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Your question:

How can I express breast milk for my premature and sick baby in the first few days?

Expert’s answer:

Day 1 of my baby’s life – What can I do today?

In the first few hours after the birth of your baby you can start to express small amounts of milk for your baby. Massaging your breast and hand expressing your milk starts ideally within the first 1-2 hours, and definitely within 6 hours of the birth. You can express at your bedside, or in the neonatal intensive care unit (NICU). Breast massage may feel a little different at first but it really helps you to start to make milk for your baby. Your baby’s tummy is tiny and every drop of breast milk matters. The first milk your body produces   is called colostrum and is yellow in colour. It forms in your breasts when you are pregnant. It is full of important nutrients and antibodies for your baby. It is sometimes called ‘liquid gold’ because of its colour and importance and every tiny drop is precious.

As soon as possible after the birth of your baby ideally within the first few hours

  • Wash your hands carefully
  • Your midwife will talk to you about expressing. It may take a couple of times of hand expressing before you produce milk. If you have any questions or any difficulties please let your midwife or nurse caring for your baby know, so they can help you.
  • Massage your breasts and hand express your milk Continue to hand express your milk every two to three hours in the early days

“The midwife sat beside me and showed me what to do and I was very grateful because expressing is very unusual at the start”


Massaging your breast and Hand Expressing your milk

Wash your hands carefully.  Your nurse or midwife will provide you with a sterile syringe or container to collect your breastmilk

To help your milk flow, you can:

  • sit comfortably
  • relax and think about your baby
  • have someone massage your back and shoulders, and
  • warm your breast. A good way to do this is to put a warm facecloth over your breast

Massage your breasts. Gently roll your nipple between your fingers.

Place your thumb on the edge of your areola and your second and third finger on the opposite edge of your areola. This point is where the dark area around your nipple meets the lighter skin of your breast. As you can see your hand forms the shape of the letter C.

You then compress and release the breast tissue using rhythmic movements. Compress and release and as you can see a little drop of breastmilk appears

Try not to rub or slide along your nipple as this may hurt. After a little while of compressing and releasing a few drops of breastmilk appears and you collect this into a sterile container or syringe which your nurse or midwife will provide for you.

Colostrum tends to drip slowly as it is thick, later milk may come in spurts or sprays. Continue then to compress, release and collect. Compress, release and collect.

There are a number of ducts in your breast so you stimulate those as well by moving your fingers around the areola to release breastmilk from all areas of your breast. Massage your breast as you move your hand around the areola.

You will notice the flow slows down while you are expressing from the fi rst breast you then move on to the second breast. Beginning with heat, massage and then compressing and releasing the breast.

When you finish, the container or syringe is labelled with your printed baby’s hospital label and you will add the date and time you have expressed on this label. Click here for further information on expressing breastmilk.

For some mums it can be difficult to make milk for their babies at first and the amount they make can be very small. Factors like, having a Caesarean birth or if your baby is born very early, can delay your milk volume increasing. Try not to be disheartened if you produce a very small amount of colostrum or if your milk is slow to come in. Every single drop of your milk is important for your baby. The tiny drops you make are precious and will help your baby


Day 2-3 of my baby’s life – What can I do today?

Well done on all you have done in the first day to help to make milk for your baby. It is important to continue to massage your breasts and hand express your breastmilk today.

It is best to hand express your milk for the first two days following the birth of your baby. Your milk will start to change now from yellow colostrum to white breastmilk. Now you can start using a hospital grade double electric pump. During the first week or so, express at least 8-10 times in a 24 hour period, including overnight, to stimulate your milk supply. This might seem like a lot but it is similar to how often a newborn baby breastfeeds. Expressing this often will really help to make the milk that your baby needs. Your nurse or midwife will assist and support you to use the hospital grade double electric breastpump. Suitable pumps are available on the post-natal ward in the maternity unit and in the neonatal unit. Your nurse or midwife will give you a double pumping set and containers for collecting your breastmilk.

You will also need a hospital grade electric pump for using when you are at home. This can be rented, and your nurse or midwife in the post-natal ward or neonatal unit will give you details. You can rent a pump or contact Irish Premature Babies Charity for information of pump use when you are away from the NICU.  

Tips to help you get the most milk, in these early days, for your baby:
  • Massage your breasts after careful hand hygiene. Massaging and hand expressing after having a warm shower or applying a warm face cloth to your breasts helps your breastmilk to flow.
  • Take photos and videos of your baby. These are lovely to have for all the family, but are wonderful to look at when you express your milk as they will get oxytocin (your ‘feel good’ or milk releasing hormone) flowing, and so increase your milk flow.
  • Keep your baby’s smell with you. The best way to do this is to leave a muslin square in the incubator with your baby for a day. Then change the muslin and keep this close to you when you express so that you have baby’s smell. This helps the milk to flow when you express.
  • Remember to look after yourself also and try to get rest. Eat a normal healthy diet and drink to thirst. Some mothers feel thirsty when expressing milk so have a drink of water nearby when you are expressing.
Getting Ready to Express

It helps to have things ready before you start, to give yourself time and try not to feel rushed. This is a skill that will get easier over the next few days. Aim to express for about 20 minutes in total each time.

What do I need to Express
  • Sterilised double pumping expressing sets
  • Sterile container for milk collection or syringes in early days
  • Hospital grade pump (cleaned with sterile disposable wipes)
  • Printed Labels detailing your baby’s name, address and hospital number
  • Comfortable chair to sit while expressing
  • Sink to wash your hands before putting expressing set together
  • Sterile wipes to wipe down the breast pump and tubing
  • Drink of water
Helping your milk to flow
  • Wash your hands carefully
  • Massage your breasts before and during pumping
  • Stroke your breasts gently towards the nipple
  • Lean forward and shake your breasts
  • Stroke your nipples and roll your nipples between your fingers
  • Look at a picture or video of your baby while expressing
  • Think about your baby
  • Try to relax and get comfortable
  • If your baby is well enough express after you have held your baby skin to skin
  • Smell something that has your baby’s scent.
  • Place a warm face cloth on your breasts before expressing
Tips on helping milk to flow

Being near your baby, or stimulating your breasts, helps to release the milk from your breasts. This is the ‘let down reflex’ and it feels different to different mothers. Some mothers say that it is like a tingling and others say it is like a slight pain that disappears when milk starts to flow. Many other mothers report that they don’t feel any sensation but notice the milk dropping from their nipples.

Tip Before using any breast pumps it is important to gently massage your breast to trigger your let-down reflex.

Hands on Pumping (HOP)

Using a combination of hand expressing and pumping using a double electric hospital grade breast pump is the best way of expressing for your sick or premature baby. This is called Hands on Pumping (HOP). It also helps to pump from both breasts at the same time. The benefits of pumping both breasts together are

  • It is quicker
  • More milk is expressed
  • The milk expressed has higher fat content which is important for your sick or premature baby
  • Mothers who are expressing often have a drop in milk supply around week 3 but by using the hands on pumping technique the milk supply continues to increase weekly until week 6.
Steps for Hands on Pumping

Careful handwashing is important before you begin and your nurse or midwife is there to support and assist you the first time you use the breast pump. This includes ensuring the fit of the flange of the attachment is comfortable for you and the suction of the pump is correct.

  1. To begin wipe the pump and tubing with a sterile disposable wipe and then connect the sterilised expressing set and container to the tubing and to the pump.
  2. Sit in a comfortable chair with your back supported.
  3. It may help if you support your breast with your hand to help you to centre your nipple in the centre of the flange/funnel.
  4. Hold the funnel so that the pump can maintain a vacuum but try not to press the funnel too firmly into the breast tissue as this can prevent the milk flow.
  5. Turn on the breast pump. The pressure will be on the minimum setting and on ‘stimulating phase’. This continues for 2 minutes and then changes to ‘expressing phase’. Every woman needs different pressures, having pressure too high can cause nipple damage and will not help you to get any more milk.
  6. After the first few days, continue to express until the flow of milk slows down. Turn off the pump. Massage your breasts for a few minutes, do some hand expression, turn back on the pump. You can use the stimulation/fast cycle speed on your pump to help your milk to start flowing again. Then turn to slow cycle speed/ expressing phase on your pump to maximum comfortable pressure. Pump until the flow slows down and then stop.

Many mothers find by adapting a bra to hold the expressing sets to the breast whilst expressing allows them to do hands on pumping more easily

Expressing should not hurt! If your nipples are sore whilst using the breast pump

  • Discuss with your midwife or the nurse caring for your baby.
  • Rub some of your breastmilk on your nipple
  • Often mothers find a nipple balm or cream may ease any tenderness

If you are feeling sore, it may be

  • The funnel of the breast pump may be the wrong size for you. Different sizes are available.
  • The breast pump suction pressure may be too high.
  • The breast pump funnel may have been removed before you turned off the suction pressure.


Your Baby’s first few weeks

You have learned the important skill of hand expressing on day 1 and 2. You may notice that your milk is changing from yellow colostrum to more plentiful white coloured milk.

After Day 2, you will need to start expressing your milk using a hospital grade double electric breast pump. Pumping from both breasts at the same time (double pumping) stimulates the hormone Prolactin. This will help increase your milk supply to meet your baby’s needs.

During the first weeks continue to express at least every 2 to 3 hours, including overnight, to help make plenty milk for your baby. It is best to leave no more than one five hour gap at night.

  • Express your milk 8-10 times in 24 hours and at least once at night between midnight and 6 a.m.
  • Double pump using a hospital grade electric pump



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