When to initiate Expressing and why? Part Two

You may have seen our post at the beginning of the week on ‘When to initiate expressing and why, as we said this is a vast topic so we broke it into two posts… today we look more closely at the Why you may express?

What if I don’t want to breastfeed but I want my baby to have my milk?

This is your personal choice and you can exclusively express your milk and give it via a bottle. You both get the health benefits and all the additional benefits associated with breastfeeding.

Initially you do need to express frequently 8-12 times for at least the first 14 days to get your milk established and then you can start to tweak the frequency but still maintain those crucial night feeds.


Will I still bond with my baby if I don’t breastfeed?

Yes of course you will, you will develop a wonderful loving relationship with your baby, the hormones for breastfeeding are the same for milk production and Oxytocin – The hormone for your milk ejection reflex is also the hormone of love. You can still have lots of skin to skin and cuddle time with your baby even if you choose not to breastfeed or express. But amazingly if you express when your baby is in skin to skin it will help with the stimulation for making milk and those essential milk ejection triggers.

Responsive feeding is still the same if you give your expressed milk in a bottle. Feed to your baby’s needs and also express when you need to – even if you are suddenly full and a little uncomfortable.


Medical indications to express

This is on the advice of a health professional when there are factors that mean that mum may have to express from birth,  or because mum has severe engorgement, mastitis, or may need to take medication. It could also be from babies point of view that they are unable to breastfeed for various reasons such as: when they are born prematurely, are term but separated from mum because they are poorly, they are unable to remove enough milk from the breast due to suck difficulties such as a tongue tie, cleft palate, or even when baby is very sleepy uncoordinated and jaundiced.

Some babies also get challenges after birth because of breathing and weight loss and as part of the breastfeeding assessment the midwife or health visitor may suggest expressing to help mum to increase and maintain her milk supply.

When a mum needs to express because her baby is unable to feed, or she is separated because her baby has been transferred to a different hospital it is important that mum gets her breastmilk to her baby and enough of it.

In this instant mums are encouraged after birth to initially remove colostrum by hand expressing to catch the small amount and use it preciously. Once mum is able to collect 5-7 mls of colostrum you should then move onto a hospital grade double electric breastpump to assist with milk coming to volume and to remove the milk comfortably and effectively.


How often do you need to express if baby cannot feed?

In the first few days day to early weeks you need to mimic a new-born’s feeding pattern and this means expressing 8-12 times night and day. During the night your breastfeeding hormones are at their highest whilst you sleep and having a couple of night time pumping sessions (just the same as if baby was nursing) boosts these hormones. It is advisable to have no longer that 4-5 hrs between pumping sessions at night. Once mum has established her supply she may find that she can achieve good volumes and reduce the frequency to every 3-4 hrs however this is dependent upon mum’s breast storage capacity and a small capacity may mean that this particular mum would need to feed or express often 2-3 hrly to keep her supply good.

Keeping an expressing diary can also help mum to keep track of their pumping schedule, the volume on average per day she is producing and also jot down little notes of when baby is making progress or having a difficult day so that she can record and see when a dip in volume may fall in with a change in expressing routine.


What if my midwife says I need to express to increase my supply?

Look at what is going on with your baby at that moment in time. Your baby may not be feeding very well and your milk supply is slowing down, or your baby isn’t gaining weight as well as they should. Your health professional may suggest that you express after a breast feed if lo isn’t feeding well so that you empty the breast effectively to keep your supply. Also you could sneak a couple of extra nursing sessions with a pump when baby is asleep to give you those extra opportunities to remove milk.

You may find that increasing your breastfeeds is all that is needed but occasionally pumping can also do this.


I can’t feed because I have mastitis and they are too sore.

Expressing can support you to remove the milk but ideally you need to increase breastfeeding first, look at the latch and frequency of breastfeeds and get additional support. The last thing you should do with mastitis is stop or feed less often. Try feeding every few hours or expressing to relieve the engorgement and then once this settles re-establish breastfeeding.