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14 Tips For Expressing To Increase/Maintain Breastmilk Supply

1.  Consider Which Method Is Best For You:
In the first few days after your baby is born when colostrum is being produced, hand expressing is typically the most effective way to express. Typical volumes are around a tsp or two and can get lost in the mechanics of a breastpump.  Using a pump after hand expression is shown in one study to be beneficial to milk supply.

One volumes increase, double pumping with a hospital grade pump (such as the Ameda Elite) is for many the most effective in terms of removing milk as well as stimulating higher levels of prolactin.(1) It is also faster - therefore if you're exclusvely pumping, trying to increase supply or need to express regularly and want to reduce time they can be great to have.  In the UK your hospital or Surestart Centre may be able to loan you one, or you can hire them privately via pump agents and online.

Some mums do find they can hand express particularly well, but using both hands on techniques and pumps as outlined in point 2 appears particularly effective where possible.  Other mums struggle to hand express, and this video clip is well worth a watch if your current technique isn't working well.

If you're using a double pump, many will also allow either one or two collection sets to be attached - so you can start out with both and then switch to single if you want to use hands on.

An alternative is a hands free expressing bra such as this - you can see this demonstrated if you click the link in point 2.  

2.  Hands On Expressing:  View this clip   Yes it's aimed at mothers expressing for their premature infant, but anyone expressing can use these techniques.  Not only will you obtain more milk per express (the mothers in the video got double), but as the clip describes also increases supply as the breasts are well drained.

3.  Power Pumping: Some mums find "power pumping" can give supply a boost.  It is basically expressing more frequently mimicking a baby having a growth spurt.

Pump for 10-20 minutes

Rest for 10 minutes

Pump for 10 minutes

Rest for 10 minutes

Pump for 10 minutes.

This can be done once per day with standard pumping at other sessions, or back to back over a day or two before returning to typical pumping.

4.  To save washing flanges etc after each use: Pop in a ziplock bag or airtight tub and store in the fridge between uses (remember to rinse under hot water to warm them up before use!)  Then wash well with hot soapy water at the end of the day.  Sterilisation is not normally needed, one study that compared bacterial contamination of  milk when collection by sterile kits and a mother’s own kit, found no difference (2)

5.  If you're trying to build additional milk: Say for building a stash ready for returning to work (but don't need the milk immediately on demand for the baby) or are maintaining supply by pump, where feasible choose set times to express and try and stick within a 2 hour window of this time.  Ie if you pick 1pm, try and express as close to that time as possible - at least between 12-2.

6.  If pumping to supplement ie you need the milk now and want to increase supply, expressing around an hour after feeding your baby can give more milk than expressing immediately after, and still allow a gap before the next feed.

Mums with chronically low supply may find their breasts refill more slowly and if baby is feeding every 1 1/2 - 2 hours, expressing after an hour can leave them feeling emptier than usual for the next feed - in this instance expressing straight after the feed (or after the supplement is given if appropriate) may work better.

7. Some mum find starting with a faster speed yet low suction help trigger the milk ejection reflex (letdown):  You can then slow the cycle down, but gradually increase the vacuum to the maximum level that is comfortable.  Some pumps have cycles that automatically follow this pattern, others require manual adjustment.  Never turn the suction up more than is comfortable.

8.  Create sensory triggers:  When a baby is feeding, the contact, smell, sounds of baby can help the milk to flow.  Pumping is in comparison mechanical, and a learnt art that can take practice - introducing sensory stimulation can therefore help.  Some ideas include applying warmth to the breast before feeding, smelling/touching/stroking baby if possible, if not a photograph and an item that smells of them can help, perhaps even a recording of sounds they make on a phone, a video clip or suchlike.

Many mums find visualising flowing milk to be surprisingly effective, and light massage to the breast as shown in the video in clip 2.  Some mums find that they literally have to tune out and watch a film, read a book or magazine once letdown has been triggered - others find they yield more by watching or visualising; play around and see what works for you.

9.  Create positive associations:  Very few mothers love expressing and a lot hate it!  Therefore trying to link a positive association to pumping can help with the psychological aspect.  One mum saved her "trashy mags" for pumping time, another had a chocolate each time she expressed and a rather nice partner recently gave mum a shoulder/neck/foot massage when she expressed.  It of course depends on age of baby, whether partners are around, how long you are expressing for etc but as they say a spoonful of sugar...

10. Night pumping:  It's best to pump when you naturally wake during the night to tend to baby if possible, if you're apart from baby or struggle to wake some recommend drinking a large glass of water to prompt a middle of the night waking.  The logic is that waking naturally occurs during a lighter sleep cycle and thus you feel more well rested by morning than if disturbed by an alarm when in a deep sleep.

Night expressing is important for most mums trying to build or maintain supply with a pump, as prolactin levels are higher in the early hours.

Keep a cool bag/box next to the bed so you can pop expressed milk and pump parts in their until morning to save trekking to the fridge, and invest in a nightlight so you don't need to turn bright lights on to find everything.

11.  Pump frequently enough:
"A normal newborn baby nurses on average 8 to 12 times in a 24 hour period. Most experts suggest it is best if mom can come close to matching what the normal nursing baby would do at the breast, and recommend she pump about every two hours, not going longer than three hours between sessions. Understanding how milk production works can help moms in their efforts to establish good milk supply. The more frequently the breasts are emptied, the more milk mother should have. Therefore, if she were to pump at least every 3 hours, for about 20 minutes, she should establish and maintain a good milk supply. In the first couple of weeks, she may also want to pump at least twice at night, but not all mothers do this." Kellymom
12.  Pump for long enough:
This is typically 15-20 minutes, some suggest 5 minutes after last drops of milk.  If your baby needs you mid express however don't panic, you can try and slot an extra express in later if needs be - or perhaps do a few shorter expressions closer together (a variation of power pumping)  there has to be some degree of flexibility if mum is home alone and expressing longer term.

13.  If you have larger breasts play around with positioning.
I supported a mum recently who expressed with massage, yet applying slightly more pressure to the flange (not an uncomfortable amount) delivered even more milk still, so play around with pressure, positioning etc during different parts of the feed for maximum production.  Similarly try not to spend long periods expressing leaning forward too much - or you can end up with sore shoulders and back.  Get some pillows, cushions and get comfy.

14.  Use heat
Evidence suggests applying heat to the breasts prior to feeding increases expressing levels.  Heat packs that can be reheated in the microwave can be an easy and affordable option.

Remember the amount you can express is not an accurate reflection of the volume produced.  As the video clip in point 2 highlights, mother's can as much as double milk production after using an electric pump - highlighting they do not alone drain the breasts well.  Oxytocin levels are typically naturally lower when pumping (hence the additional sensory stimulation) and some mums do struggle to express well, even when they have lots of milk.

Do you have any other tips and tricks that worked for you?

1. Auerbach, K. Sequential and simultaneous breast pumping: a comparison. Int J Nurs Stud 1990; 27(3):257-65.
2. Mohrbacher, N. and Stock, J. The Breastfeeding Answer Book, 3rd Rev Ed. Schaumburg, IL: LLLI, 2007

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