for a maximum of 15 minutes each breast or 2 minutes after the milk stops flowing. Frequency is more effective than duration of extraction on milk production. It is better to shoot 8 times 10 min per day than 4 times 20 min. The amount of milk expressed will vary from time to time depending on the time of day, your tiredness and your level of stress… By doing it on a regular basis, it will become easier and you will harvest more.
I hope that each of you will find here one or more answers to your questions and that this information will help you in your breastfeeding. Above all, do not hesitate to consult to help you find the answers that suit your breastfeeding needs.
IBCLC lactation consultant
La Leche League
« Breastfeeding management for the clinician » de Marsha Walker, 2011
« Expressing breast milk » par Dr Jack Newman
« Breastfeeding and human lactation » de Jan Riordan et Karen Wambach, 2010
« Breastfeeding, a guide for the medical profession » de Ruth A. Lawrence et Robert M. Lawrence, 2011
Blog post translated from French. You may distribute and share this article without further permission, provided that it is used exclusively in contexts where the WHO “International Code of Marketing of Breastmilk Substitutes” is followed in full. This text by Marie-Caroline Bergouignan, IBCLC, was sponsored by Momzelle inc. This statement is considered an integral part of the text and must therefore be part of its distribution.