Mother`s Expressing Breast Milk` - Our Lady`s Children`s Hospital
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1. Created by OLCHC Staff March 2011 10 e How do label the eer expressed breast milk Date of Birth bottles Hospital Number at Label each express breast milk oe Name ait xpressed D Frozen Date _ Time Thawed Date Do not yee after bottle using the hospital Expressed Date Breast Milk labels where available Mother me rs Time EE Remember to include your name Motheg s Medication Foci Yes Ne ignature _ baby s name date time expressed hospital ID number ward name and if taking any medication Breast Milk Label e lam taking medications what should do If a doctor has prescribed medicine for you let them know that you are providing breast milk for your baby to ensure the medication is suitable Remember to tell the nurse and doctor caring for your baby if you are taking any medication Check with the pharmacist doctor if you need to take medication prescription or over the counter medicine or herbal remedies when you are breastfeeding expressing as some are not recommended for mothers that are breastfeeding expressing or may decrease your breast milk supply If you discuss birth control with your doctor remember to tell him her that you are breastfeeding expressing as this may affect the method of birth control they prescribe Do not forget to write the medications you are taking on the breast milk label e My nipples are sore from using a breast pum2. Push the thumb and two fingers into the chest wall e Roll the thumb towards the nipple like taking a thumb print changing pressure from the middle finger to the index finger e Aim the nipple into a bowl container to collect the breast milk e Repeat the position push roll action until the milk duct is empty e Rotate the thumb and finger position C shape around the breast until the breast is empty 1 C Hold Position 2 Push to chest wall 3 Roll 4 Finish Roll 5 Rotate position around the nipple e When and how do I clean and sterilise expressing equipment All new expressing sets for breast pumps or bowl container if hand expressing must be e washed in warm soapy water e then sterilised in either e an electric steam steriliser e asterilising unit containing water and a sterilising tablet acticlor e This must be done between each expression You will receive your own expressing set or bowl do not share with others The expressing set tubing does not need to be sterilised but once visibly clean they can be stored in a clean plastic container after each use Breast pumps are shared by mothers in the hospital Pumps must be washed with warm soapy water and dried with a paper towel before and after use Created by OLCHC Staff March 2011 6 e How do l express with a breast pump e Assemble the expressing set once cleaned and sterilised as above connect the tubing to the pump
3. and the funnel e Sit in a comfortable chair with your back supported e It may help to support your breast with your hand by placing your thumb on the upper side of your breast and your fingers on the other close to your ribs this position will help perform Breast compression for the HOP Method This will also help to centre the nipple and areolar area into the funnel e Turn on the breast pump The pressure will be at a minimum setting gradually increase the pressure on the breast pump up to the maximum comfortable level for you e Continue to express until the flow of breast milk slows down and stops Massage your breasts for 1 2 minutes and express any remaining milk either by hand expressing or pumping Pump for a further 1 2 minutes Turn off the breast pump Remove the funnel It is important to ensure that the breast pump is turned off prior to removing the funnel to avoid hurting your breast Continue to the other breast if single pumping e The Medela Symphony breast pump uses two phase expression to mimic a baby s natural breastfeeding rhythm rapid stimulation Phase 1 followed by slower expression Phase 2 It is normal for the breast pump sound to change and sound slower during Phase 2 e How do know if the breast pump funnel fits my nipple correctly e When the breast pump is turned on the e Nipple should move freely in the breast pump funnel and be pain free e Areolar tissue is pulled into the p
4. continue expressing breast milk until your baby is totally established on breast feeds this will keep your breast milk supply Most two week old babies go through a growth spurt and feed frequently for 24 48hours to increase their mothers breast milk supply Researchers advise mothers expressing breast milk for sick or pre term infants to express more frequently hourly for about 8 hours during this time This mimics the increased frequency of feeding by breastfeeding babies so as to increase mother breast milk supply We understand that this is time consuming and difficult when you have a baby who is sick but it will increase your breast milk supply to meet your baby s needs If you do not have much time it is better to pump for short periods 5 10minutes more frequently than to leave long gaps between pumping sessions e Can I express breast milk from both breasts at the same time Yes this is also known as double pumping from both breasts at the same time It can save you a lot of time and work Research has shown that double pumping may increase your breast milk supply especially if your baby is premature e How do l increase my breast milk supply The following tips may help e Get plenty of rest Choose a comfortable seat and private place so that you can relax while expressing e Do not feel rushed while expressing e Make time for meals snack regularly have plenty of drinks available e Express more often if necessa
5. first 24 48 hours this is normal Later on the amount of breast milk you express may change depending on the time of the day and how you feel Try not to compare yourself to others as everyone is different Some mothers who are expressing regularly can quickly get 90 120ml from both breasts every three to four hours Others mothers simply cannot express such big volumes at one time and find it easier to express small amounts more frequently e g up to 30ml every 1 2 hours A few mothers may find it difficult to express even though they have a good supply and the baby is thriving If your breast milk supply is less than your baby s feeding needs your baby will be either given some of your frozen breast milk supplies or supplemented with artificial feeds until your breast milk supply increases e My breast milk supply has reduced why Your breast milk supply may reduce for many reasons especially if you are e Stressed e Not expressing frequently enough Engorgement e Mastitis or blocked ducts e Breast pump funnels are too large or small e Sick unwell due to an illness Created by OLCHC Staff March 2011 p e How long should I express each time This depends of the method of expressing you chose Breast milk may take 1 2 minutes to flow when you start expressing e If single pumping Breast milk can be continuously expressed from one breast only for a few minutes before the supply slows down or appears to
6. sterilise expressing equipment How do express with a breast pump How do know if the breast pump funnel fits my nipple correctly How often should express How do increase my breast milk supply Are there ways that I can establish a good breast milk supply What is Skin to Skin Contact Kangaroo Care How much should I express Can express breast milk from both breasts at the same time My breast milk supply has reduced why How long should I express each time Do I have to measure the volume of breast milk expressed How do label the expressed breast milk bottles I am taking medications what should do My nipples are sore from using a breast pump Why did this happen and what should do Should try to stimulate my baby s suck when they are not feeding from the breast What do store the breast milk in What do I need to know when sto ngt breast milk How will my baby receive breast milk How do I defrost breast milk What do I need to know when transporting fresh frozen breast milk to and from the hospital My baby is starting back on feeds which breast milk will they get Why does my breast milk need to be fortified Will always have to tube feed my baby What do I do with extra breast milk What is a Human Milk Bank How do wean correctly How will look after myself while expressing Renting or buying a breast pump Reference List List of Useful Breastfeeding Literature and websites Other Useful Breast
7. stop Breast milk should then be expressed from your other breast Then go back to the first breast and start again Keep changing breasts until the breast milk stops or drips very slowly e If double pumping It is a faster and more effective than single pumping especially if expressing for longs period of time Double pump until your breast milk flow stops and then for an extra 1 2 minute i e If hand expressing Continue to express from one breast and then move to the other 2 breast see single pumping instructions C0 e It is important to empty your breasts as A thoroughly as possible as breast milk increases in fat as the expressing time Double Pumping progresses i e Dol have to measure the volume of breast milk expressed No but it may be helpful to keep a record of your breast milk volumes so that any decrease can be acted on a Log for Mother s Expressing Breast Milk is available from your nurse It is best to judge your breast milk volume in a 24 hour period than each time you express as the volume of breast milk at each expression period may vary Log for Mother s Expressing Breast Milk Date of Time of Type of Volume mis per Total Daily Comments expression expression Expressing expression Volume mis Type of Expressing HE Hand Expression MHH Manuel Hand Held EH Electric Hospital Grade EHH Electric Hand Held
8. Ospid at huire na Leana Our Lady s Children s Hospit Crumlin INFORMATION LEAFLET FOR MOTHERS EXPRESSING BREAST MILK Our Lady s Children s Hospital Crumlin OLCHC encourage mothers to provide breast milk for their babies when they are in hospital All babies whether well or sick benefit from breast milk There are factors in breast milk that may help prevent infections Breast milk is very easy for your baby to digest and specifically designed to meet each baby s different needs When a baby is sick or born prematurely they may not be strong enough to get all their nourishment at the breast At this time you will need to express your breast milk for your baby This leaflet should give you guidance on how to do this Where children s health comes first Created by OLCHC Staff March 2011 1 Table of Contents Frequently Asked Questions Why should express breast milk for my baby What does expressing breast milk mean How do express breast milk Which expressing method do I choose Is it better to hand express or use the breast pump to express How do do Hands on Pumping HOP Where can I express breast milk in the hospital How soon can start expressing How do I prepare to express How do stimulate the let down reflex just before expressing What do I need if want to express Do wash my hands before expressing and how How do I hand express When and how do I clean and
9. alth Expenses form under the section called Expenses incurred on any medical surgical or nursing appliance For more information contact www revenue ie If your baby was born prematurely in Ireland Medicare has kindly agreed to give a 12 5 discount on breast pump rentals Please quote the Irish Premature Babies Organisation with their sales staff when renting your breast pump Created by OLCHC Staff March 2011 14 Always remember if you have been expressing you can start or restart breastfeeding whenever your baby is able Please do not hesitate to talk to your nurse If you have any concerns or further questions regarding expressing breast milk Please do not hesitate to talk to your nurse Reference List Gotsch G 1999 Breastfeeding your premature baby Le Leche League International London King C and Jones E A 2005 Feeding and Nurtition in the Preterm Infant Elsevier London Morton J Hall J Y Wong R J ThairuL Benitz W E and Rhine W D 2009 Combining hand techniques with electric pumping increases milk production in mothers of preterm infants Journal of Perinatology 29 757 764 West D and Marasco L 2009 The Breastfeeding Mother s Guide to Making Milk McGraw Hill London List of Useful Breastfeeding Literature and websites Baby Friendly Hospital Initiative in Ireland www ihph ie babyfriendlyinitiative Health Promotion Uni
10. d pumps suction is created by squeezing a handle which can be tiring after awhile They are a cheaper option and are easily available to buy in your local pharmacy e Electric pumps are available in either hospital grade or hand held versions e Electric hospital grade pumps are a good choice if you have to express for a long time or if expressing more than a couple of times a day There are several types and most can be adapted to allow single or double pumping e These pumps are expensive to buy but can be rented for home use See pg 14 e Medela Symphony is the electric hospital grade breast pumps available in OLCHC e Electric hand held pumps are good for expressing for short periods of time or if expressing the odd time They are a cheaper option and are easily available to buy in your local pharmacy They are available in battery or mains operated versions e Information sheets are attached to the electric hospital grade breast pumps within OLCHC about using the breastfeeding pump and how to assemble clean and sterilise the expressing sets e Hands on Pumping is a combination of both breast compression breast massage while using a electric hospital grade pump See pg 4 e Hand expressing is the most basic way of expressing and is an important skill to learn as it provides you with a way to relieve fullness or to express breast milk for your baby in any situation It is also a convenient and cheap way to express C
11. feeding Websites Notes Created by OLCHC Staff March 2011 2 OOOOVOONNODANANAARAA AAW W W 11 11 12 12 12 12 12 12 13 13 13 13 13 14 14 15 15 15 16 FREQUENTLY ASKED QUESTIONS e Why should I express breast milk for my baby The breast milk you provide for your baby is easier to digest and better suited to the needs of your baby than any other milk and particularly for premature babies Breast milk is far more than food it is more like a first vaccination It is very rich in antibodies to fight germs your baby may come in contact with so each drop is precious It can protect against infection as babies who receive breast milk have fewer colds diarrhoea allergies and ear infections While your baby is sick they may be unable to feed directly from the breast or their feeding pattern may change Therefore in order to establish and or maintain your breast milk supply for when they are well enough to feed again you should express your beast milk e What does expressing breast milk mean Expressing breast milk means squeezing milk from your breasts either with a manual or electric pump or by hand It is the only way apart from breastfeeding itself which releases breast milk Once you express the breast milk you can store it in bottles or containers to feed your baby at a later date e How do l express breast milk You can express by the following methods e Breast pumps e With manual hand hel
12. feel rushed Choose a comfortable seat and private place so that you can relax while expressing 2 The let down reflex can be stimulated by i mm e Massage your breasts gently with your fingers Massage in small circular motions around each breast from the chest towards the nipple There is no right or wrong way to massage Hl Stroke e Stroke your breasts from the chest towards the nipple with a light tickle like stroke e Lean forward and shake your breasts gently e Warm moist compress such as a face faae cloth can be placed on the breasts Shake What do I need if want to express If expressing with a pump e Expressing breast milk bottle Sterile e Expressing set Clean and Sterile e Expressing breast milk label e Breast pump Clean e Hand washing facilities If expressing by hand e Bowl Container Clean and Sterile e Do wash my hands before expressing and how You must wash your hands before handling breast milk and expressing equipment Step 1 Step 2 Step 3 This is to prevent dirty hands contaminating the breast milk h Wash your hands with either y e soap and water if they appear dirty Step 4 Step 5 Step 6 or e apply alcohol gel if they appear clean using Steps 1 7 Step 7 Created by OLCHC Staff March 2011 5 e How do I hand express e Position the thumb and 1 two fingers in a C shape about 1 2 inches behind the nipple e
13. ither by pumping or hand expressing For this to be possible while double pumping you may need to adapt a bra or buy a specially designed one available to buy from http Awww onceborn com to hold the funnels leaving both your hands free to do HOP e Where can express breast milk in the hospital You can express breast milk in your baby s room in an expressing room where available on your babies ward St Peter s Ward Nazareth Ward parents rooms St Theresa s Ward PICU1 PICU2 in parent s accommodation or at home e How soon can start expressing Ideally the sooner you start expressing the better as your breasts receive the message from your brain to make breast milk as soon as your baby is born If your baby cannot start breastfeeding within the first few hours of birth breast milk should be expressed This is best done in the first few days of birth by hand expressing e How dol prepare to express Whether you are expressing by hand or by a pump you need to stimulate your breasts to release breast milk The release of milk from the breasts is called the let down reflex Your baby stimulates the let down reflex by starting to suckle on your breast So if you are expressing you must use other ways to stimulate the let down reflex Created by OLCHC Staff March 2011 4 e How do I stimulate the let down reflex just before expressing Give yourself plenty of time do not
14. k Bank is a service which collects screens processes and dispenses human breast milk donated by nursing mothers These nursing mothers are not the parents of the receiving infant The human milk bank that provides donor breast milk for OLCHC is called Sperrin Lakeland Human Milk Bank This bank is situated in Irvinstown Co Fermanagh and is overseen by the United Kingdom UK Association of Milk Bank Guidelines and the National Health Service NHS in the UK For more information about Human Milk Banks please contact http www ukamb org Created by OLCHC Staff March 2011 13 e How do I wean correctly Firstly congratulation for breastfeeding and or expressing for as long as you did Weaning starts when your baby begins to take anything other than breast milk and it is a natural stage of any baby s development Despite your reasons for weaning gradual planned weaning will be the easiest on both yourself and your baby Gradual planned weaning means stopping one breast feed or time you express per day every 2 3 days This allows your breast milk supply to decrease slowly without causing breast fullness or discomfort It will also give you time to make sure your baby is adjusting well to their change to formula milk For further advice about weaning ask your baby s nurse e How will look after myself while expressing It is important that you maintain a healthy diet and lifestyle for both you and your baby whi
15. le in hospital You should e Get enough rest and sleep so that you have energy to care for both your baby and yourself e Eat a healthy diet Eat regular meals e Drink to thirst e Avoid alcohol Alcohol does pass into breast milk so ideally keep your drinking within the limits recommended for pregnant women which is no more than one or two units per week Extra alcohol of any type will not increase your milk production and may reduce it e Avoid smoking If you smoke cigarettes your breast milk will contain nicotine and it may slow down your flow of breast milk and or decrease your breast milk supply If possible reduce the amount you smoke and do not smoke immediately before you express breast milk or breastfeed e Renting or buying a breast pump There are many types of breast pumps produced They are available to either buy and or rent OLCHC provides hospital grade electric breast pumps for use within the hospital If you need one at home they are available along with many other types from Medicare Health and Living Their contact details are Address Glencormack Business Park Kilmacanogue Co Wicklow Phone 01 2014900 If you have or would like to use another type of breast pump while in hospital follow the manufacturer instruction booklet for direction on its use and ask the nurse caring for your baby for advice and guidance You can claim tax relief for the rental or purchase of a breast pump through the MED 1 He
16. ore breast milk as long as it can be sealed If you are expressing breast milk for your baby in OLCHC it should be collected and stored in a sterile plastic breast milk bottle supplied by OLCHC This bottle can attach directly to the expressing set at the time of expressing Do not fill the bottle with breast milk leave at least 1 2cms free at the top as milk expands when frozen If not using immediately store the breast milk in fridge freezer e What do I need to know when storing breast milk Breast milk storage e Fresh breast milk Refrigerator 2 4 C 48 hours e Defrosted breast milk Refrigerator 2 4 C 24 hours e Supplemented fortified breast milk used immediately Do not freeze e Fresh breast milk Freezer 20 C up to 3 months Do not store breast milk in the fridge door There is limited space in the hospital for frozen breast milk Breast milk expressed during your baby s first two weeks of life must be kept in the hospital and given first If possible store extra breast milk in your freezer at home e How will my baby receive breast milk If for some reason either you or your baby cannot breastfeed your baby can be given your breast milk in any of the following ways e Cup feeding e Bottle e Finger feeding e Syringe dropper e Breastfeeding supplementer e Gastric feeding tube Continuous small volumes through an electric feeding pump or larger volumes every few hours e How do I defros
17. p Why did this happen and what should do Sore nipples may occur from using the breast pump for the following reasons e The collection funnel of the expressing set may be too small rubbing off the nipples Medela have different size funnels on their expressing sets available to suit all size nipples and ensure that you centre the nipple in the collection funnel e Ifthe breast pump suction is too high It is recommended that you increase the suction pressure slowly until it becomes slightly uncomfortable and then decrease it slightly Always stop the breast pump before removing the collection funnel e At the end of pumping rub a small amount of breast milk around your nipples to prevent them becoming sore If your nipples become sore it may be helpful to hand express until the nipple area heals e Should try to stimulate my baby s suck when they are not feeding from the breast Yes this is also called non nutritive sucking and can be encouraged by e your little finger clean this is similar to your nipple when elongated with breastfeeding e a soother during feeding times e sucking directly at your breasts when they are empty if your baby s condition allows These are good ways of encouraging the sucking experiences in your baby and may also increase your breast milk supply Created by OLCHC Staff March 2011 11 e What do I store the breast milk in Any sterile airtight container can be used to st
18. reated by OLCHC Staff March 2011 a e Which expressing method do choose Different methods of breast milk expression suit different mothers in different situations so you should choose the one or several methods that best suit your needs and situation Seek advice from your baby nurse to help you choose e ls it better to hand express or use the breast pump to express Research has suggested that using a combined method of Hands on Pumping HOP Breast compression and breast massage while pumping using a hospital grade electric pump will ensure you produce more breast milk e How do I do Hands on Pumping HOP Hands on pumping involves using breast compression and breast massage while using a breast pump This technique has shown to increase the amount of breast milk mothers produce e Breast compression consists of support your breast with your hand by placing your thumb on the upper side of your breast and your fingers on the other close to your ribs Squeeze the breast to increase the internal pressure of the whole breast e Do not roll the fingers along the breast just squeeze and hold firmly without causing discomfort e You should see some extra milk spurting into the funnel e Release the pressure when the flow slows again and repeat moving around the breast When the flow of breast milk has stopped turn off the breast pump e Massage your breasts for 1 2 minutes and express any remaining milk e
19. ry especially for mastitis or blocked ducts e Are there ways that I can establish a good breast milk supply In addition to the above points of how often should express the following tips may help such as e having your baby near by or a photo of your baby e having a baby grow or blanket that has the scent of your baby near you Created by OLCHC Staff March 2011 8 e breast massage e Kangaroo care Skin to Skin Contact See below It can helpful to express in short bursts Try expressing either every hour 15 minutes each session or every 2 hours 30 minutes each session for an 8 hour period e What is Skin to Skin Contact Kangaroo Care Skin to skin contact or Kangaroo Care means holding and cuddling your baby as much as possible Your baby will be dressed only in a nappy if possible placed on your chest skin to skin inside your clothing This will help stimulate your breasts to make more breast milk It can also help stimulate your immune system to make more antibodies in your breast milk Ask your nurse if and when you can do this e How much should express How much you need to express depends on your reason for expressing There will only be a little breast milk for the first few days after your baby is born This first breast milk is called colostrum Mothers who have delivered prematurely may produce as little as a few drops of colostrum each time they express for the
20. st milk supply Why does my breast milk need to be fortified Your breast milk is a perfect source of nutrition for your baby However when babies are sick premature or have a poor weight gain they may have extra nutritional needs If additions are needed these will are prescribed by your dietician They will be added to breast milk in the form of fortifiers either e Preterm breast milk fortifiers available in sachet form for preterm or low birth weight infants only added at ward unit level by your baby s nurse e Term breast milk fortifiers added in the Formula Room Breast milk fortifiers can help babies improve growth and can prevent some nutritional deficiencies Your dietician will discuss with you the need to start fortifying your breast milk and the length of time it is needed for e Will always have to tube feed my baby Not always it depends on your baby condition ask the nurse doctor caring for your baby The best thing you can do for your baby until he she can breastfeed at your breast if this is your intention is to increase your breast milk supply by adequate pumping It is easier for your baby to learn to breastfeed when you have a good flow of breast milk e What do I do with extra breast milk If you are pumping more breast milk than your baby needs you can e Store it in the freezer and use it at a later date e Donate it to a Human Milk Bank e What is a Human Milk Bank A Human Mil
21. t breast milk Remove frozen breast milk from the freezer several hours before it is needed and thaw it in the breast milk fridge Frozen breast milk can be defrosted quickly by holding it under tepid running water Do not defrost breast milk in the microwave Never refreeze breast milk once thawed Defrosted breast milk can only be stored in the breast milk fridge for 24 hours e What do need to know when transporting fresh frozen breast milk to and from the hospital Breast milk should be transported to or from the hospital in e upright express breast milk bottles e an insulated container cold box with coolant block This helps to keep the breast milk cool Transport the breast milk directly to the ward unit area and give it to the nurse looking after your baby so they can store it in the appropriate fridge or freezer Don t forget to label the bottle correctly Created by OLCHC Staff March 2011 12 e My baby is starting back on feeds which breast milk will they receive If your baby has been fasting for a period of time and is allowed to start back on breast milk but is not well enough to feed directly from the breast they should receive e Fresh frozen colostrum breast milk supplies first if available then e Fresh breast milk then e Frozen breast milk starting with the oldest frozen breast milk supply in the freezer but no older than 3 months and working towards the most recently frozen expressed brea
22. t www breastfeeding ie La Leche League www lalecheleague org Cuidiu www cuidiu ict ie Irish Premature Babies Organisation www irishprematurebabies com Donor Milk Banks www ukamb org On line breastfeeding retail supplier www onceborn com Medela breast pump suppliers www medicare ie Other Useful Websites Central Revenue Information Office www revenue ie Created by OLCHC Staff March 2011 15 Notes Document Number Approved By Nurse Practice Committee NPC Edition Number Date of Approval Number of Copies Ratified By Geraldine Regan Director of Nursing Signature Responsibility for this Document NPC Date of Ratification 2011 Our Lady s Children s Hospital Crumlin Dublin 12 All rights reserved No part of this publication may be reproduced stored in a retrieval system or transmitted in any form or by any means without the prior written permission of the copyright holder Our Lady s Children s Hospital makes no representation express or implied with regard to the accuracy of the information contained in this publication and cannot accept any legal responsibility for any errors or omissions that may be made Created by OLCHC Staff March 2011 16
23. ump funnel e Breast should feel e a gently rhythmical motion e empty after expressing There are different pump funnel sizes available from Medela If the regular pump funnel does not fit your nipple correctly talk to your nurse Pump funnels are available in the Material Management Department OLCHC Breast pump funnel Created by OLCHC Staff March 2011 7 e How often should express You will need to express as often as your baby would need to feed e If your baby is a newborn express milk 8 10 times in 24 hours Try to avoid leaving gaps of more than three hours during the day At night it is best to express every 5 6hours While it is difficult to get up at night you naturally produce more prolactin the milk producing hormone at night so by expressing once over night it will ensure you have a higher breast milk production during the day also This will help keep a breast milk supply that satisfies your baby s needs The more often you express the more you produce and by emptying your breasts they will make more breast milk After a few weeks when you produce about 750 900ml per day you can cut back on the number of times you express per day while also maintaining your milk supply e If your baby is not a newborn express at regular intervals or at the same times as your baby would usually breastfeed e If your baby is starting to breastfeed after receiving expressed breast milk for a while you may need to
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