Milk donors share their tips for expressing breast milk

This article is republished from Donor Research Network. Read the original article.

Expressing breast milk, that is removing breast milk by hand or by pump to feed an infant, is very common in high-income countries.  In the two weeks after giving birth to their baby, 62% of Australian mums had expressed at least some breast milk.  Many Australian mums prefer to use an electric breast pump after their milk has come in, and common reasons they express are so they can go out and leave their baby with family or carers, to store extra milk, to manage their over or under supply, or because their baby has trouble breastfeeding.

“Struggling to be able to produce enough breastmilk can actually be quite traumatising. It makes you feel like a failure and that you can’t provide for your baby.”

For some mums, expressing breast milk can be really hard. It can take too much time, and it may be painful or unpleasant.  Mums may lack confidence or practical information about expressing, or they may lack support from their close networks.  Mums who have premature babies in hospital and those with low milk supply may find it especially hard to express breast milk, and to stay motivated enough to continue. When faced with these challenges, mums do not always know where to turn for advice.

Online and social media sources are common avenues for help, yet these sources do not always include the views of mums who are skilled at expressing breast milk. With this in mind, we asked 45 mums who donate to a non-profit milk bank about their preferences and experiences and if they had any tips that could help other mums who are finding it hard to express breast milk.

Why did they express breast milk?

Key reasons why donors started expressing breast milk were to manage their milk over or under supply, as well as to help with latch problems, or to allow someone else to feed their baby while they were away.

Where did they look for information about expressing breast milk?

Donors commonly found information from nurses, lactation consultants and educational resources on the internet. They also thought these three information sources were the most helpful. (See ‘Do you need help?’ below for links to specific resources donors and lactation consultants found helpful).  These sources were helpful because they either offered hands-on, personalised advice from experts, or they were easy to access and had a greater variety of information.

“Lactation consultant was a professional and gave correct information that I could understand and apply to my personal circumstance.”

“The internet is really the only source that's available to answer questions when you need it. I find the over the phone services give more or less the same information but with a newborn it can be tricky to find time to be on the phone.”

What was their experience like expressing breast milk?

Donors talked about what they found difficult and easy about expressing breast milk.

What made it difficult?

• Emotional & physical impact of expressing
• Time required & working out correct timing
• Volume of milk expressed (not enough, too much)

“Waking to express in the middle of the night and the reminder that my babies weren’t home with me. Feeling constantly on the clock and the relentlessness of pumping.”

“At the start when I was using an electric pump, I didn’t have the right size flange & this caused a lot of pain & discomfort. Once I had the correct size it was much better.”

What made it easier?

• The 'right' equipment or setup
• Routine & planning
• Finding a way to be relaxed
• Warmth & massage
• Hydration & good nutrition
• Focusing on benefits for baby or others

“Pumping at the bedside of my baby or watching videos of him helps with my let down and warm compresses are very effective.”

“If I express when I’m feeling relaxed and doing something like watching TV it really helps.”

What were donors' tips for mums about expressing breast milk?

Donors consistently offered five tips for mums who are starting out or struggling with expressing their breast milk.

1. Choose the right pump for you

“Choose an easy pump without lots of parts to keep track of and assemble.”

“If you are at the beginning definitely hire a hospital grade pump, get the flange size checked to be perfect for you.”

2. Focus on your baby when pumping

“If you can have some peace and quiet and I watch videos of my baby feeding which makes a letdown happen easily.”

“Relax, look at photos or videos of your baby if you are away from them while expressing.”

3. Relax

“Be as relaxed as possible. It is amazing the difference being relaxed can make in how much milk you are able to express. Being next to or with your baby definitely helps with that too.”

“Find a 20 min show you can watch on Netflix or something and just switch off- relaxing will help the milk flow.”

4. Take care of yourself by staying hydrated and eating well*

“Keep your hydration up. By carrying around a little water bottle everywhere, I drink more water than I would if I had to get a glass when thirst strikes.”

“I’ve found personally diet and hydration make a huge difference to supply and regular eating/healthy snacks, especially when starting out breastfeeding and expressing really makes you hungry.”

5. Find the 'right' time for you to pump

“I always pump in the morning when my supply is best.”^

“Start early and get into a routine. Try just frequent short pumps if a longer pump doesn’t work for you. First thing in the morning after baby’s first feed is a good time.”

“I do it morning and night. I like to use that time well; by reading to my baby in the morning or watching a movie with my husband at night.”

^{*Note that this tip is based on donors’ personal opinions. There is currently not sufficient clinical evidence showing that drinking more water increases milk production. See: https://pubmed.ncbi.nlm.nih.gov/24916640/}

 ^{^The hormone, prolactin, that initially kick starts lactation, increases after each feed and overnight. This may contribute to the better supply of a morning. See, The physiological basis of breastfeeding - Infant and Young Child Feeding - NCBI Bookshelf (nih.gov)}

Other advice to mums suggested by some donors included:

• Create a routine and space for pumping
• Use heat & massage to aid milk flow
• Do what suits you, everyone is different
• Take care of your own wellbeing
• Be patients & keep on expressing
• Seek help, information or support when needed

How do they prefer to store expressed breast milk?

Donors preferred bags rather than bottles or cups to store expressed breast milk, although some donors used bags for freezing and bottles or cups for refrigerating. Bags were viewed as easier to use and defrost, and took up less space during storage. Bags specifically designed for storing breast milk were the most popular.

What were donors' tips for mums about storing expressed breast milk?

Donors commonly shared five pieces of advice for other mums who are storing their expressed breast milk.

1. Freeze milk in bags specifically designed for storing breast milk so they don’t break.
2. Label the bag before freezing with the date, time, and volume expressed.
3. Lay bags flat for freezing and once frozen stack upright in a container.
4. Have a system that ensures older milk is used first (e.g., organise by date).
5. Have a dedicated space and equipment for storing expressed milk.

“Freeze it straight away if you aren't going to use it. And label accurately with the date and time (and amount) so that you know exactly when it will go out of date.”

“Freeze your bags laying down. Then when frozen, stand them up so they take up less room. I put my bags standing upright in a container so you can take it out the container and easily have a look.”

“Use permanent marker on masking tape to label bottles in the fridge. Sticks for long enough but also peels off easily in the sink.”

Mums want to help and support each other

Donors shared that their experiences were not often easy, especially when they first started pumping. Many said that encouragement and support were especially helpful for them, and they wanted to share what they’ve learned with other mums.

"Thanks for sharing collective experiences. Parents should do more sharing about parenting babies as it is a team sport!"

"It might be at all what you hoped or expected, but this is still a valid breastfeeding experience!"

"Know you're amazing and to speak to someone if you need help and that's ok."

We sincerely thank the donors who took part in our research and so generously gave their time and advice

Do you need help?

• If you are in Australia and you would like to speak to a trained breastfeeding counsellor about breastfeeding (including expressing breast milk), please call the Australian Breastfeeding Association Breastfeeding National Breastfeeding Helpline on 1800 686 268.
• If you prefer to have an online chat with a volunteer Breastfeeding Educator or Counsellor from the Australian Breastfeeding Association you can use their LiveChat service.
• An App called Mum2Mum is also available.
• Guides for finding the breast pump that will work best for you and information about expressing and storing breast milk are also available on the Australian Breastfeeding Association website.
• If you are struggling with supply and would like to learn more about maximising pumping, Stanford Medicine, Newborn Nursery has freely available resources including the following video clip.

What's next?

We are working with Lifeblood to create a webpage or flyer based on the advice donors gave us for mums who need help expressing breast milk. This webpage or flyer will be available on the Lifeblood website and Donor Research Network website.