Using a Breast Pump for Expressing Milk

Learning how to express milk with a breast pump takes time, but once you familiarise yourself with the equipment and the process, it can, with practice, become straightforward. In fact, once you are confident, you may find that using a breast pump is something that slips seamlessly into your usual routine.

When to start expressing milk

Your baby’s first few weeks of life are precious. At this point there will be lots of feeds and lots of skin-to-skin contact. This will help you and your child bond and produce plenty of feel-good hormones. It’s very likely that you won’t need to start expressing milk at this stage and it’s almost certainly best not to start unless you are going to be apart from your baby during the early weeks.

However, life can and frequently does throw challenges in our way, so if you do need to separate for a short time, there is no need to feel guilty about it. By learning to use a breast pump, you are doing everything you can to help your baby and will be able to continue giving her the best nutrition possible.

It is also important to note that some women may have no choice about expressing milk at an early stage – for example, if your baby is premature and is too small to latch on, or because of some other impediment. In these cases, it is likely that the sooner you begin expressing, the more milk you will be able to produce over the first few weeks(1). In these circumstances, your midwife should explain how to use a hospital expressing machine. Once you know how to express, you will need to pump milk as often as your baby would normally feed; this will help your body to establish the right feeding rhythms so that you are able to produce the right amount of milk for your baby.

Why express milk?

Aside from having a premature baby or one that is otherwise unable to latch on, there are plenty of reasons why you might decide to use a breast pump to express milk. These include the following:

You’re returning to work.
You’re undertaking a period of study.
You and your baby find direct breastfeeding a challenge.
You need relief as your breasts are uncomfortably engorged with breastmilk.
You need to increase your milk supply.

Sometimes, you might just wish to let somebody else take over the feeding duties, and by expressing milk you may be able to get a full night’s sleep or have a day out while your partner or a grandparent looks after your baby.

Choosing a breast pump — manual or electric?

There are two main types of breast pump available: manual and electric. Electric pumps are typically quicker to use and manual pumps are generally cheaper, but even if an electric pump is within your budget that does not mean that it will be the right expressing method for you.

It can be useful to speak with your health visitor, midwife or breastfeeding supporter as well as friends and family about the pros and cons of the various pumps available. You may be able to borrow a pump to try it out or even hire an electric pump to see if it works for you.

Even once you begin, it may not be clear which is the best option for you. For example, different electric pumps may have different suction strengths and others may not be a good fit for your nipples, in which case, you may wish to try another pump or see if it has different attachment sizes available.

The first time you pump

Your first time expressing breastmilk is likely to feel like quite a challenge. However, you can pump without pressure because at this stage it is all about stimulating the breasts so they will be encouraged to produce milk. Your first breast pumping session should last for at least 15 minutes but try not to worry if it does not yield much milk – give it time and the milk will eventually begin to flow more readily.

Using a breast pump – creating the right conditions

It is really important that you find somewhere warm, calm, comfortable and low-pressure for you to use a breast pump. Of course, family, work and other circumstances do not always make this possible, so you may have to compromise and find ways to help you relax – for example, listening to music, reading a book or watching a relaxing film.

You will also need to set aside enough time to express milk. When you’re still getting to grips with using a breast pump, you should ensure that you have at least 30 minutes; however, as you become more comfortable at expressing milk, you may only need 15 or 20 minutes per session.

Although you are not breastfeeding your baby directly, it might help if you have your baby with you while you express milk, perhaps even for skin-to-skin contact. Milk is produced by signals in your brain stimulating the production of hormones prolactin and oxytocin, the presence of your baby may help stimulate these important hormones. If it’s not practical to have your baby nearby, try having your baby’s photograph to look at, a blanket of theirs or an item of their clothing; the smell and/or sight of your child should help you produce more milk.

Find the best position to express milk

There are no hard and fast rules for pumping milk, but you will need your back and arms to be sufficiently supported as you pump. The key thing is to be relaxed as this will help you release oxytocin to stimulate your let-down reflex.

Ensure good hygiene

Wash your hands thoroughly with soap and water before and after every breast pumping session. You will also need to be sure that the pump parts and bottles are properly cleaned and sterilised and that they are dry before being used or stored.

Expressed milk is likely to be stored in your fridge or freezer, so you will need to also make sure these are as clean as possible.

Top tips for pumping

Ideally, you should speak with your midwife, health visitor or breastfeeding supporter before pumping for the first time.

Using a manual breast pump

Manual pumps may not be as efficient as their electric counterparts, but they are simpler, cheaper and quieter. You should always consult the instructions of any manual pump you use.

Using an electric breast pump

Every breast pump is different, and, again, you should always read the manufacturer’s instructions before using your electric breast pump.

You should do the following when using a breast pump.

Hygiene: wash your hands and ensure that the pump (including all the parts) and the bottle are clean and sterilised before use.
Be calm and comfortable: find somewhere warm and restful.
Massage your breasts: this helps with the let-down reflex. You can do it for a few minutes, ideally while looking at your baby or at its photograph.
Get started: once you have comfortably fitted the breast shield or funnel over your nipple you can make a start. For an electric pump you should begin with a slow setting so that you can get comfortable. Once your milk begins to flow, you may wish to increase the speed setting. Remember it may take a few minutes for your milk to flow, so be patient.
Change breasts: you can switch breasts once your flow begins to slow, and you may then wish to switch again. Don’t worry if one breast produces more milk that the other — this is completely normal.
Finish up and store your milk: once you’ve finished pumping both breasts, remove your breast shield or funnel (switch the electric pump off first), and fix a lid to the bottle of expressed milk. It can then be stored in the fridge. Freshly expressed milk can be left at room temperature for a short while if you intend to feed your baby soon, but this should be for no longer than 6 hours and it is highly recommended that breast milk is refrigerated or frozen as soon as it’s expressed.(2).
Wash and sterilise the breast pump and all it’s parts: keep on top of this and you will make the next breast pump that much easier.

How to store expressed breast milk

According to the NHS, expressed breast milk should be stored in a sterilised container or in breast milk storage bags. It can then be:

stored in the fridge for up to 8 days at 4̊ C or lower (you should use a thermometer to check the temperature of your fridge;
stored in your fridge’s ice compartment for up to 2 weeks;
stored in your freezer for up to 6 months (at -18̊ C or lower);
stored in a cool bag with ice packs for up to 24 hours.(3)

Learn your flow pattern

Once your first expressing sessions are under your belt, you will begin to feel more confident about the breast pumping routine. In fact, within a month you should be able to recognise your own milk flow pattern. This will help you understand how many minutes you need to pump for each session and for how many times a day.

Every woman is different and it will take some time for you to work out what your pattern is. For example, some women will have an early let down and will pump most of their milk within the first 10 minutes, while others may have late let downs and will need to pump for 20 minutes or longer.(4)

Do you need to double pump?

Double pumping (using a double pump or two breast pumps simultaneously) stimulates additional milk flow so may be the right option for you if you have to regularly express milk. Not only does double pumping help you to produce more milk more quickly, it also helps to produce milk that has a higher fat content.(5) This means that your milk will contain more calories, something that is particularly beneficial for preterm infants. Double pumping may also help increase your milk production over the long term.

What to do if breast pumping is difficult

Although there are parts of breast pumping that may feel uncomfortable, especially at first, if you regularly experience pain or discomfort while expressing you should speak to your GP or health visitor. Likewise, seek help if you develop chafing or blisters on your nipple or breast.

Sometimes you may simply need a better fitting breast shield or may need to turn down the suction level of your electric pump. Never be afraid to ask your health visitor or breastfeeding supporter for advice.

Summary

Expressing breast milk using a pump can feel difficult, impersonal and crudely functional at first. However, once you familiarise yourself with the equipment and by following the instructions you should become comfortable with the process after a few sessions. If expressing milk is right for you, whether by using a manual breast pump or an electric one, it should soon become part of your regular routine.

References

1 https://faseb.onlinelibrary.wiley.com/doi/abs/10.1096/fasebj.31.1_supplement.650.19
2 https://www.laleche.org.uk/storing-your-milk/
3 https://www.nhs.uk/conditions/pregnancy-and-baby/expressing-storing-breast-milk/
4 https://pubmed.ncbi.nlm.nih.gov/22150998/
5 https://pubmed.ncbi.nlm.nih.gov/9025426/