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• How to express breastmilk
• Expressing by hand
• Expressing with a pump
• How to store breastmilk
• How to feed expressed breastmilk to your baby

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It is recommended that babies have only breastmilk for the first six months.  You may need to express and store breastmilk to feed to your baby for different reasons: 
• if your baby is not able to breastfeed;
• if your breasts are too full; or
• if you are going to be away from your baby. 

If your baby is not able to breastfeed, begin expressing your milk within 6 hours of giving birth.  In the first 2 to 3 days after birth, your breasts do not produce much milk.  However, they do make colostrum.  Colostrum is high in antibodies and an excellent food for newborns. 

You should express at least 8 times in every 24 hours until the baby can nurse at your breast.  Express your milk at least once during the night because this is when milk production is greatest.  Expressing regularly, during the day and once at night will make sure that you have a steady supply of milk.  You will probably have to express more often as your baby’s appetite increases. 

When your breasts are too full, you can express some breastmilk until they feel better.  Before long, you will produce less milk, and the amount of milk you have will match the amount your baby needs. 

When you plan to be away from your child, be sure to express milk for each time the baby would have nursed.  If not, you can end up with plugged ducts or a breast infection.  If you want to store some breastmilk as a backup supply, early morning is the best time to express.  You can express milk either before you nurse when your breasts are fullest, or afterwards if you still have lots of milk. 
 

How to express breastmilk

Learning to express breastmilk takes practice.  In the first 2 or 3 days after birth, you will get only 1 to 2 teaspoons of milk; expressing it by hand is less work than a pump.  Hand expression is also convenient and free. 

Whether you are hand expressing or using a pump, it may take a few minutes for your milk to come down.  At first your milk will come faster, then slower, then faster again.  This is normal.  You may have 3 to 6 letdowns of milk from each breast. 

It will probably take 10 to 15 minutes to empty each breast.  With practice, you will find out what works best for you. 

Getting ready

No matter how you choose to express your milk, the key is to relax so that your milk will let down, and move into the ducts.  You can try some or all of these things to see what works best for you. 

• Put a warm, wet cloth around your breasts, or have a shower to start the let-down reflex.
• Choose a private, comfortable place.
• Get comfortable.  Help yourself relax by thinking about your baby, listening to music, or watching something funny on television. 
• Lean over a table with your head on your arms, and have someone massage both sides of your spine by pressing slowly and gently with their thumbs.
• Massage your breasts to help the milk to come down.  There are different ways to do this.  You can massage in a circular motion with your fingers together.  Or, you can support your breast with one hand, and stroke the other side of your breast firmly with your other hand.  Always go from the chest towards the nipple, and work all around the breast.  Use Vaseline or olive oil to prevent chaffing of your skin.
• Gently shake the breast while you are leaning forward.
• Gently roll your nipple with your thumb and finger.
 

Massage

Stroke

Shake

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Expressing by hand

Keep your fingernails short.  Short nails are easier to clean, and they make expressing easier. Always start by washing your hands with soap and water for at least 15 seconds, then rinse and dry them.  Wipe your nipple area with water only.

• Use a clean container with a wide opening.  Put it on a surface in front of you, or hold it under your breast to catch the spray.
• Hold your breast with one hand, not too close to the nipple.  The thumb and fingers of your hand should be opposite each other and about 1 to 1½ inches back from the nipple.
• Lift your breast slightly, and gently push the breast inwards toward your chest.
• Lightly press your thumb and fingers together in a rolling motion towards the nipple.  Keep doing this every 4 or 5 seconds, the way a baby would suck.  Do not squeeze the bottom of your nipple, as this will stop the flow of milk. 
• Move around your breast so you are milking the entire breast.  Continue this until the flow of milk has completely stopped.  You may want to switch hands now and again. 
• Moving back and forth from one breast to the other can help with the milk flow.  Be sure to massage the breast each time before you start. 

Position

Push into chest

Press thumb and fingers together

Roll towards nipple

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Expressing with a pump

If you decide to use a pump, you can choose a manual or an electric pump.  Most manual pumps use either arm or hand action to create suction.  If you have arm or hand problems, a manual pump might not work for you. 

A good electric pump will cost $125 or more.  If you only need a pump for a few days, you can rent one.  If you need a pump for a longer period of time because your baby is unable to feed at the breast, or you are going back to work, a double electric pump will save you time.  Single electric pumps take 10 to 15 minutes to empty each breast.  A double pump empties both breasts in 10 to 15 minutes.  Battery pumps are not a good idea for long-term use because they lose pressure as the battery wears out.

Whether you decide on a manual or an electric pump: 
• choose one that lets you adjust the pressure from low to high; and 
• make sure it has a valve that prevents backflow.

Do not use pumps with rubber bulbs.  They can damage your nipples. 

When you are using a pump, make sure your whole nipple area is right inside the funnel so it won’t hurt.  Adjust the pump to its lowest setting, and increase the pressure as your milk starts to flow.  Use as much pressure as is needed to keep your milk flowing.  None of this should hurt.

If you have trouble getting your milk to come down, try pumping one breast while your baby nurses on the other.  You will probably find that the amount you get will depend on the time of day and whether you are tired or stressed.  If you want to express more milk, take a break and then try again.  Before long, you’ll know what works best for you.

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How to store breastmilk

Fresh breastmilk is better for your baby than frozen breastmilk, but frozen breastmilk is still better than formula. 

How long you can safely store breastmilk depends on where you store it, and whether your baby is healthy or sick. 

Since babies in hospital are not as strong, they need to be protected from harmful bacteria.  Parents must be especially careful how they store breastmilk for sick or premature babies. 

• Always put your milk in the refrigerator within 1 hour of expressing it. 
• Do not store milk longer than 2 days in the refrigerator.

These are storage times for healthy babies who are at home.
 

Where to store	Longest storage time
At room temperature	4 hours
In a cooler with a freezer pack	24 hours
Fresh milk in refrigerator	3 days
Thawed milk in refrigerator	1 day
In a freezer that is inside a refrigerator	2 weeks
In a refrigerator freezer with a separate door	3 to 6 months
In a deep freezer	6 to 12 months

• Use clean glass or hard plastic containers, or bags made for freezing.  Do not use baby bottle liners because they often break.
• Mark the date you expressed the milk on the container, and use milk in the order of the date it was expressed.  Throw out any milk that is older than the storage times above.
• Store breastmilk in the amounts your baby needs for one feeding.  If you don’t express enough milk for a full feeding, you can add smaller amounts of milk together, as long as you cool all the milk before you combine it.  Then use the milk according to the oldest date. 
• Store breastmilk near the back of the refrigerator where it is coldest.  Don’t store it in the fridge door where it is not as cold. 
• When freezing milk, leave a ½ inch space.  It will expand when it freezes.  If you are using a bag, don’t seal it until after the milk has frozen.  If you have a self-defrosting freezer, place the milk on a shelf, because the bottom of the freezer warms up when it is defrosting.  You can add fresh, cooled breastmilk to milk that has already been frozen. 

Thawed milk may taste or smell different from fresh breastmilk.  It can also look slightly blue, yellow, or brown, depending on what the mother has eaten.

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How to feed expressed breastmilk to your baby

Whenever possible, use fresh breastmilk.  It is better for your baby than frozen milk, but frozen breastmilk is better than formula. 

Heat the container of breastmilk by placing it in a bowl of hot water.  Do not use a microwave, and do not heat it on the stove.  These methods can cause hot spots that can burn your baby’s mouth, and they also destroy some of the benefits of breastmilk. 

Throw out any milk your baby doesn’t finish at a feeding.

There are many ways to feed a baby expressed breastmilk.  The most common ways are to use a cup, bottle, or supplementary nursing system.  For the first few days, your baby only takes a very small amount of milk, and you may find it easier to use a small cup. 
 

Try to avoid using a bottle during the baby’s first 4 to 6 weeks because it may cause ‘nipple confusion.’  When this happens, a baby is less able to latch onto the breast well.  You want to develop a good supply of breastmilk, and to do this your baby has to suck at your breast often.

Feeding your baby using a cup

All babies can drink from a small cup.  If you feel unsure, ask a nurse or a lactation consultant to show you how.

• Sit your baby up.
• Rest the cup on the baby’s lower lip, and slowly tip the glass to let your baby taste the milk.  Your baby will use its tongue to lap the milk like a puppy or kitten does. 

After babies are 6 months old, they can use a sippy-cup.  They only take small amounts when they are first learning.

Feeding your baby using a bottle

If you need to use a bottle, it is still important for your baby to work at sucking strongly.

• Use a long nipple with a firm tip and a wide base.
• Always hold your baby close.  Babies love skin-to-skin contact.
• Sit your baby upright. 
• Hold the bottle level so your baby will have to suck to get the milk.  Make sure there is always some milk in the nipple so your baby will not swallow air.
• Touch the nipple to your baby’s mouth, and wait for the baby to open up very wide.
• Never prop your baby up with a bottle as this can cause choking.  It can also lead to ear infections.  In older babies, it can lead to tooth decay. 

Feeding your baby using a supplementary nursing system.

If your baby is able to latch onto the breast, but is not getting enough milk, you can feed your baby expressed breastmilk or formula at the breast.  To learn more, talk with a nurse or lactation consultant.  See the section called Getting Help.