Supporting

Conflict of Interest
mothers Declaration
• Cherished Parenting Services sells breast pumps
with and expressing products

• I have not been paid to make any statement

• No brands will be mentioned - I am giving this

JUSTINE VAN DER WATT
information to educate
RN, RM (Endors.), IBCLC
• Pictures are used for illustrative purposes

Topics covered Introduction

• What can be used to express
• NICU nursing ->
• Frequency of expressing and optimising output
• Flange sizing Midwifery -> IBCLC
• Common misunderstandings/myths on • My breastfeeding/
expressing long term
expressing journey
• Some interesting hints
• Weaning • Increasing my supply

There are always exceptions to rules and variations on 'normal'. Just like
with direct breastfeeding, it is not 'one size fits all' - this is a good place to
start

What type of pump to Frequency of

use expressing
• Does it matter? • Frequent, effective removal of milk is the best starting
point for milk production
• Hand expressing vs manual vs non-hospital
• Directly breastfeeding babies will feed 8 - 12 times in
grade vs hospital grade
24hrs
• We don't prescribe set times at the breast
• We encourage babies to drain the breast and feed
overnight - is it different for expressing?
 Frequency of
expressing
• DRAIN the breasts AT LEAST 8 times in 24hrs, with at
least session between 1 and 5am
• EG - 2am, 6am, 8am, 11.30am, 2pm, 5pm, 7.30pm, 9.30pm

Considerations Power pumping

Pump as normal to drain the breasts • Mimics cluster feeding
• Not about how much
• What about oversupply? Wait 10 minutes

they get in that session -

• How long will this need to be done Pump for 10mins

to increase overall output

• An expressers' 'magic number' Wait 10 minutes

• Pump again at their next

• What if expressing starts when the baby is xx Pump for 10mins

scheduled time
months old? Wait 10 minutes
• Ideally once a day for 3
Pump for 10mins
days

Flange sizing Flange sizing

• Informal Facebook survey - "If you have been sized properly,

what size are you"

• Flange size can make or break output and comfort
⚬ 105 respondents ~3/4
• 'Size does matter....but bigger is not always better'
⚬ 53% - 21mm or 19mm SMALLER
• Flange should fit the nipple like a shoe ⚬ 12% - 17mm than a
• Trialing different sizes may be the only way to ⚬ 14% - 24mm 24mm
⚬ 13% - 27 or 30mm
know which one works
⚬ Rest (~8%) smaller than 24mm (13, 16, 20, etc)
• Comfortable* and efficient
⚬ Numerous comments about being incorrectly sized (too big)
(*relatively)
by health professionals
 Flange sizing Common myths
• Supply cannot be maintained just by expressing
• Starting point - • If you are not directly feeding the baby then what is
• Measure the diameter of the point?
the nipple BEFORE • Expressed breast milk is 'bad' or not as good as milk
expressing directly from the breast
• Add 3-4mm • Expressing is not breastfeeding
• Long term expressing can cause damage
• No one would choose to exclusively express

Tips & hints Weaning

• How to know when it is time - "Don't stop on a bad
• Dried milk on nipples day, but if every day is bad maybe it is time to stop"

• How does the body know if the baby is sick • Stop compressions/hand expressing

• Hands free bras - hacks • Don't drain the breasts

• Storage of milk and cleaning of parts • Once down to 2-3 sessions/day supply may drop

• Valves anyway

• Express if any lumps/engorgement

• Weaning 'flu'

Conclusion
• Think of expressing in the same way as baby feeding

- frequent sessions at the start, draining, cluster

feeding, weaning

• Size flanges properly

• Be supportive