When to initiate Expressing and why? Part One

When sitting down to write this topic we quickly realised this needed to be a few posts as there is just so much to cover – so please come back over the coming week to get all the info you need to support the question – When to initiate Expressing, and why?

Many mums are often surrounded with conflicting advice regarding when to start expressing. This weeks blog posts will look at when to start and the reasons behind you wanting to express.

For some mums expressing may never have crossed their minds at all and the unique relationship a mum has with her baby when nursing means she may never need to.  Other mums may have already considered that expressing is part of their feeding choice so that dad / partner / family can be involved in feeding. It may be that you have a special occasion coming up and baby can’t come along or you want to have some social time or go to the gym etc, it may be you are returning to work.  In all of these situations you will have a varying demand for the pump, but nonetheless you will need the support of a breastpump to ensure you leave expressed breastmilk for baby and can continue your breastfeeding experience for as long as you choose.

Whatever your reasons, if you are planning to express or not, every mum is now given information on hand expressing as part of their antenatal care and discharge pack.

 

Why information on hand expressing?

After birth, milk comes into volume around day 3-5 and often mums experience a sudden fullness and engorgement during this stage. Occasionally the pressure and tenderness within the breast at this time flattens the nipple and makes it difficult for your newborn to latch. Hand expressing a little of the milk off can soften the nipple and areola so that baby can latch on a little easier.

Managing engorgement in this early stage is a fine balancing act – as your milk supply is being established hand expressing supports this better. Using an electric pump can also support, but be cautious not to pump to empty at this stage as you don’t want to have challenges with oversupply and have more milk than you need leading you to still experience engorgement and potential mastitis.

You may also want to express a little milk off to mix in with medication or to support healing with sore and tender nipples.

 

When to initiate expressing?

Many health professionals would say wait 6 weeks before you start to express. There is a reason for this,  but to wait 6 weeks is not generally required, however there are a few things that need to be considered.

If baby is well and feeding ok with lots of wet and soiled nappies in the first week it is a positive sign that you and your baby are doing well at breastfeeding. You may find that your baby is feeding frequent with different nursing patterns, one, both or a cluster of breasts at a feeding session which is perfectly normal – their tummy is adjusting to the increase in milk volume and having lots of opportunity to feed and practice getting a good latch, with good burst of active sucking and swallowing of milk is good for you both.

In the first two weeks babies support mums milk coming in and also gives the milk making cells in the breast the ‘blueprint’ to make a good production of milk. The more baby nurses and removes the milk the better the cells work. Over these 2 weeks it could be said that this is the honeymoon period or some may refer to it as the crucial time to get milk production established in demand to what your baby needs. Investing in nursing at this time really does support having enough milk long term.

During these 2 weeks post birth your baby will also lose some weight as he adapts to life outside mum and this again is perfectly normal. Your midwife will expect around 10% weight loss and when they weigh your baby around 5 days postnatal age they will also do a feeding assessment with you. Chat with you to about your needs, how it’s going any worries.

Around 3 weeks of age your baby goes through another growth surge; again feeding and nursing patterns change becoming more frequent or longer and more night feeds. You may find that all you do is nurse and this is perfectly normal as long as baby is gaining weight and lots of wet and soiled nappies.

Trying to fit in expressing at this stage is difficult and your baby’s feeding pattern is unpredictable so it is best to wait a week or so whilst you support the growth surge and wait until your milk supply is well established. It is also a key time to start to understand and learn from your baby, what are his feeding cues, when he’s satisfied and when it is a power feed or just thirst.

At around 4 weeks of age you could consider starting to express. Watch and try and see when it suits your baby’s feeding pattern to do an expression session.

 

Tips to start expressing:

  • Expressing one breast just in-case little one wakes and wants a feed.
  • If your little one only feeds from one breast express at the same time or after from the other.
  • Once you learn your baby’s feeding cues you can express about 45 mins after you finish feeding as your breasts will have refilled
  • If you double pump you also get more available milk compared to single pumping as both breasts will release the milk with the milk ejection reflex at the same time, and you also get an additional milk ejection – just one unknown fact.

 

So coming back to why wait 4-6 weeks. It supports you and your baby to practice lots of breastfeeds. It ensures you learn about your baby’s feeding cues and nursing needs, supports your baby through the 3rd day and 3rdweek’s growth spurt and ensures that you have established your milk production to meet your baby’s needs to minimise difficulties that occur with over supply.