How to express breast milk?

During the first few weeks of breastfeeding, your baby will help you establish your milk supply. They will feed as often as needed to meet their requirements. The more they feed, the more milk your body produces. 

If the mother is separated from her baby at birth, if the baby is unable to feed at the breast (due to a sucking difficulty), or if the baby was born prematurely, a breast pump can help in the first weeks of breastfeeding to establish and maintain milk production. In this case, opt for a hospital-grade breast pump and express your milk to stimulate production for 100 minutes daily. Spread the sessions across 8 to 12 pumping sessions every 24 hours, to replicate as closely as possible what an effective feeding baby would do at the breast.

After these first few weeks, expressing your milk can be useful if you need to be away, for example, or if you want to build up a small reserve ahead of returning to work. Although the breastfeeding leave does not exist, it is possible to express milk at work. 

In this case, you can start expressing your milk once a day, after breastfeeding. Sometimes your baby may be fully satisfied after feeding from just one breast. Take the opportunity to collect the milk from the other breast and store it.

If you need to be away for a full day and are wondering how much milk to prepare in advance: from the time your baby is over 15 days old until they reach 6 months, you should allow approximately 750–800 ml of milk per 24 hours. As surprising as it may seem, once lactation is established, it remains at roughly the same level throughout the period of exclusive breastfeeding. 
 

Expressing your milk can also help in cases of engorgement or breastfeeding mastitis. 

A breast pump is not as effective as a baby at the breast once breastfeeding is well established. As a result, the amount of milk you obtain when expressing is not an exact reflection of what your baby actually consumes. It is possible to collect only a few drops in the early sessions, but this does not mean you have no milk or that your supply has dried up. With a little practice, the milk will begin to flow more freely. If this is not the case, it is a good idea to seek advice from an IBCLC lactation consultant, or to check with a professional equipment supplier whether the pump and associated accessories you are using are suited to your needs and your profile.

Expressing milk in practice

- Massage both breasts and warm them up to get them ready

- Express for a maximum of 10, 12, or 15 minutes during the first session, on both breasts.

- If you are using an electric breast pump, start with a low to moderate suction speed.
Pay attention to how it feels. Using a breast pump should not be painful. 

- Find the best time to express your milk. Studies have shown that better results are obtained when expressing 30 to 45 minutes after the start of a feed. Some women prefer to express every other feed. 

- Expressing takes practice. It is common for a steady rhythm to develop after 2–3 days of trying

- Do not wait until your breasts are too full before expressing, but do so regularly in line with the schedule you have set.

- You can purchase a pumping bra to create a "hands-free kit", which will allow you to express milk without holding the breast shields in place.

Your breast pump needs to be right for you

- Make sure the breast shields are neither too small nor too large. Your nipple should be able to move freely in the tunnel. You should not feel any rubbing or pain

- If expressing is painful, you need to adjust the speed, suction strength, or breast shield. Sometimes it may also be helpful to try a different breast pump model. 

- Do not hesitate to seek help from an IBCLC lactation consultant if you experience any difficulties with breastfeeding.

Expressing milk: being prepared

Have everything you need to hand before starting a session: a drink, a snack, your collection containers, a good book or some music. Make yourself comfortable in a calm and private space. Stress can block the body's production of oxytocin — the hormone that triggers the let-down reflex. Listen to music, watch a series, or look at photos of your baby. Enjoy a breastfeeding snack that you enjoy.

Hygiene rules for expressing milk

- Remember to wash your hands before you begin

- Thoroughly clean all accessories (breast shields, the small membrane through which the milk flows…) with warm soapy water, and leave them to dry in the open air (never with a tea towel, which is a breeding ground for bacteria) before putting them away.

- After the expressing session, you can place the breast pump accessories in a ziplock freezer bag and store them in the fridge. This means you will not need to wash them after every single expressing session. You can wash them when you get home, once every 24 hours. Please note this only applies to full-term, healthy babies. This protocol is not suitable for milk intended for a premature or unwell baby, for whom a stricter hygiene protocol will be required. 

Storing expressed breast milk

For the storage of breast milk, you should start by washing your hands thoroughly. Rinse the containers with cold water, then wash them with warm soapy water. You may use a suitable, unscented soap. Rinse them again and leave them to dry in the open air without wiping.

There are broadly 3 methods of storing milk: at room temperature, in the fridge, or in the freezer:  

At room temperature, in a sealed container, for 4 to 6 hours between 19°C and 22°C.

In the fridge, between 0°C and 4°C, for 48 hours. 

In the freezer, 2 weeks in a simple freezer compartment of a fridge, up to 3–4 months in a three-star compartment, and 4 to 6 months in a freezer at -18°C.

Defrosted milk can be kept in the fridge for 24 hours or at room temperature for 1 hour. Never refreeze milk that has already been defrosted.

When out and about, you can bring it home by keeping it in an insulated bag (such as a lunch bag) with an ice pack inside. Do not exceed 1 hour of transport or 24 hours in a proper cool box.

How to give expressed milk

You can give expressed milk in a bottle. It is perfectly possible to do mixed feeding, alternating between the breast and the bottle. To find out more on the subject, see our article on how to giving a bottle to a breastfed baby.

There are alternatives to bottles. Most of them will be used temporarily: 

The syringe.

The teaspoon.

The babycup. It resembles a small graduated cup or the cap of certain baby bottles. It is designed to fit small hands. Place the milk against the baby's mouth so they can lap it up at their own pace. Best used from 6 months onwards.

In flan form. Once you start weaning your baby, you can also make breast milk flans using agar agar.

There are a few things to consider when choosing the right breast pump for you.

Being able to express from both breasts at the same time

The ability to express from both breasts simultaneously: if your breast pump will be used regularly — for example when you return to work — opt for an automatic electric double breast pump. This halves the expression time and helps stimulate prolactin release, allowing you to collect more milk than if you were to pump one breast at a time.

Speed and noise

The speed and number of suction cycles per minute: it is worth noting that babies perform approximately 50 sucks per minute.

Noise during operation: some breast pumps are noisy, others relatively quiet.

Weight

The weight of the breast pump: some breast pumps are portable, meaning they are compact and relatively lightweight. There are models with rechargeable batteries that can run for up to 3 hours without losing power. Some require mains connection. Not all models offer the same suction efficiency, however. Seek advice from a specialist hire provider. 

Breast shields

Choosing the right breast shield size: many mothers find that one nipple is larger than the other, or that over time they need a different size breast shield from the one they started with. Others simply don't find the standard size comfortable. If in any doubt, seek advice from a specialist hire provider.

Programmes and charging

The availability of programmes that replicate the baby's sucking pattern (fast to encourage milk let-down at the start, then slow and deep once the milk is flowing). This feature is particularly useful when using a breast pump to establish or maintain milk supply in the baby's absence (for example, when returning to work). 

The option to use it plugged into the mains, and possibly via a car adaptor.

There are various types available: manual, electric, more or less compact, and so on. Every mother will find the product that suits her best. 

Manual breast pumps

The manual breast pump is not reimbursed. You can purchase one in large supermarkets or pharmacies. It is compact, quiet, and requires no electricity. It is ideal if you want to use it occasionally and if your breastfeeding is already well established. Many brands sell them: Avent, Dodie, Medela... The advantage of Medela is that most of their breast pumps come with several flanges, allowing you to determine which one suits you best.

Rental electric breast pumps

These are the "Rolls-Royce" of breast pumps. They are considerably more expensive, but you can hire them and the rental cost may be partially or fully covered by the national health service and your health insurance, with a prescription (do not hesitate to ask your midwife, gynaecologist, or GP for one). This prescription will need to be renewed every 10 weeks in accordance with French regulations. 

Next-generation breast pumps

Wireless and completely hands-free, discover the Perifit Pump electric breast pump, which frees you from the frustration of conventional breast pumps so you can express your milk whenever and wherever you want. The innovative soft silicone flange adapts to the shape of the nipple and areola during expression. 

With our tips, expressing milk should hold no more secrets for you.