Expressing and Feeding Breast Milk

Birth & Beyond California: Breastfeeding Training & QI ProjectWith funding from the federal Title V Block Grant

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Objectives

• Identify three reasons for hand expression

• List two indications for milk expression in the hospital

• List at least two alternative feeding methods which can be used to support breastfeeding

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Hand Expression

DVD:

Breastfeeding Management, Teaching Tools for Physicians and Other

Professionals

Jane Morton, MD

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Why Teach Hand Expression?

• To provide supplementation with own mother’s milk

• Softens areola for easier latch• Assists with milk transfer

– instruct mother to hand express directly into the baby’s mouth

• The skin to skin contact of hand expression provides stimulation for milk production and letdown

• Reinforces to mother that every drop is valuable.

Mannel, Core Curriculum for Lactation Consultant Practice, 2007

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Indications for Breast Milk Expression in the Hospital

• Baby is premature or sick

• Maternal illness

• Baby unable to latch or breastfeed well

• Mother at risk of inadequate milk production

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Milk Expression to Initiate and Maintain Lactation

• Combine hand expression and breast pumping for the first few days

• Use hospital grade pump with dual collection kit

• If baby is separated from mother, begin milk expression within 6 hours after birth

• If baby needs to be supplemented, mother should express milk

• Express at least 8 times per day6

Cleanliness Concerns

• Hand washing

• Breast cleansing unnecessary

• Personal collection kit – wash with hot soapy water after each use

• Gloves unnecessary

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Storage GuidelinesMethod OMM- Term

Infant (fresh expressed)

OMM- Preterm Infant

(fresh expressed)

PDHM

Room temperature26ºC/ 79°F

< 4 hrs ☼< 24 hrs at 15ºC ( a cooler with frozen gel packs)

< 4 hours ☼ Only for completion of feeding, then discard

Refrigerator <48 hours (hospital use)

Less than 8 days (home use)

<48 hours < 48 hours

Completely thawed in refrigerator but not warmed

< 24 hours (hospital use)

< 48 hours (home use)

<24 hours < 48 hours **

Freezer compartment(1-door refrigerator)

2 weeks Not recommended Not recommended

Freezer compartment*(2 door refrig. 12ºC, 5-

15ºF)*not in door

3-4 months < 3 months < 3 months

Deep Freeze (-20ºC, -4ºF) < 12 months

Less than 3 mo is optimal

6 monthsDo not refreeze

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OMM- Own Mother’s Milk ☼ with preterm or sick infants, it is safest to refrigerate milk immediatelyPDHM- Pasteurized Donor Human Milk

In general: use the first two (2) weeks of milk in chronological order, then proceed to fresh breastmilk whenever available.

HMBANA Guidelines 2006CPQCC Nutrition Tool Kit 2005** Rhodes, JHL, 2006

Alternative Feeding Methods

– Syringe or dropper feeding

– Cup feeding

– Spoon feeding

– Supply line/ tube feeding

– Finger feeding

– Bottles

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Baby-led Bottle Feeding

• Baby upright; bottle held horizontally• Stroke lips to elicit wide gape• Follow baby’s sucking rhythm• When baby needs a break, tip bottle

down

Summary

• Breast pumping and hand expression are important techniques for initiating and maintaining mother’s milk supply when the baby is unable to breastfeed or cannot breastfeed well

• Hand expression is a valuable, empowering technique that every mother can learn

• When feeding expressed breast milk to babies, various feeding methods should be considered

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