When you express, you can involve your spouse or a caregiver in baby’s feeds, especially at night. A mother can also offer expressed breastmilk if her infant cannot make a good latch, points out Helen Espina Cruz, a senior lactation consultant at Raffles Hospital.
If a mother cannot be with her baby as it is premature or ill, expressing encourages the brain to release prolactin, the hormone that triggers breastmilk production. As long as the mum maintains her breastmilk supply, expressing also helps prevent the breasts from becoming engorged, Cruz adds.
Also, not all women feel comfortable about breastfeeding directly. Some prefer to use a bottle, so that they can keep track of how much baby drinks. Then there are babies born with conditions such as tongue-tie or cleft lip/palate, which makes it difficult for them to feed at the breast, explains Cynthia Pang, assistant director of nursing and senior lactation consultant at KK Women’s and Children’s Hospital.
You can pick one of three ways to express your milk: Using a manual pump, an electric one or express by hand. Choose a breast pump wisely, especially if you have tight schedules or are planning to go back to work, Cruz advises.
It’s important to set aside adequate time to express. “It takes at least 15 to 20 minutes to pump each breast. Gently massage your breasts in between to help stimulate more milk collection,” Cruz says. On average, a mother should be able to produce 450 to 500ml from a single breast within 24 hours, she adds. The more the mum breastfeeds or expresses, the more milk she produces. The “best time” to express, Cruz notes, is when you are relaxed because it’s easier to elicit a let- down, which boosts your milk yield.
“The average woman — who expresses exclusively — should be able to produce 600 to 800ml of milk per 24 hours some 10 days after delivery,” says Pang.
If you plan to switch from latching on your baby to expressing, Cruz has this advice, “Enjoy and master breastfeeding for at least a month to establish your milk volume and for baby to master the latch. Then, gradually introduce bottled breastmilk, so baby will get used to the texture of the teat.”
“This technique works by emptying the breast repeatedly, which signals the body to make more milk, more quickly,” Pang explains. To power pump, she suggests allocating one hour each day or night (for example, at 7am every morning) and follow this pattern: Pump for 20 minutes; rest 10 minutes. Pump another 10 minutes; rest for 10 minutes. Pump again for 10 minutes; finish. This provides 40 minutes of pumping in a 60-minute period. At other hours of the day, use routine pumping, suggests Pang. Some mothers find power pumping on three consecutive days or nights sufficient, while others may power pump up to seven consecutive days to get results, she adds. “Also, breast pumps are not one-size-fits- all. Try different shield sizes and adjust the vacuum settings,” she suggests.
To express manually, use this method to get the flow going: Use clean hands to massage the breast gently by placing your fingers on opposite sides of your areola. Press back towards the chest and compress fingers towards each other, drawing slightly towards the nipple but not sliding over the skin. Release the pressure and relax your hand. Repeat several times. Don’t expect anything immediately, Cruz says. Shift hand to a different position to get the milk flowing from other ducts. Express into a pump funnel or a large bowl to collect your milk.
If you want to try alternative means of increasing your breastmilk “production”, consider herbal alternatives such as pengaga (centella or Indian pennywort, a herb), red spinach, avocado milk, oatmeal, Milo or Horlicks, suggests Rokiah Jantan, who leads a team of expert masseurs at Traditional & Holistic Post-Natal Centre, which specialises in postnatal massage.
“Avoid taking supplements like fenugreek as it can cause baby to have constipation, while nursing tea can cause colic in babies,” she advises.
“Reduce the intake of cabbage, onion, garlic and brussels sprouts, which may cause wind and crying in some babies,” adds Cynthia Pang, assistant director of nursing and senior lactation consultant at KK Women’s and Children’s Hospital. “Limit caffeine, too, as it may trigger the restlessness in baby.”
Rokiah also suggests going for breast massages. “Mothers usually see results after two to three sessions, but they need to attend the sessions at least once or twice a month,” she notes. “We have had mothers who thought they had low milk supply, but it was only a blockage or from choosing the wrong pump or the incorrect ﬂange (plastic funnel-like device that ﬁts over the breast),” she points out. “During our massage sessions, we also give breastfeeding advice.”
If it’s to be consumed within days, you can keep it at the back of the refrigerator (the coldest part) for 48 hours. Store for up to three months in the freezer, or for up to six months in the deep freezer (minus 20 deg C), says senior lactation consultant Helen Espina Cruz. Store the milk in either sterilised storage bottles or disposable breastmilk storage bags to prevent wastage, she notes, and label with the date and time (ﬁrst in, ﬁrst out). Do not re-freeze breastmilk once it has been thawed; also, DO NOT warm it in the microwave or on a stovetop, as it will destroy the nutrients. To warm up frozen milk, ﬁrst thaw under cool water — there shouldn’t be any frozen chunks ﬂoating around. Heat a pot of water but not till boiling, then sit the bottle or bag in the hot-water bath.