Expressing Milk - Who, Why and how!
Not every woman can breastfeed and not everyone wants to, but if you have milk and feeding from the breast isn't possible then full time expressing should be considered as an exclusive feeding option.
Unfortunately there is a lack of support for this type of feeding with many women encouraged to just go onto formula if they can't feed from the breast. It isn't by any means an easy option (although every type of feeding has its positives and negatives) but if you want your baby to get all the health and nutritional benefits of breastmilk then it is certainly possible to exclusively feed expressed milk for as long as needed.
I expressed for a whole year and learnt lots of things about breastmilk and making the most of what nature gave me.
Photo: Here is a picture of my cute boy at just over 3 months, fed exclusively on breastmilk.
My Expressing journey
Before my son was born I was determined I would breastfeed. It was important to me that he got all the health benefits of breastmilk and I really didn't want all the routines involved in making formula. When he was born he had other ideas though and would either fall asleep or scream when put to the breast. Despite help from several nurses and midwives, 6 hours after he was born we made the decision to give him formula. This felt like a massive failure to me.
As he was a caesarean section birth he had some fluids in his stomach still and he began to vomit up all the formula that was given to him. By day 3 he was screaming with a combination of hunger and reflux pain and was being fed just 10ml of formula every 4 hours through a tube in his nose, most of what went in came back out.
It was a very distressing time. What should have been the most natural thing in the world wasn't happening for us. We tried shields, various positions and tried to nurse at every feeding time with no success. We had midwives helping throughout my stay in hospital but despite everyone's best efforts he wasn't feeding well and wasn't thriving on either regular or lactose free formula.
So 3 days after his birth I decided to try expressing. I felt that breastmilk was what he needed and I spent a frantic afternoon searching the internet for advice and information on how to go about providing the breastmilk my baby needed without actually breastfeeding. It seemed I had missed the boat with most websites telling me I should have started pumping straight after the birth.
I found the task ahead extremely daunting. I bought a secondhand manual breast pump from a friend (an Avent Isis) and gave it a go. Manual breast pumps are not the most glamorous things to use, they squeak and fart and you feel like a dairy cow being milked. Despite no milk leaving my body for 3 days after the birth, I was hugely impressed with myself though as I managed to express 40ml of orangey-yellow colostrum in my first session.
For the next 3 days, I fed the baby 20ml of breastmilk every 2 hours, changed him, put him back to sleep then expressed again. I was making just enough milk to keep this up but It doesn't need to be said that I got pretty much zero sleep. The breast milk worked wonders and within a day he really began to pick up. He stopped losing weight, stopped screaming with pain (and hunger) and was not vomiting so much. By day 6 we were discharged from hospital.
I continued expressing at every feed. I was lucky that my husband had 5 weeks off work so I had a lot of support which allowed me to concentrate on establishing my milk supply. We did still top up with formula for the first few days but by the fourth week, I was starting to freeze excess milk. I continued to express and exclusively feed expressed breastmilk until we started weaning at 6 months. I then carried on expressing until 10 days after his first birthday.
Get the Avent Isis manual pump
My manual Avent Isis pump was my best friend in the early days.
How much milk will I need to make?
All babies are different and some will drink a lot more or less than others. I recorded how much milk my baby drank each day for the first 9 months and have listed the amounts at the bottom of this page.
Babies requirements for breastmilk are lower than if they were drinking formula, as breastmilk is more efficiently digested by the body. Most breastmilk fed babies will take around 90-150 ml (3-5 oz) in each feed whilst many formula fed babies will take over 200ml (7-8 oz). Breastfed babies demands for milk don't increase from 1-6 months so they should still want around the same amount at 5 months as they did at 2 months. The average intake for babies between 1 and 6 months old is 750 ml a day (25 oz)
The first few days after birth your milk will be almost yellowy orange in colour, this is colostrum and you will get only a small amount of this. Baby only has a very tiny stomach at this stage: the size of a marble so don't worry if it doesn't seem much. Around day 5 your milk should come in, you will know when this happens as your breasts will feel very full and heavy. At this stage your supply should increase to between 500ml-800ml per day.
Your milk will then go a more buttery colour and you will start to produce larger quantities. If by day 10 your supply is lower than 750ml you may need to take a supplement such as fenugreek, Metodopramide (reglan) or Domperidone (motilium). If your supply at 10 days is less than 500ml and you have tried all methods to increase supply then you may have to consider mix feeding or formula feeding. By around 3 weeks your supply should be established and fairly reliable, you may be able to pump less often or go longer between expressing sessions, although some people find they have to maintain a rigourous expressing schedule to maintain supply.
To work out how much milk you need you can multiply the number of feeds your baby has per day by the amount of milk in each feed. Breastmilk digests quickly so feeds would normally be between 1.5 - 3 hours apart. Breastmilk is digested efficiently and so each feed is generally smaller than the equivalent in formula.
A baby's stomach capacity is tiny. At 1 day old, it can hold around 5-7ml. By 3 days it can hold around 22-27ml. This increases to 45-60ml by 1 week and 80-150ml by 1 month old.
Trick your body into making more milk
Many people will tell you that a pump is never going to be as efficient as getting breastmilk out as a baby is. This may be true if you breastfeed and also express but if you exclusively express then the pump is your baby. Ugly as it may be, don't hate your pump. You need to be producing love hormones to make lots of milk so think nice thoughts about your pump. Keep your baby nearby, or even look at a picture of it to keep the hormones flowing while you pump.
I used 2 pumps. A manual Avent Isis pump and an electric Mothercare Innosense pump. I believe that by using the two different pumps at different times of the day I tricked my body into thinking it was feeding 2 babies. I stopped using the manual pump after about 5 months and my supply dropped quite sharply at this point. The manual is tiresome compared to the electric and is hard going on the forearms but it is useful to have a back up pump for when you haven't had chance to sterilise your pump since the last session, or when you need to pump quietly. If you are in a public place a manual pump is often easier and more discreet to operate.
Figures on how much milk I produced each day and how many times a day I expressed can be found at the bottom of this page.
How to choose a breast pump
There is a huge variety of breastpumps on sale these days. It is actually a daunting and complicated prospect trying to choose which is best. I already had my manual pump when the baby was born but wasn't expecting to use it. As I was confined to hospital when my son was born it was left to my husband to go and buy me an electric one to make the job easier.
From advice I found on-line, Medela seemed to be the most recommended brand and the "swing" model the most popular. So I sent my husband off to find out prices and what was available. The Medela models were priced between 150-180 Euro which was an expense we hadn't budgeted for and really was beyond what I wanted to spend. So my husband chose a Mothercare own model pump from their Innosense range.
At that time the Innosense range had only recently been launched and so there were few reviews available online, but the price (around 85 Euro) was reasonable and so we gave it a go. Like all pumps it has it's plus points and negatives but overall I was pleased with the pump and it served me well for a year. It could also be run on battery power as well as mains electric which I found very useful on long car journeys.
The improvements I would make to it would be to change the body from frosted to clear plastic so you could easier see what was coming out, and to improve the valve which often got overwhelmed by fast flow of milk.
I found I would generally spend around 10-15 minutes on each breast to empty it fully. Double breast pumps can do the job quicker than a single, but do give more of a dairy cow feel to the whole process. Electric pumps are generally quicker but may not empty the breast fully if they don't vary in speed or pressure, a good pump will gradually increase in pressure or allow you to control the pace, simulating a baby's sucking. A manual pump can allow you to vary the pace and pressure and is much quieter, although will probably take longer to empty the breast.
I found it best to have both a manual and an electric pump and this certainly made keeping on top of the sterilising easier. If you need to pump every 3-4 hours, sometimes the time to clean and sterilise your pump isn't available so having a back up was a lifesaver at times.
Did you express milk?
How long did you express for?
Increasing and maintaining milk production
Top tips for top milk!
Empty each breast as thoroughly as possible each time. Continue expressing for a couple of minutes after the last drops. Pumping for 2-5 minutes after the flow stops tells the breasts to produce more next time. Some people recommend hand expressing to finish, I never did this but I found squeezing whilst pumping effective.
Massage breasts before and during expressing. A good 5 minute massage before you start will encourage the milk ducts to start flowing. In the early days you may not get more than a few seconds of massage before the milk leaks out. collect as much as you can, don't waste any.
Skin to skin with baby and bringing baby to your breast will increase your output. The hormones needed to produce milk are released when you are close to your baby.
Express while looking at the baby or are close to it, or even looking at a picture of it to raise your hormone levels. If you pump in a room away from your baby, especially in the early days, you may find you will produce less milk. Don't worry about the sound of the pump waking the baby. The hum of the pump is great background noise and may actually send the baby to sleep.
Express every 2-3 hours round the clock until supply is established. Prolactin (the hormone that makes milk) is at its highest between 1am and 5am so try to pump at least once between these hours. You need to mimic a newborn's feeding pattern to train your body to produce regularly enough.
Once your supply is established take a break of 4-5 hours at least once in every 24 period (to simulate baby's night time sleep), but don't go more than 6 hours without expressing.
You may find it handy to keep a chart of your schedule to keep track of times and number of sessions. From the research I did online, the suggested number of expressing sessions per day was 8. I only expressed 8 times for the first week or so, I was down to 7 times by week 3 then dropped down to 5 times by 3 months. I continued at 4 times a day until 7 months, when I dropped to 3. My supply dropped gradually as I pumped less times.
You will produce more milk if you rest so if you need to, skip a pumping session and sleep. You will produce more if you are relaxed and rested and look after your own health.
Keep drinking lots of fluids, you will feel thirsty and will dehydrate easily. Breast milk has a high water content as it is also a drink for your baby so several litres of water each day are needed or your supply will drop.
Avoid sugar free and diet drinks as most contain phenylalanine which lowers prolactin levels.
Eat oats, jumbo rolled oats you cook on the hob are best but you could also try snacking on muesli, flapjacks, oatcakes or cereal bars. You will feel hungry as milk production can burn 500-800 calories a day. Eat well. Take iron and calcium supplements if your diet isn’t high in these.
Don’t set alarms to wake up and express in the night, you will produce more if you wake naturally. Rely on your baby to wake you and express when they wake (after they've fed or while someone else feeds is best)
Add shorter less productive sessions to raise supply by telling your body to make more. An extra expressing session can encourage it to make a little more. It takes 1-4 days for breasts to respond to changes in demand though so just one extra session probably won't do a great deal.
Don’t take decongestants or medicines containing pseudoephedrine, as it lowers supply.
Essential expressing equipment
The best thing for cracked and sore nipples. You don't need to wash it off before expressing.
Good comfortable nursing bra's make life much easier.
My flirtation with formula feeding.
Expressing full time is mentally as well as physically challenging. You have to stay positive about expressing and stay focused on why you chose to do it. If you can't remember why you are doing it or don't want to do it anymore, then nothing is stopping you from going and buying formula.
Mix feeding is considered to be a "best of both worlds" situation for many with both formula and breastmilk being fed at different times. Some women choose to top up with formula, especially at night as it takes longer for the baby to digest and so can make them sleep a little longer through the night. If you choose to include formula in your baby's diet then there is a good chance your milk production will rapidly decline unless you continue to express as much as before. You would have 2 options at this point, either go with formula feeding full time or attempt to increase milk production, which isn't always possible once it drops.
Switching to or supplementing with formula isn't always easy. At 5 months and again at 8 months I tried to introduce formula. Apart from during his first week, my baby had had only breastmilk and by 5 months I was finding expressing very hard going. The baby was more active and was sleeping less. The time I had in between feeds was minimal, I was exhausted from lack of sleep and my husband was working 7 days a week at that time. My milk supply was dropping, and I was only expressing 4 times a day by then but despite the tiredness I tried to increase to 5 or 6 times a day. This really wasn't sustainable and didn't produce much more milk for the extra effort.
I tried to introduce formula, just one feed a day to take the pressure off myself. At 5 months though, the baby is starting to know what it likes and what it does not like. Formula smells very different, personally I think it stinks so maybe he picked up on my negative thoughts, it's also a lot thicker and obviously tastes different. He took maybe 50ml - 80ml of formula here and there but wasn't enthusiastic and within a week it was outright refused, despite trying 3 different brands of formula and 3 different types of bottles, a sippy cup, hot milk, cold milk etc.
We decided to start weaning at 5 and a half months and muddled through with what I was expressing, some frozen milk, and introduced a range of solids which combined provided enough food for him. At 8 months I wanted to give up expressing. He had taken well to solids and was enjoying a range of new tastes so I tried again to introduce formula. My milk supply had dropped yet again but it was way too early for him to wean off milk completely. I was producing around 300-400ml a day which was less than the recommended amount that he should have been drinking.
It didn't work out and he once again refused any attempts to get him to drink formula. He was drinking less and less breastmilk though and much preferred eating solids. He was drinking a lot less milk than I expected at this stage and compared to other babies so I did worry whether he was getting enough calcium and other nutrients. Around 11 months I started to mix the little milk I was producing with cows milk and this was generally accepted but only when he was sleepy. He quickly reduced to one small milk feed a day. I was expressing first thing in the morning and last thing at night only and the freedom to go all day without having to pump was lovely.
By his first birthday I decided to drop to expressing just once a day, in the morning to match his one milk feed a day. My milk supply was virtually non existent at this point, around 100ml a day so within a couple of weeks I decided to stop altogether. We continued offering a cows milk feed but he wasn't very keen and never finished a bottle.
Some days will feel like this
The bad points about expressing
You have to feel happy and confident in your decision to express otherwise you will quickly start to feel like a slave to the pump and restricted in your day to day life. Many women will give up inside 1 month.
Feeling like a slave to the pump is common. It may seem that you're constantly attached to your pump like a dairy cow. Negative feelings towards your pump will result in a lower output of milk so try and remain positive. Think of your pump as a baby you have to feed. Remember why you decided to express in the first place and be determined to stick to your regime however hard it may seem. This time will pass quicker than you know.
You will find yourself in a grey area with little support from breastfeeding women and little from formula feeding women. Most people will not understand why you make things harder for yourself and create work by expressing.
You will worry endlessly about dwindling milk supply. Are you making enough, is the baby getting all it needs, should I express more, What if my milk dries up. There isn't much you can do about the worrying.
You may find you prefer to stay at home rather than go anywhere due the equipment you have to carry around and the inconvenience of finding somewhere to express whilst out in public places. It is possible to express almost anywhere, especially if you have a manual or battery operated pump. Bring along a cool bag and ice pack for the milk or feed it as needed.
Expect to not have a huge amount of free time, especially in the early days. A supportive partner, family members or home help is essential. A baby's routine is usually repetitive every 2 to 3 hours and once you add expressing into your timetable you will need to be super efficient. Catching up on sleep or housework while the baby naps may not be possible. You will be sleep deprived anyway with a newborn plus milk production burns up a lot of energy (as well as calories). Once you factor in expressing and then cleaning and sterilising equipment you will not get much rest.
Having someone else feed the baby whiles you express may be the easiest way to manage in the early days after birth to get your supply established and produce enough milk but this can mean lack of bonding time with baby.
As with breast feeding, you can expect sore and cracked nipples and heavy full breasts.
You will need quite a lot of equipment. Pumps, storage cups, freezer bags, bottles, teats, steriliser, bottle brush and nursing bra's are the basics.
Storing your milk
Expressing on demand for each feed is highly impractical and so you will need to store your expressed milk. Breastmilk can be stored in the fridge until it's needed or can be frozen for up to 6 months. Try and put only as much as your baby will drink at each feed into each container to avoid waste and contamination.
You can express directly into the bottle you will feed with, however it is more practical and efficient to use storage containers in the fridge and then transfer the right amount into feeding bottles when needed. Otherwise you will need lots of bottles and a large fridge! Avent and other companies do storage containers which can also be connected to their pumps for expressing and teats for feeding. Milk storage bags are ideal for the freezer as you just pour the milk into them, seal them and they stand upright. Always leave space at the top of the bag or container as the milk will expand when it freezes. Remember to mark the date on each storage bag.
Different sources state different guidelines on the amount of time milk is good for when refrigerated. If in doubt, smell it. It gets pretty funky when it's off. Human milk smells a little like cows milk. It smells nothing like formula. You can usually keep the milk at room temperature for an hour if you are coming up to feeding time, some sources suggest up to 4 hours. In the fridge, it is usually ok for 2-3 days but personally I tried to always use expressed milk within 24 hours and freeze any excess.
As breastmilk has a high water content, when stored it will separate into a thin, watery blue/green layer at the bottom and a thick cream layer on the top. Do not shake breastmilk, just swirl gently. The fat will separate from the whey on storage, so standing the storage cups upside for a few minutes or warming (if using straight away) will mix the milk.
Milk storage essentials
To express full time you need to be efficient so having your milk storage systems organised is essential.
The best thing for storing excess milk in the freezer.
Using refrigerated and frozen milk
Most babies won't take milk straight from the fridge and cold milk can make some babies vomit it straight back up so warm expressed milk by standing the bottle or storage cup in a jug or pan of hot water for a couple of minutes. Alternatively it can be ran under the tap until warm enough. Test the temperature of the milk on the inside of the wrist as you would with formula.
Frozen breastmilk needs to be used straight away once it's defrosted. It goes off a lot quicker than when it's fresh. Either thaw under a running tap or in the fridge. Frozen breastmilk tends to separate and can smell almost soapy compared to fresh breastmilk.
It isn't recommended to microwave breastmilk or to thaw frozen breastmilk in the microwave as it can cause hotspots.
Don't mix freshly expressed milk with that which has been previously cooled or frozen unless you are about to feed it straight away as the warmer fresh milk with raise the overall temperature of the milk and increase the speed it will spoil.
Cleaning your pump and equipment
Breast pumps need to be kept clean and it is best to sterilise all the parts after each use. Breastmilk is greasy and sticks to bottles and pumps. A sturdy bottle brush is need to scrub everything with hot soapy water before sterilising. Choose a steriliser with space for all your pumping equipment and not just bottles.
Make sure your steriliser has space for your pump, suction pad and storage cups as well as bottles.
I found this brush to last longest against vigorous cleaning
Milk Output vs Milk Consumption
I recorded how much milk I expressed and how much the baby drank from one week after he was born for 9 months.
The records below show how much milk I produced each day, How many times each time I expressed milk and how much milk the baby drank each day.
My Milk Productiion
How much milk I made!
How many times a day I expressed milk
My pumping routine!
How much milk my baby drank
Milk consumption of my baby from birth to 9 months
Read more about it!
Want to read more about expressing? Get in depth advice and insights into different women's experiences with expressing milk.