Breastfeeding… Do I need to express my milk?
Navigating motherhood for the first time is often overwhelming, especially when trying to get breastfeeding off to the best start for you and your baby.
“Do I need a breast pump?” or “How does breastfeeding even work?” are typical questions that I often receive as an in-home Lactation Consultant (IBCLC), so I wanted to break some of these down for you.
Do I need to buy a breast pump?
I am often consulted about what type of breast pump to buy as if all mums-to-be think that it is an essential item that must be on their shopping list. My answer is almost always “your baby will be your best breast pump”. This generally results in a very confused look from Mum until I explain to them the basic principles behind demand = supply. These principles should be the very foundation of ANY education regarding Breastfeeding. Sounds simple enough?
How does breastfeeding work?
The milk made in the first days is called Colostrum and on average if a baby has a really great breastfeed, they only require approximately 5 -7mls to fill their newborn tummies.
During the first few days after birth, your baby should demand the breast very frequently. This often leaves parents feeling concerned that baby is not getting enough milk however, this is the way nature works. The more your baby feeds, the more your body is able to establish its natural milk supply. If your baby is sleepy at this stage of life, you need to wake them and encourage feeding or hand express your milk (more on that later).
You want to make sure that your baby has access to the breast each time they show a feeding cue - turning their little head, open mouth, sucking etc. This will be frequent and this is exactly the way it should be. The more we offer the breast and the breasts are stimulated by feeding, the more milk Mum will make.
All of those frequent early feeds help to bring your milk in. A few days down the track, this can result in very full breasts making optimal attachment difficult. This frequent feeding, accompanied by a high amount of postnatal hormonal will result in a plentiful milk supply.
There can be instances where baby is happily lapping up all of this milk from a very full breast, but Mum is not quite so happy if baby is attached incorrectly causing nipple pain and damage. Suddenly all that was learnt during the 1st day or so after birth does not quite work at home with some now very full breasts! This is an all too common scenario and has poor mums reaching for nipple creams, shields, pumping milk and giving it by bottle or on their worst days , throwing in the towel.
There is a very simple solution to this problem. Your baby and your body have done amazing work establishing your supply. Now you are at the stage where regulation of supply needs to occur. This is where the art of hand expressing comes into play. Some of you may have mastered this in the Prenatal period and expressed drops of your colostrum. The only difference is now when you hand express, you will get squirts of milk rather than just drops…
Hand expressing your milk
Why might I need to hand express my milk?
It may be suggested by your Health Care Professional (HCP) to do some Pre/Antenatal expressing of your colostrum from around 36-37 weeks gestation. This can result in colostrum being stored away in case it is needed for baby after birth. This is often referred to as “harvesting your colostrum.” To learn more about Prenatal/Antenatal Expressing click here.
If your baby does not attach to the breast, is born premature, unwell, requires extra fluids or has a difficult birth he/she may take some time to start breastfeeding well. If your baby is still not breastfeeding after around 48 hours, this is when you might need to introduce a breast pump.
To give your breasts some extra stimulation after a breastfeed, helping your milk to come in. This will also provide extra colostrum for your baby which may be needed for numerous reasons.
To manage full breasts once your milk has come in. A few minutes to soften the full breast and the area around the nipple and areola will then make attachment much easier. This results in a more optimal, deep attachment and adequate draining of your full breast meaning less discomfort/damage to the nipples. Adequate drainage of the full breast prevents blockages that may go on to become mastitis. Click here to read more.
Hand expressing is preferable to using a pump to manage full breasts. Women who express large amounts of milk when they are very full do not understand that this then sends a signal to the body to continue making excess for baby’s needs.
When your breasts are full and baby feeds only on one side and has had enough. Hand expressing a small amount from the side baby did not feed on to aid your comfort levels. During babies’ next feed, make sure to go to the side you just hand expressed a little bit from to help regulate your milk supply.
When you might need a Breast pump..
If your baby is still not breastfeeding after 48 hours you should begin using a “hospital grade” pump at least three hourly. These pumps work like the baby would in establishing supply if you are using them in the correct manner. Hospital-grade pumps may be available for hire locally through your hospital, local ABA branch or pharmacy. An IBCLC can assist with the correct sizing of the equipment you require to express, often pumps are sold or hired as a “one size fits all”. Correct sizing is extremely important as too big or too small can result in problems such as mastitis and poor drainage of the breast, damaged nipples, and inadequate milk supply to name a few.
If your baby is born prematurely, he/she may take a while to get the hang of breastfeeding. If your goal is to breastfeed you will need to continue to pump to provide your milk for your baby and maintain your supply. Most hospitals that have a Neonatal Nursery will allow the use of their hospital grade pump. Ask to see the IBCLC on staff to assist with set up as they are usually available in public hospitals.
If you wish to increase your milk supply. In this case, you would be breastfeeding your baby, pumping for extra stimulation and providing your extra milk to your baby. This is usually short term and more economical to hire a hospital grade pump rather than purchase your own.
Breast pumps for sale in pharmacies and other stores are usually not hospital-grade and will not establish or “bring in” your milk supply like a hospital-grade pump will. Consult your IBCLC to ensure you are fitted for the correct size for you as this has an effect on how well the pump stimulates your breasts and the amount of milk obtained.
Want to know more?
It is important to note that the best removal of milk from the breast comes from your well-attached baby. After all, that’s the way nature designed things. So, expressing even with a hospital grade pump is not an indication of supply, your well-attached baby will always get more milk than what you would express.
I recommend learning the art of hand expressing and how your breasts work, well before your baby arrives, this can help to get things off to the best start possible. If you find that you do need to use a hospital-grade pump it is a good idea to make contact with an In-Home Lactation Consultant (IBCLC).
You will make lots of purchases preparing for the arrival of your baby. Instead of spending money on a breast pump, you may not ever need why not invest in an appointment with an In-Home Lactation Consultant? I encourage you to make a Prenatal appointment or look at the packages that might suit you by checking out my services page. Studies show * that being prepared can set you up for better feeding outcomes. I look forward to helping you feel as well prepared as possible before you welcome your little one.
*Blixt I, Johansson M, Hildingsson I, Papoutsi Z, Rubertsson C. Women's advice to healthcare professionals regarding breastfeeding: "offer sensitive individualized breastfeeding support"- an interview study.Int Breastfeed J. 2019;14:51. Published 2019 Dec 16. doi:10.1186/s13006-019-0247-4
- Leanne O’Connor, RN RM IBCLC