Expressing and Storing Breastmilk For Healthy, Full Term Babies
Expressing and Storing Breastmilk For Healthy, Full Term Babies Expressing and Storing Breastmilk Table of Contents Introduction 4 Step 1: How to Clean Containers for Breastmilk Storage 5 Step 2: Getting Ready to Hand Express or Pump 6 Massage Methods 7 Step 3: Expressing Your Breastmilk 8 Step 4: Breastmilk Storage 12 Step 5: Warming and Serving Breastmilk 13 References 14 KFL&A Public Health Introduction Giving your baby only breastmilk until he is six months of age helps to protect him from allergies and certain diseases. Expressing and storing milk allows your baby to have breastmilk when you are separated from him. Many mothers like to have a small supply of breastmilk in the freezer for emergencies. It is best to start pumping when breastfeeding is going well because you will have established a good milk supply and your baby will know how to latch well onto your breast. On average, this takes about 4 weeks. The method of expressing depends on your preference, and may depend on the situation. You may express breastmilk by hand or with a pump. If you have questions about pumping, call Child & Babytalk at 613-549-1154 or 1-800-267-7875, ext.1555 for more information. 4 Expressing and Storing Breastmilk Step 1 How to Clean Containers for Breastmilk Storage •Use containers such as baby food jars, mason jars, glass baby bottles or polyethylene bags designed for milk storage. • Always start by washing your hands with soap and water for at least 15 seconds. Rinse and dry them with clean paper towels. • Wash the jars, bottles, and lids. Also wash any part of the breast pump that will touch your milk. Use hot soapy water and a brush. Rinse under hot running water. •Place on a clean paper towel or tea towel and allow to air dry. Babies who are sick or premature need to be protected from harmful bacteria. Sterilized containers are provided in the hospital. KFL&A Public Health 5 Step 2 Getting Ready to Hand Express or Pump •Many mothers find it best to express breastmilk when their breasts feel the fullest, in the morning or about an hour after feeding. •Sit somewhere warm and comfortable, and allow yourself time to relax. •Think about your baby and if possible, have him close to you. If you are away from your baby, having a photo, a tape recording of his voice, or a piece of his clothing to feel or smell may help. •Apply either moist or dry heat to your breasts by taking a bath or shower, using a heating pad set on low, or applying a warm, wet washcloth or disposable diaper. •Gently massage your breasts using one of the methods shown on page 7. •Rub the nipples with the palm of your hand held flat, or gently roll the nipples between your fingers and thumb. This helps to get a let-down. 6 Expressing and Storing Breastmilk Massage Methods Try a variety of methods to find one that works best for you. Finger tip massage: •use two fingers, •press fingertips lightly onto breast, •make small circles, •start from the back and move towards the areola, •cover your whole breast, and •massage firmly, but gently. Diamond hand position: •support your breast with both hands, thumbs on top, fingers below, and •press gently as you move towards the nipple. Parallel hand position: •place one hand above, one below, •gently press towards your nipple, and •rotate your hands as they move forward. Warm washcloth massage: •wet washcloth with warm water, and •press firmly on your breast, from back to nipple. KFL&A Public Health 7 Step 3 Expressing Your Breastmilk A. Hand Expressing Hand expressing is more like breastfeeding than pumping. When you use a pump, you draw the milk out of your breast. When you hand express, you compress the milk ducts, which is what your baby does while breastfeeding. It often takes some practice to get milk out at first, so be patient with yourself. Some women find hand expressing better than other methods. It is also cheapest, because it requires no special equipment. Remember that the milk must be gently squeezed from the milk ducts behind the nipple. Try this method for hand expressing: •Hold a wide mouthed clean container under your nipple, or place the container on a table in front of you. •Position your thumb on top and first two fingers under the areola, a few centimetres behind the nipple. 8 Expressing and Storing Breastmilk Push to chest wall Roll Finish roll •Press straight in toward your chest wall about 1 inch. •Roll your thumb and fingers toward the areola. Roll as if you were making a finger print. This action compresses and empties the milk reservoirs without damaging sensitive breast tissue. •Repeat rhythmically and collect the milk. When the stream of milk slows, vary the position of your hand. Rotate around the areola to reach more milk ducts. Change hands and repeat. After 5 to 7 minutes, change breasts. Massage (see pg. 7), stroke, and shake your breasts. Express again for 3 to 5 minutes at each breast. Repeat once more. The whole procedure can take about 30 minutes. Shake Massage Stroke KFL&A Public Health 9 Step 3 Expressing Your Breastmilk B. Using a Breast Pump •There are two kinds of breast pumps; hand operated (manual) pumps, and electric pumps. Many of the electric pumps recommended on our website (www. kflapublichealth.ca) also convert to battery operated. Electric pumps can pump one breast (single pump) or both breasts at the same time (double pump). Follow the pump directions on how to use and clean it. •A double electric pump stimulates your milk supply better than a single electric pump, and saves time. •When using a pump, make sure your whole nipple area fits inside the funnel so it won’t hurt. Start the pump on the low setting and increase the pressure as your milk starts to flow. This should not hurt. •Pumps can be purchased or rented. Call Child & Babytalk Phone Line at 613-549-1154 for more information. 10 Expressing and Storing Breastmilk Tips When Hand Expressing or Pumping •Massaging your breast while you are pumping or expressing can help collect more milk. •It may be helpful to breastfeed on one side while you express or pump the other side. •Express from each breast for about 5 minutes, then go back and repeat on each breast again. •You may have several letdowns while expressing. Taking a break between letdowns to relax, massage, and shake your breasts (see page 9) will help to get the milk flowing and empty your breasts. If your baby is sick, premature, or cannot feed at the breast, you may need to use an electric pump. KFL&A Public Health 11 Step 4 Breastmilk Storage Where to Store Longest Storage Time At room temperature 6 to 8 hours In a cooler with a freezer pack 1 day Fresh milk in refrigerator 8 days Thawed milk in refrigerator 1 day In a freezer that is inside a refrigerator 2 weeks In a refrigerator freezer with a separate door 3 to 6 months In a deep freezer 6 to 12 months •Breastmilk that is in a clean, tightly sealed container needs to be refrigerated within 6 to 8 hours. Refrigerate immediately if the room temperature is over 25º C. •Store breastmilk in the amount that your baby is likely to need at one feeding (i.e. 60ml to 120ml quantities) to eliminate waste. •Cooled breastmilk may be added to already frozen breastmilk if there is more frozen milk than fresh milk. •When freezing breastmilk, leave an inch of space in the container. Breastmilk expands when it is frozen and may crack the containers. •Store breastmilk at the back of the fridge or freezer where it will stay the coldest. Do not store it on the door of the fridge as it will not be cold enough. If you have a self-defrosting freezer place the milk on a shelf, because the bottom of the freezer warms up when it is defrosting. •Transport breastmilk in an insulated container with ice packs. •Date the stored breastmilk and use in the order it was dated. •Once the frozen breastmilk is thawed, it can be kept refrigerated, as long as it was not offered to the baby. It can be kept for 24 hours in the refrigerator. Never refreeze breastmilk. 12 Expressing and Storing Breastmilk Step 5 Warming and Serving Breastmilk •Whenever possible, use fresh breastmilk. It is better for baby than frozen milk, but frozen milk is the second best choice. •Frozen breastmilk can be thawed in the refrigerator. This takes approximately 12 hours. •A quicker way to thaw and warm the milk to body temperature is to place it under cool, then gradually warmer running water until the breastmilk is thawed and warmed to room temperature. Test the breastmilk on the inside of your wrist before offering it to your baby. •Breastmilk separates into layers as it is not homogenized. Shake gently to mix before feeding. •Thawed breastmilk may taste or smell different from fresh breastmilk, but it is still good. The altered taste and smell is caused by the enzyme lipase that breaks fat down in the breastmilk. It will not harm the baby. •Discard any remaining breastmilk that was not used at the feeding. KFL&A Public Health Caution: Do not microwave breastmilk. This may alter its nutrients and cause hot spots which can burn your baby. 13 14 Expressing and Storing Breastmilk Breast Pumps A variety of pumps are available for rent or sale from various businesses in the community. Call Child & Babytalk Phone Line at 613-549-1154 or 1-800-267-7875, ext. 1555 or visit www.kflapublichealth.ca and click on Parents and Caregivers, then Learn About Breastfeeding for more information. References Breastfeeding [Internet]. Atlanta: Centers for Disease Control and Prevention. Proper handling and storage of human milk. 2007 May 22; [2 pages]. Available from http://www.cdc.gov/breastfeeding/recommendations/handling_breastmilk.htm Breastfeeding [Internet]. Peterborough [ON]: Peterborough County-City Health Unit. Expressing, storing and feeding your baby breastmilk. 2008 June 23; [4 pages]. Available from http://pcchu.peterborough.on.ca/BF/BF-expressingstoring-breastmilk.html Jones F, Tully M. Best practice for expressing, storing and handling human milk in hospitals, homes and child care settings. 2nd ed. Raleigh (NC): Human Milk Banking Association; 2006. Mohrbacher N, Stock J. The breastfeeding answer book. 3rd rev. ed. Schaumburg (ILL): La Leche League International; 2003. Nova Scotia. Health Promotion and Protection. Public Health Services; MacGregor D. Breastfeeding basics [monograph on the Internet]. Halifax (NS): Department of Health Promotion and Protection; 2007 [cited 2009 April 7]. Available from: http://www.gov.ns.ca/hpp Riordan J, editor. Breastfeeding and human lactation. 3rd ed. Toronto: Jones and Bartlett Publishers; 2005. Toronto Public Health. Breastfeeding protocols for health care providers. Toronto: Toronto Public Health; 2007. Copyright Permissions Graphics and text on pages 7, 8, and 9 are from Breastfeeding Basics, Nova Scotia Department of Health Promotion and Protection, 2008. Adapted and reprinted with written permission from Nova Scotia Department of Health Promotion and Protection. 221 Portsmouth Ave., Kingston, ON K7K 1V5 613-549-1232 or 1-800-267-7875 www.kflapublichealth.ca September 2009
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