Breast milk decanting: what is it for and how is it done?

In order not to disrupt the natural process of lactation after the birth of a child, but, on the contrary, to promote normal breastfeeding and avoid problems with the mammary glands, you should know when it is necessary to express breast milk, as well as how to do it correctly. [ 1 ]

What is the purpose of milk expression?

When explaining how to properly latch a baby to the breast, care for the mammary glands during lactation, when and how to express milk from them, a certified lactation consultant - who is also a specialist in milk expression - must clearly define the fundamental purpose of this manipulation in each specific case, taking into account possible complications of lactation.

They can be avoided if the baby is breastfed not according to a “schedule”, but as needed (as they say, as much as he requires), because stimulation of lactopoiesis or lactogenesis, that is, milk secretion, occurs reflexively - when the baby actively sucks.

The sensory receptors of the nipple and its areola, stimulated by sucking, initiate nerve impulses that reach the brain, which causes an increase in the synthesis of the hormones prolactin and oxytocin. The first is responsible for the secretion of breast milk in the mammary glands, and the role of the second hormone is the contraction of the myoepithelial cells of their tissues, leading to the release of milk from the alveoli into the milk ducts. Experts call this endocrine control of lactation.

During the first week of the postpartum period, the mother's body produces breast milk automatically - at the peak of increased prolactin synthesis, but after a certain time its level drops, and the process of milk production switches to the "supply-demand" mode, that is, the control of lactopoiesis becomes autocrine, dependent on the frequency and degree of emptying of the mammary glands (which after feeding should become soft until the next "portion" of milk arrives). Thus, the simplest and most effective way to support the production of breast milk - without pumping - is considered to be frequent breastfeeding of the baby at any time of the day.

But if there is not enough milk to meet the baby's needs, as evidenced by insufficient weight gain, decreased urination and darker urine, then breast milk is expressed after or between feedings. For more details, see - Insufficient milk secretion: how to increase lactation?

But if it is impossible to feed the baby directly from the breast due to respiratory distress syndrome and weakness of the sucking reflex in prematurity, perinatal pathologies of the baby, etc., as well as due to the health of the mother or her temporary separation from the baby, regular pumping (at least five to six times a day) is indispensable. And it is recommended to start it six hours after birth.

It is necessary to express breast milk by hand in case of milk stagnation and severe engorgement of the glands; expressing in case of lactostasis, which is observed when there is an excess of milk, which the baby is simply unable to suck out at first; in case of blockage of the milk ducts.

In women with hyperlactation (often accompanied by dilation of the milk ducts) or with an increased oxytocin reflex, too much milk quickly comes out of the breast, which during feeding leads to the baby choking and swallowing air, causing colic. To slow down the release of milk, it is recommended to express a little before feeding, and also to express excess milk very little by little (no more than three times a day) - in order to alleviate your own condition.

In most cases, the first milk expression is associated with the fact that at the beginning of lactogenesis there is engorgement of the mammary glands. It is recommended to start expressing only when the milk, as they say, "has come up", and this, as a rule, happens on the second or third day after birth, but for primiparous women it is possible a little later. And if milk does not come when expressing during the first three days after birth, it means that its full secretion has not yet begun, since the process of transformation of the acinar epithelium of the mammary glands from the presecretory to the secretory state has not yet been completed. At this time, the newborn sucks out a thick protein secretion of the mammary glands that stimulates its immune system - colostrum (colostrum). In addition, milk does not come when a woman expresses it incorrectly, in particular, squeezes the nipple too hard. [ 2 ]

Rules for expressing milk

There are rules for expressing milk that explain how to perform this manipulation so as not to injure the mammary glands.

Methods of expressing milk: manually and using milk expression devices – breast pumps.

How to properly express milk by hand into a bottle or other container, and how to increase milk when expressing?

When there is enough milk and you just need to express the excess to avoid stagnation - this is one situation, and three to five minutes are enough for the mammary gland to become soft after feeding.

It's a different matter when you need more milk to feed a premature baby without putting it directly to the breast. Then the question arises of how to induce a flow of milk during pumping and, in general, how to increase milk during pumping so that it is really enough for the newborn.

Lactation consultants recommend taking a moderately warm shower on the breast area before expressing, placing a warm compress on the same area for five minutes, and then doing a light massage for several minutes while expressing breast milk, for more details see – Breast massage during feeding.

Next comes:

• support the chest from below with one hand;
• place the thumb of the other hand above the nipple (at the border of its areola);
• place the index finger at the same distance from the nipple, but on the opposite side, that is, from below - opposite the thumb (the shape of the fingers is similar to the letter "C");
• then you need to press on the gland with your fingers in the direction of the chest wall (in no case until pain appears) and release, without removing your fingers, without sliding them along the skin, without touching the nipple, but gently squeezing them towards each other behind the nipple for a couple of seconds, and releasing.

How should milk come out when pumping? Such rhythmic movements will result in drops of milk coming out of the nipple first, and then it may come out in streams. If the mother is a lactating mother, the milk comes out in streams under pressure, which is why breast milk foams when pumping.

If drops do not appear, you need to move your fingers slightly (in a circle around the areola), and when the milk stops flowing, move your fingers to another part of the breast and repeat the described actions.

Another question that lactating women ask doctors is how long after pumping does the milk arrive. If during feeding it arrives after a quarter of an hour, then after pumping – after 40-60 minutes.

How much milk should there be when expressing?

The amount of milk expressed after each breastfeeding is individual and depends on the total volume of its secretion, as well as the baby's appetite. According to pediatricians, most newborns consume 30-60 ml of breast milk per feeding in the first month of life, and as they grow, the volume of one feeding reaches 90-120 ml (with daily consumption up to 700-900 ml).

If a mother is forced to express both breasts for 20 minutes five to six times a day to ensure feeding without putting the baby to the breast, then the milk requirement for one feeding, which is carried out every two hours, should be taken into account.

When a woman feels that there is not enough milk when pumping, it is worth focusing on the data provided, and not panicking about the insufficient amount of milk. Because excessive worries and stress have a negative effect on lactation. And complaints that milk has disappeared after pumping are actually caused by negative emotions and stress, which release adrenaline into the blood, which is an antagonist of prolactin.

It should also be borne in mind that milk production is higher in the morning than in the afternoon and evening, and fatigue and poor nutrition of the mother reduce milk secretion.

In addition, the influence of so-called lactation crises may also be felt, when milk secretion decreases for several days when the child is between three weeks and one and a half months old, and such declines may be repeated at intervals of approximately one and a half months during the period from three to eight months. [ 3 ]

Expressing breast milk with a breast pump

The better the mammary glands are emptied, the faster new milk is produced, and in some cases milk expression devices – breast pumps – can help.

The simplest of them is a pumping bulb (with a glass cover and a reservoir).

There are also types of piston-action breast pumps, but manual mechanical pump-type breast pumps are more commonly used: Canpol babies, (Manual Breast Pump) Avent Philips), Lovi, Baby Team, Mamіvac Easy, Chicco Natural Feeling, Tommee Tippee, etc. Many models come with special jars for expressing milk and bottles with nipples for feeding.

To solve more serious problems with breastfeeding or if it is necessary to create its reserves, there is an electric milk pump Medela Mini Electric and an electronic two-phase pump (with a sucking effect) – Medela Swing.

How to use them is indicated in the instructions included. [ 4 ]

Storing milk after pumping

An equally important question is where to put the milk after pumping? As breastfeeding consultants note, if the baby is full without finishing the next portion, then the remainder should simply be poured out, and if the excess is untouched, store it for additional feeding if necessary or for insurance.

Where, how and how long to store milk after pumping?

Milk can be stored after expression at room temperature: at +25°C – no longer than 5 hours, at lower temperatures (+20°C) – up to 10 hours.

But it is much more rational to store milk after pumping in the refrigerator, since its shelf life increases to two or three days. And if you freeze it, then up to six months.

How to freeze breast milk after pumping?

For freezing, use plastic containers with a lid or hermetically sealed sterile bags for storing expressed milk. Each portion of milk should be labeled with the date it was expressed.

In a regular freezer, milk can be stored for three months, and in a special freezing chamber (at -18°C) - twice as long. After defrosting a portion of milk, it must be fed on the same day.

Is it possible to mix milk from different pumpings? Yes, but only portions obtained within 24 hours, which should be kept in the refrigerator for an hour beforehand.

How to warm breast milk after pumping? Before feeding the baby with expressed milk, it is warmed to body temperature by placing the bottle in a container with warm water. [ 5 ]

Problems with pumping

When the temperature rises after milk expression, it may be due to milk flow or irritation of the nipple and areola, which leads to the release of oxytocin and the action of the oxytocin reflex. In addition, thirst and headache may occur.

But pain in the chest during and after expressing milk occurs when this manipulation is performed incorrectly (too much compression of the breast) or in cases of lactation mastitis.

If the milk outflow is disrupted, partial coagulation of milk in the milk ducts is possible, and then milk clots appear when expressing.

Yellow milk when expressed may mean that it is the fattier hind milk. Also, pigments from food products or medications (for example, yellow dye contained in the shell of vitamin pills and tablets) easily get into the milk. In general, the normal color of breast milk is considered to be slightly bluish or yellowish. [ 6 ]

Pink milk when pumping may be caused by a broken capillary in the nipple or by the mother eating beets the day before. Also, pink or brownish color is caused by blood in the milk when pumping, which can get into it from a broken capillary of the glandular tissue of the gland or damage (cracks) of the nipples. This does not affect the nutritional properties of the milk in any way and does not harm the child.