King Edward Memorial Hospital
Breastfeeding Centre of WA
Expressing breast milk
Expressing may be used to:
- Help you attach your baby to the breast when your breast is full.
- When returning to work (check with your employer about the breastfeeding policy in your workplace) See www.breastfeedingfriendly.com.au.
- Give your baby expressed milk when breastfeeding is not possible.
- Stimulate the letdown reflex by:
- rolling your nipple between your finger and thumb and
- gently stroke your breast towards your nipple.
- Position your finger and thumb about 2cm to 3cm behind the tip of the nipple.
- Press the finger and thumb together towards your chest without sliding the fingers on the skin and gently compress.
- Repeat the action in a rhythm similar to the baby’s sucking, about once a second.
- Rotate the position of the finger and thumb around the nipple, so that all the milk ducts are expressed.
- If regular expressing is required to give extra breast milk to your baby, an electric breast pump is recommended.
Expressing by electric breast pump
- Hospital grade breast pumps can be hired from the Australian Breastfeeding Association or your local pharmacy (your midwife can give you a list).
- Ensure the correct size breast shield is used as one that is too small can damage the nipple and will not adequately drain the breast.
- You need to express your breastmilk as often as you expect your baby to feed, at least 8 times a day if your baby is not breastfeeding, or between feeds if you need to increase your milk supply.
- If your baby is in the neonatal nursery you may like to look at this booklet about expressing milk for your baby.
Supplementing a breastfed baby with expressed breast milk
Finger feeding is a way of giving your baby expressed breast milk (EBM) without using a bottle teat as some babies may take preference to a teat and refuse the breast. Finger feeding uses a bottle with a thin tube rather than a teat.
Note: Nails should be trimmed short and artificial nails should be secure.
How to finger feed
- After washing your hands, securely wrap your baby.
- Sit in a comfortable position.
- Support your baby with a pillow.
- Using the index or middle finger gently stroke your baby’s lips from the chin upwards until baby’s mouth is open.
- Allow the baby to begin sucking your finger (with your finger pad towards the top of baby’s mouth).
- If your baby is sleepy gently introduce your finger into their mouth. If baby’s lower lip is sucked in pull down on the chin to release baby’s lip.
- Insert large end of the tube into the bottle below the milk line.
- Gently insert the tube along side your finger to the finger tip and raise the bottle so that the EBM flows down the tube.
- The technique is working if the baby is drinking. If the feeding is very slow – but the baby is swallowing well – raise the bottle to increase the flow. If your baby is gulping, lower the bottle to slow the flow.
Cup feeding is an alternative means of providing colostrum/expressed breast milk (not formula) to babies unable to attach and/or suck at the breast successfully. It is most successful when your baby is wide awake and interested.
- Wrap you baby securely.
- Support you baby in an upright sitting position.
- Fill a small clean medicine cup half full with expressed milk.
- Tip the cup so that the milk is touching your baby’s lips. Do not pour the milk into baby’s mouth.
- Tilt the rim of the cup touching the baby’s bottom lip, towards the upper lips and gums.
- As your baby’s jaw is lowered, a small amount of feed will be taken and swallowed.
- Leave the cup in the correct position during the feed as this allows your baby to self regulate the feed as desired.
- After use, wash the cup in warm soapy water and rinse well.
Paced bottle feeding for the older breastfed infant
Using a bottle is another method of giving your baby EBM. A bottle teat does not always allow a baby to ‘pace’ their intake as they do when breastfeeding. If the bottle is held vertically, the milk pours out. It is important to adjust the angle of the bottle to allow your baby to ‘pace’ themselves.
- Place your baby in a more upright position than ‘traditional’ bottle feeding techniques.
- Support the baby’s back so the baby’s head can extend into a natural drinking position.
- Use a slow-flow round teat.
- Stroke the bottle teat gently from the baby’s chin up to the lower lip to encourage him/her to make a wide-open mouth. When your baby has a wide-open mouth place the entire teat into his/her mouth.
Important: Avoid pushing the teat into a baby’s mouth that is not open.
- Hold the bottle horizontally so there is just enough milk in the teat. This will ensure no air is in the tip of the teat. This will encourage your baby to suck on the teat without gulping or using their tongue to slow the flow.
- Withdraw the teat slightly every few minutes to allow your baby to take a pause as they would naturally on the breast.
- Switch sides to assist with eye stimulation and to prevent preference for one side.
- As the amount of milk in the bottle decreases, gradually lean your baby backward.
How long should a ‘paced’ bottle feed take?
You should aim for the feed to take at least 20 minutes. If a feed takes less time than this the flow is too fast and if the feed takes more than 45 minutes then the flow is too slow.
Watch your baby’s cues to know when to finish the feed rather than encouraging them to finish the bottle.