Establishing breast milk supply
How often should I express?
When you are expressing breast milk it is best to try and copy breastfeeding as closely as possible. Newborn babies breastfeed around eight – 10 times each day. If your baby is not breastfeeding you will need to express to remove milk eight – 10 times each day, including at least once overnight. The longest break between expressing sessions should be no longer than five hours. This is very important in the first two weeks to build a good milk supply.
Some mothers can reduce to six times per day when their milk volume reaches approximately 750ml per day, while other mothers do need to continue to express eight times each day, with one session overnight to maintain their milk volume.
Breast massage, and the use of warm compresses before expressing, helps your breasts release milk for your baby. Gently massage the breast towards the nipple. At the same time, assess each breast for lumpy areas within the breast and massage any lumps while expressing.
Any lump within the breast that does not resolve with breast massage and regular expressing needs to be reviewed by the Lactation Consultant or your doctor.
Always wash your hands well before handling your breasts. The amount of colostrum expressed in the first few days after birth may only be a few drops or it may be several millilitres. Expressing for 15 to 20 minutes, alternating between breasts, usually results in multiple let-downs and more colostrum being collected.
Once you have started to regularly express using the electric pump on low suction and/or hand expressing, milk volumes should start to increase by day three to five after birth. Signs of increasing milk production include warming, tingling and firming of the breast.
To hand express please follow the steps below.
- Place the thumb and finger diagonally opposite each other on the areola.
- Gently press inwards towards the centre of the breast, squeezing the finger and thumb together.
- Repeat with a rhythmic rolling movement.
- The fingers should not slide over or pinch the breast.
- Once the flow has stopped, move the fingers around the areola and press again.
- When hand expressing, try not to squeeze or handle the breast roughly – hand expressing should not hurt.
If you are having any problems hand expressing your breast milk, please talk to the nurse caring for your baby or the Lactation Consultant. The aim is to build up a daily volume of approximately 750 to 1000 ml over the two to three weeks following your baby’s birth.
For more information, see the Hand expressing technique fact sheet.
Electric breast pumps
The Queensland Children’s Hospital (QCH) has hospital grade electric pumps available for your use. The nursing staff at the hospital will provide you with a one-day breast pump kit to use with the electric pump while your baby is in hospital. These kits are available in various sizes for your comfort. You may wish to buy or hire a breast pump for use at home.
At this point in time, QCH does not hire breast pumps.
Check list for expressing:
- hospital grade electric pump
- one-day breast pump kit
- expressed breast milk (EBM) container – bottles, bags, syringes or small container to collect drops of colostrum
- baby’s identification (ID) stickers to label each container/ syringe of expressed breast milk
- expressed breast milk labels – to write the date and time you expressed your milk.
Hospital grade electric breast pumps are available throughout QCH. The pump is pre-programmed with two phases. The first phase is the stimulation phase- fast speed but low suction. This can help the milk to start flowing. After two minutes in the stimulation phase the pump will automatically switch to the pumping phase; here the suction becomes stronger and the speed slower.
In the first few days after the birth of your baby:
- use the pump on the stimulation phase for two minutes
- turn the pump off, then hand express for up to five minutes. You can hand express into a small container or draw up the drops with a syringe
- repeat this stimulation phase on the other breast for two minutes, and then hand express for up to five minutes
- repeat this process again.
Once you can express 5ml of breast milk by hand, you can allow the pump to proceed to the next phase of expressing – the pumping phase. When expressing on the pumping phase, turn the vacuum dial up as high as you can comfortably tolerate.
Expressing should not be painful so reduce the suction if it hurts.
Single pump or double pump?
When expressing with an electric pump, you may use a single kit and alternate between each breast every five minutes for a total of 20 – 30 minutes. Milk volumes can be increased if you apply some pressure and massage the breast during pumping. You may also express both breasts at the same time. This is called double pumping. If using a double pump, massage both breasts first, then express for five minutes, massage again then express for five – 10 minutes.
After using the electric breast pump, wipe it over with antibacterial wipes.
Milk volumes will vary from mother to mother, and vary over the day. All mother’s breasts have a different capacity to hold milk and this is not determined by breast size but by the amount of glandular (milk producing) tissue in your breasts.
As a general guide amounts to express are:
By day 5: 200ml to 300ml per 24 hours
By day 8: 400ml to 500ml per 24 hours
By day 14: 750ml per 24 hours
Thereafter: 750ml to 1000ml per 24 hours.
Things that may help you to express more milk include:
- being comfortable, having food and water handy
- cuddling your baby skin to skin – this will help release hormones that make your milk flow
- simple things such as sitting near your baby or looking at a photo of your baby
- the smell of your baby may also enhance milk ‘let-down’
- apply warm compresses and massage your breasts before and during expressing
- relaxation exercises, aromatherapy and music may help.
Stress, pain, anxiety and illness may decrease your supply. If you feel there are ongoing concerns with expressing your breast milk, please talk to the nurse caring for your baby or the Lactation Consultants on staff.
Increasing milk volumes
Often supply can be improved by expressing more often for a period of time. Try to express 10 – 12 times each day for a few days. You may get a smaller volume with each expression for the first two days, but the extra stimulation may increase the overall production. Record when and how much you are expressing to keep track. Ask the Lactation Consultant for an Expressing Log Sheet. If there are ongoing concerns regarding milk volumes, despite frequent expressing, some medications may assist with increasing supply. You can discuss these medications with the Lactation Consultant, your General Practitioner or your baby’s Medical Team.
All milk given to your baby is valuable and all your efforts appreciated so remember – every drop counts.
No matter how small each expression, always save the milk for your baby.
Maintaining your milk supply (older baby)
If your baby had already been breastfeeding prior to this hospital admission, and is now too unwell to breastfeed (or fasting for surgery), you can maintain your milk supply by:
- expressing six to eight times each 24-hours
- resting when possible
- eating a healthy diet and have a supply of healthy snacks
- drinking water when you are thirsty – keeping a drink bottle with you may help
- skin to skin contact and allowing your baby to cuddle at the breast.
If you are concerned your supply is decreasing, ask to speak to the Lactation Consultant.
Checking your breast milk
To ensure that the correct Expressed Breast Milk (EBM) is being given to your baby it must be checked by two people. We prefer to check this EBM with the parent/guardian. If you are not present the EBM is to be checked by two authorised staff members which include:
- registered nurse
- endorsed enrolled nurse.
If you (the parent/guardian) are present, the nurse giving the EBM will show you the container of EBM and together you need to ensure that the container has on it the:
- correct patient name
- correct date of birth
- date and time the milk was expressed.
This is an important safety check. If you are not present, two nurses will check these details by using the ID band on your baby’s arm/leg.
Transporting and storing your breast milk
If you need to go home while your baby is still in hospital, continue to express your milk to bring to the hospital for your baby. Each container needs to be labelled with your baby’s ID sticker and an expressed breast milk label. Remember to write on the date and time of expressing. EBM can be transported to the hospital in an insulated bag containing ice bricks to keep it cool.
When your baby is discharged home from hospital you will be asked to take your breast milk home with you. Please bring an insulated bag/esky and ice bricks to the hospital to safely transport your breast milk home. Speak to your baby’s nurse, the lactation consultant or the nutrition assistants if you have concerns about transporting your breast milk home.
If your baby has been discharged and you have forgotten to take your breast milk home, we will make every attempt to contact you on the phone number you have provided us with. If we have not been advised of your wishes within one week of your baby’s discharge from hospital, we will need to dispose of your breast milk.