References:

1. Best Start - Breastfeeding Matters
2. Toronto Public Health - Breastfeeding Protocol: Expressing, Collecting and Storing of Human Milk
3. International Breastfeeding Centre - Expressing Breastmilk 
4. Stanford Medicine - Maximizing Milk Production with Hands-On Pumping

What is breastmilk expression?

• Removing milk from the breast either by hand, with a pump or a combination of both hand and pump.

Why express breastmilk?

• Expressing colostrum after each feed can increase milk volume in the following weeks.
• Expressing a bit of milk before a feed in the first few weeks can help improve a baby’s latch.
• Used for comfort to manage breast engorgement.
• Expressed breastmilk can be used to heal sore nipples.
• To build milk supply to use expressed breastmilk to supplement a feed as needed
• Infant unable to breastfeed or latch and transfer milk.
• Increase milk supply

Before starting expression:

• Wash your hands with warm soapy water and rinse well
• Use a waterless hand cleanser if hands do not appear dirty.
• Wash any pump parts with warm soapy water and rinse well before each use
• Massage the breasts prior to expressing to allow the milk to start flowing

How to express breastmilk:

• There are three ways to express breastmilk:
  1. Hand Expression:
     • Useful to use to express colostrum especially within the first few days after birth.
     • Hold the breast holding the hand around the breast in a “C” shape with forefinger and thumb opposite each other about 1”-1.5” back from the nipple.
     • Press the breast towards the chest, lightly compress the thumb and fingers together towards each other, relax your fingers and then repeat the same motion.
     • Repeat the above-press, compress, relax- while rotating the hand around the breast to empty all areas of the breast.
  2. Expressing using a Pump:
     • The type of pump (manual, purchased electric or rental electric) needed depends on the reason for the pumping. Many factors influence the type of pump that is needed to express breastmilk. Discuss the best pump choice with a breastfeeding expert.
     • Regardless of the type of pump (manual, purchased electric or rental electric) ensure the flange size is correct. The pump should pull the nipple into the base of the flange but there should be no pain when pumping.
  3. Expressing Using a Combination: (Hands on Pumping):
     • Hands on pumping can increase the volume of milk removed from the breasts when using a pump
     • Begin by shaking your breasts and massaging them
     • You will need to use both hands. Use a hands free pumping bra or a sports bra with holes cut in them to hold the pumping flanges.
     • Use both hands to compress the breast while you are pumping. Massage your breasts towards the nipple. Make sure to move your hands around the whole breast while massaging.

Further Your Learning: 

1. Toronto Public Health - Breastfeeding Protocol: Expressing, Collecting and Storing of Human Milk
2. International Breastfeeding Centre - Expressing Breastmilk
3. About Kids Health - Expressing breast milk for your hospitalized baby
4. Stanford Medicine - Maximizing Milk Production

Shareable Resources for Clients:

1. Best Start – Breastfeeding Matters

Referral Sources: 

1. Niagara Parents - Infant Feeding Appointments with a Public Health Nurse - 905-684-7555
2. Health811 - Breastfeeding advice and referrals - 1-866-797-0007
3. La Leche League Canada – Mother-to-mother breastfeeding support - 613-238-5919