Expressing and storing breast milk

Expressing can help when:

• Your baby is premature or in the neonatal unit.
• Your baby cannot latch well yet.
• Your breasts feel too full and painful.
• You are going back to work or will be away.

If your baby is in the neonatal unit, start in the first hours after birth. Colostrum comes in drops, so hand expression works best at first. Then express often, day and night, about as often as a newborn would feed. This tells your body to make more milk.

Going back to work? Start expressing a couple of weeks before. This gives you time to learn and to build a small stock.

To express by hand:

1. Wash your hands. Have a clean container ready.
2. Gently massage your breast, from the armpit toward the nipple.
3. Make a C shape with your thumb and finger, a few centimeters back from the nipple.
4. Press back toward your chest, then squeeze and release in a rhythm.
5. Do not slide your fingers on the skin or squeeze the nipple itself.
6. When the flow slows, move your fingers around the breast. Then switch sides.

Pumps can be manual or electric. Manual pumps cost less but are slower. Electric pumps are faster and help if you express many times a day. Start on low suction and increase slowly. The funnel should fit your nipple. Pumping should never hurt or bruise.

Wash your hands before each session. Use clean containers with tight lids, or bags made for breast milk. Store milk in small portions, about one feed each. This avoids waste. Write the date on each container. Use the oldest milk first.

These times are for healthy babies born at term. For a premature or sick baby, follow the neonatal team’s rules.

• Room temperature, up to 25°C: up to 4 hours. In a hotter room, put it in the fridge sooner.
• Fridge: up to 4 days. Keep it at the back of the fridge.
• Freezer: best within 6 months. Up to 12 months is acceptable.
• Cool bag with ice packs: up to 24 hours, for milk already chilled in the fridge.

Leave some space at the top of the container before freezing. Milk expands as it freezes.

• Thaw milk in the fridge overnight, or in a bowl of warm water.
• Use milk thawed in the fridge within 24 hours, counted from when it is fully thawed.
• Never refreeze thawed milk.
• Once milk is warmed or at room temperature, use it within 2 hours.
• Throw away what your baby leaves in the bottle within 2 hours after the feed.

You do not have to warm breast milk. Your baby can drink it cold or at room temperature. If you warm it, keep the container closed. Set it in a bowl of warm water, or hold it under warm running water. Fat may rise to the top. Swirl the milk gently to mix it. Test a few drops on your wrist. It should feel lukewarm.

Never warm breast milk in the microwave or on the stove. Milk heats unevenly and can burn your baby’s mouth.

After each use:

1. Take the pump kit apart.
2. Rinse every part that touches milk under running water.
3. Wash those parts soon, in warm water with dish soap. Use a clean brush and basin kept only for baby items.
4. Rinse off all the soap.
5. Let the parts air dry on a clean towel. Do not rub them dry with a dish towel.

Sanitize the parts at least once a day. You can boil them for 5 minutes or use steam. This matters most for babies under 2 months, premature babies and babies with weak immunity. Store dry parts in a clean, covered place.

Call your doctor if:

• Your milk supply keeps dropping even when you express often.
• Part of your breast is red, hot and painful, or you have a fever.
• Pumping hurts or damages your nipples.
• Your baby has fewer wet diapers than usual or is not gaining weight.
• Your baby is premature and you are unsure how to store or give your milk.

In an emergency in Lebanon, call the Red Cross on 140.