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In the period of breastfeeding, there are various situations in which expressing breast milk is a useful, and sometimes the only solution. Some mothers never feel the need to express, others exclusively express breast milk and use it to feed their children. Expressing stimulates, maintains or increases milk production. Expressing can be done by hand or with mechanical breast pumps.

Expressing is a special skill that should be acquired in good time. With some practice and persistence, every mother can master this skill.

Why express breast milk?

Choosing how to express

The choice of milk expression method depends on the circumstances of the mother and child, healthcare staff recommendations and the mother’s personal preferences.

Therefore, the milk expression methods of a mother who is separated from her hospitalised child can differ significantly from those of a mother who expresses sporadically or on appropriate occasions.

The most widespread method is expressing by hand, as it does not require any kind of equipment: just the skill of the mother’s hands. It is therefore always recommended in hospitals as the first choice. Some mothers find expressing by hand more natural than mechanical expression, due to the pleasant feeling created by hands touching the breast skin, which can have a stimulating effect on the milk ejection reflex (when compared to contact with the plastic parts of a breast pump). In contrast, some mothers prefer mechanical expression as the more comfortable solution, since it is shorter and suitable in situations when the mother is unable to express manually (e.g. due to illnesses, such as arthritis, muscle weakness, etc.). Some studies suggest that expressing with a double electric breast pump is the most effective in increasing breast milk production.

Manual expression takes at least 20 to 30 minutes for one breast, while the double electric breast pump takes around 10-15 minutes to express milk from both breasts simultaneously.

Manual and battery-operated breast pumps require 10-20 minutes to express milk from one breast.

Milk expression requires a lot of patience, effort, love and support from one’s surroundings. The key to successful expression is developing the milk ejection reflex (the so-called “let-down” reflex). If you are just starting to express, try to relax and give yourself a few days to master this skill before you start questioning your ability to produce milk. If you truly feel you are not making progress, seek help!

When to begin expressing?

If your infant was born with low birth weight and you are starting to express in order to stimulate milk production, you should begin expressing within 24 hours of delivery – ideally six hours after the delivery (depending on your health condition).

If, in a period of 18 to 24 hours after the delivery, your infant is suckling unsuccessfully, it is necessary to use a double electric breast pump and express at least eight to 12 times (a total of 100 minutes) in 24 hours.

If necessary, expressed milk can be administered immediately after the expression, using alternative means such as spoons, syringes or cups. Avoid using a bottle to feed your child, except in special cases when this is the only way. Expressed breast milk can be stored in the refrigerator or freezer for future use. To store expressed milk, use special-purpose glass or plastic vessels, intended for breast milk storage. To freeze breast milk, use specially designed freezer bags which protect the contents from contamination. In addition to being impeccably clean, all equipment that comes into contact with the infant or breast milk must not contain the harmful bisphenol A. Manufacturers usually display the fact that their product is bisphenol-A-free on the packaging.

Before expressing:

Choice and use of breast pumps

Manual breast pumps – most popular, relatively cheap and readily available

Bulb-style breast pumps, also called bicycle horn pumps

Rarely encountered in clinical practice, but mothers continue to use them.

Part of the rubber “bulb” is attached directly to the glass or plastic/polycarbonate part which is placed on the breast.

The most recent manual breast pump models operate on the principle of pressing, holding and releasing the pump handle

Electric breast pumps with battery backup

Small electric breast pumps, also called semi-automatic or mini electric

Use

Pros

Cons

Medium electric – cylinder/piston pumps or diaphragm electric pumps – independent or part of an expanded set (portable)

Use

The motor is less powerful than motors in large automatic electric breast pumps, but no less effective (applies to the most recent models)

Pros

Lighter than large breast pumps and easier to transport.

This possibility can improve the milk-release reflex in some women.

Some models do not have this option as the speed is set, and only the vacuum can be adjusted.

Depending on the manufacturer, the pump is also available as a double set, which cuts the expression time in half and increases the possibility of maintaining breastfeeding for a longer period of time.

Cons

Large electric cylinder/piston breast pumps – for hospital use/rental; “Hospital Grade” single/double

Use

Pros

It is important to note that in addition to choosing the right breast pump, you should also pay attention to the accompanying parts which come with the pump (these vary depending on the manufacturer), e.g. breast shields in different sizes, 24mm being the standard size for most well-known manufacturers.

New and modern technologies provide mothers with a large number of different breast shields (22, 24, 26, 28, 31 and 36 mm in diameter), as well as different combinations, depending on the mother’s (or healthcare staff’s) individual needs (e.g. an electric breast pump set which can turn into a manual pump if necessary, and vice versa).

Additional equipment also includes the popular “soft” insert, which in some models is meant to merely “soften” the part of the breast shield that is attached to the breast, while in others it assumes a more active role of massaging the breast(s) during expression.