BREASTMILK EXPRESSION and storage

 

Is there a particular type of pump to use?
There are several types of breast pumps available on the market. How and why a mother intends to use the pump can assist you in recommending a pump that suits her needs. All pumps consist of basic parts: A breast flange, a collection area, and something that produces a vacuum. Pumps that use a squeeze bulb for suction, regardless of the size of the bulb, are not recommended. The suction produced by the pump should be intermittent, not constant. It is the rhythm of the suction, and compression of the areola inside the flange that empties the milk in combination with the suction. Suction alone, will not empty the milk.

Will insurance companies cover the cost of the pump rental?
It has been my experience that few insurance companies will reimburse the parents for the cost of the rental for a sick baby. Companies may view the rental of a hospital grade, electric pump as a luxury, when there are small hand pumps available at a lesser cost. If the pediatrician writes a prescription for the hospitalized baby for "breastmilk," the prescription and the pump rental bill sent to the insurance carrier.

How are the pumps used?
The "draw and hold" pump is used by applying suction for a few seconds then releasing the suction for a second or two, and then applying suction again. This should be done in a rhythmic fashion. The mother should avoid applying too much suction or holding the suction for too long. If the pump causes pain and/or leaves marks on the breast, she is using too much pressure.
The "one pump per second" pump, (Medela ® Manual) limits the amount of suction against the nipple and areola. The pump can be set for light, medium or firm pressure. Simply pull the piston back to the stop, push in, then pull out again; in a rhythmic fashion. Medela ® has a spring for their manual breast pump that will automatically push the piston out making the pump easier to use.
Large electric pumps are much easier to use. Simply connect the equipment to the pump, plug the pump in and turn it on, adjusting the suction for comfort.

How do I keep the equipment clean?
Always use clean equipment for pumping. Instructions for cleaning come with most pumps. Only the parts that contact the breast or milk need to be cleaned after each use. Mother should rinse the parts immediately after each use in cold water to remove any residual milk. The parts should then be washed in hot soapy water and rinsed well. Between uses store the pump kit in a clean area or clean plastic zip type bag. Daily sterilization of the breast pump parts [not the tubing] is recommended only when the milk is collected for a hospitalized infant. Sterilization can be done by boiling the parts in a large pot at full boil for five minutes. If mother notices hard water spots on the equipment, adding a little white vinegar to the water each time she sterilizes the parts should help. If the tubing has a filter (Medela ® ), be sure that the filter does not get wet, as this will block the suction.

Will I pump as much as the baby takes?
The pump is not as efficient as the baby. It also will take a while for the mother's let- down reflex to become trained to the pump. If no let-down reflex occurs, the mother can expect to obtain one-half to one ounce or less of milk from each breast. The mother who is pumping immediately after delivery for a sick baby, may, at best, express only a drop or two of colostrum. The goal of early pumping is to establish a milk supply by repeated stimulation of the breasts.
When a mother is learning to use the breast pump before returning to work, I recommend that she begin at the first morning feeding. Nurse the baby from one breast and then pump the other. The baby will help get the breast "primed." If the pump doesn't seem to work the first time she uses it, mother should be encouraged to practice pumping frequently. If the pump still doesn't seem to work after a week of practice, the mother should try a different type of pump.

How can I encourage let-down?
There are many things the mother can do to encourage the let-down reflex. Below are some suggestions. Not all the techniques work for each mother.
1. Relax. Try Lamaze breathing techniques.
2. Warm packs or wash clothes applied to the breast for a few minutes before pumping. Or take a hot shower.
3. Massage the breasts gently, with the heel of your hand, starting at the chest wall and moving toward the areola.
4. Bend over and let the breasts hang free for a moment or two.
5. Develop a pumping routine. Always follow the same steps each time you pump.
6. Turn the pump on for a minute before placing the flange against the breast.
7. Stroke your breasts in a feather light manner from the upper edge near the arm pit, toward the nipple and areola while you are pumping.
8. Look at pictures of your baby.
9. Listen to a recording of your baby's cries.
10. Smells are very powerful.  Try smelling a piece of unwashed clothing that the baby has recently worn.
11. Don't worry about how much you obtain.

How is manual expression of breastmilk done?
Manual expression of breastmilk is easy once a mother can get the technique down. The technique for manual expression is discussed below. Mother will need a clean, wide mouthed jar, bowl or a manual expression funnel, because it is difficult to aim the streams of milk into a small opening. With practice, some mothers feel that manual expression is easier and less time consuming than a breast pump.
1. Position the thumb and first two fingers at the edge of the areola [Table].
2. Push in toward the chest wall, spreading the fingers apart slightly.
3. Let the thumb and fingers roll toward the nipple using light compression (don't squeeze).
4. Rhythmically repeat compressions.
5. Rotate the thumb and fingers around the breast to ensure emptying of the ducts. Remember to avoid squeezing, pulling or sliding on the breast or nipple.

TABLE : MANUAL EXPRESSION OF BREASTMILK

Copyright Marie Davis, RN, IBCLC 1999     

Last reviewed: February 11, 2012