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Expressing Breast Milk

Session 15
Expressing breast milk

After completing this session
participants will be able to:
 know the situations when milk
expression is useful
 Explain how to stimulate the oxytocin
reflex
 Explain the steps of expressing breast
milk by hand
 Describe how to prepare a container
and store expressed breast milk
In what situations is it useful to
express breast milk (BM)?
In what situations is it useful to express breast milk (BM) ?

Expressing BM is useful to: 

When mom goes out or goes to work 
Feed LBW who cannot breastfeed 
Feed sick baby who cannot suckle enough 
Keep up the supply when mom / baby is sick 
Prevent leak when mom is away 
Help baby attach to a full breast / engorged 
Transition to another method
RECALL
How to stimulate oxytocin reflex

These help reflex These hinder reflex

• Thinks lovingly of
• Worry
baby
•Stress
• Sounds of baby
• Pain
• Sight of baby
• Doubt
• Touches baby
•(temporary)
• Confidence
How to stimulate oxytocin reflex 

Help the mom psychologically
 Build her confidence
 Try to reduce source of pain or
anxiety
 Help her to have good thoughts and
feelings about her baby
How to stimulate oxytocin reflex - cont

Give mom PRACTICAL advice/ help 

Sit quietly / privately or with supportive
friend 
Hold baby with skin to skin contact if possible
( baby on lap / look at baby / picture ) 
Warm the breast; take a warm shower 
Stimulate nipple 
Massage or stroke breast lightly
( fist / comb / finger tips ) 
Ask helper to rub her back
 Massage of the breast using a ‘fist’ and
rolling action.

This is for teaching purposes only. This cannot be published.
Back massage With the hands placed flat
on the back, the tips of the fingers facing
towards the vertebral column

This is for teaching purposes only. This cannot be published.
 Back massage With the hands placed
flat on the back, the tips of the fingers
facing towards the vertebral column

This is for teaching purposes only. This cannot be published
 Stroking

This is for teaching purposes only. This cannot be published.
How to rub a mother’s back
1. Head resting on
the table
2. Mother is naked
with the breast
hanging
3. Rub with the
thumb both sides
of the spine in a
circular motion
from the neck to
the shoulder
blades
Practicum :

Rub the back of your friend now !
How to express breast milk by hand

Pointers:

 Most useful way
 Anywhere / no appliance needed
 Show her how to express
 DO NOT touch her body
 Be very gentle
Prepare container : 

Cup / glass / jug / jar with wide
mouth 
Wash cup with soap and water 
Pour boiling water into the cup &
leave for a few minutes to kill
bacteria 
Pour the water out when ready to
express
Breastmilk expression

POSITION
PUSH
PRESS
RELEASE
ROTATE
Important pointers

Demonstrate it as much as possible
with your own body or a breast model
or soft part of your arm or cheek
How to express breast milk by hand

Put her thumb on
her breast above
the nipple and
areola and her first
finger on the
breast below the
nipple and areola
opposite the thumb

This is for teaching purposes only. This cannot be published
 Press her thumb and her first finger
slightly inwards towards the chest wall

This is for teaching purposes only. This cannot be published
 Press her breast behind the nipple and
areola between her fingers and thumb.
Sometimes in lactating breast it is possible
to feel the ducts like rods and peanuts

This is for teaching purposes only. This cannot be published
 Press and release , press and release

This is for teaching purposes only. This cannot be published
 Press the areola in the same way in the
sides to make sure that milk is expressed
from all segments of the breast

This is for teaching purposes only. This cannot be published
 Express one breast for at least 3-5 min
until the flow slows ;then express to the
other side and repeat on both sides.
Adequate milk expression takes 20-30 min

This is for teaching purposes only. This cannot be published
 Avoid squeezing the nipple itself

This is for teaching purposes only. This cannot be published
How often to express ?
It depends on the reason for expressing
BUT
usually as often as the baby would
breastfeed
How often to express ?

1. To establish lactation, to feed LBW or
sick newborn

 Do immediate latching
 Start on first day
 Few drops of colostrum but it helps BM
production to begin
 Express at least every 3 hours
INCLUDING night
How often to express ?

2. To keep up her milk supply to feed a
sick baby - at least every 3 hours

3. To build up milk supply which seems to
be decreasing –
 every 1-2 hrs for a few days
 and at least every 3 hrs during the night
How often to express ?

4. To leave milk for her 5. To relieve symptoms
baby while she is at such as engorgement or
work leaking at work

Express as much as Express only as
possible BEFORE she necessary
leaves
And express while at
work to keep supply
Practicum :

Rolling action of fingers on the
breast model or arm

Breastmilk expression – on yourself
Breast pumps

Use if available – for engorged and
painful breast
Manual breast pump or automatic
breast 
Automatic breast pump
Summary on page 85-90