If you are planning to spend time away from your baby whilst Breastfeeding, it is
important to protect your Breastfeeding and your milk supply by being careful to continue to stimulate your milk by using a breast pump or hand expressing.

Your breast milk supply is very finely tuned to the demands of your baby, therefore to maintain your milk supply it is important to mimic your baby’s feed frequency and not doing this can result in your breasts beginning to shut down milk production often preceded by engorgement or mastitis.

Expressing Breast Milk

Before you start, it is important to find a comfortable place to sit and to relax as much as you can. Some mothers find that expressing takes a bit of practice, having a picture of your baby to look at can help.

Hand expressing

Some mothers are quite good at this, and others find it difficult, this is normal. Hand expression is best used in the very early days of Breastfeeding as you cannot collect tiny amounts of colostrum and transitional milk in a pump. Some mothers find that it easier to express if you are Breastfeeding your baby at the other breast.

To hand express, first wash your hands, place your index finger and thumb on the areola and apply pressure simultaneously back into the areola and together, it takes some time to master this. Move your fingers around the areola to find the best places to get the milk to flow. The best results are achieved by moving all around the breast and expressing both breasts. Use small clean bowl to collect the milk.

Using a breast pump

The use of a breast pump takes practice and you may find that the pump does not always stimulate the breasts in the same way as baby would.

The correct way to use a breast pump

When using any pump it is important the funnel part of the pump is the correct size for you, only the nipple and no more than about 1cm of areola should extend into the funnel when the pump is being used. If more areola is going into the pump the pump will not work efficiently and it will also make you very sore! You can buy different sizes funnel inserts for most pumps.

Some mothers find that their milk flows more readily with or without the use of the flexible funnel insert that is included when you purchase some pumps.

For more information on feeding your baby from a feeding device, read Katherine’s complete guide Your breast fed baby and expressed breast milk

Offering baby an alternative feeding method too soon in the early days whilst they are learning to breastfeed may interfere with the way your baby is Breastfeeding. It is better to wait until your Breastfeeding and lactation are established; this can vary between mothers but generally it takes 2-4 weeks.

I have also noticed that there appears to be a developmental window in which babies readily take an alternative feeding device without appearing to refusing the breast, I have also noticed that if this is overshot you may need to wait until the next window!

Go at your Baby’s pace

Plan ahead, particularly if you need to return to work. Check with your employer that they will permit you to perhaps divide your lunch break to express your milk.

There is useful information on your rights when returning to work and returning to work whilst Breastfeeding at the following links:

• www.hse.gov.uk
• www.maternityaction.org.uk
• www.nct.org.uk

Try short lessons with your chosen feeding method every day to increase your baby’s tolerance.

Contrary to belief it is better not to offer a bottle or other method when your baby is really hungry, better to give it after or during a breastfeed. Some babies can go without feeding all day and wait for your return home to breastfeed!

Stay calm, go at baby’s pace, baby will let you know if you are going too fast, it’s my experience that breastfed babies who feed well at breast feed happily feed by other methods and back again.

How much to give baby?

Breast fed babies need their weight in kilos multiplied by 20mls per feed, for example if your baby weighs 4.5kg they need 90mls for a feed, some babies who are light for their age may have their weight in kilos multiplied by 30mls.

If your baby is fed exclusively on breast milk they will need their weight in kilos multiplied by 150mls a day (24 hours) if they are light for their chronological age they need 180mls a kilo a day.

The above calculations are different to those used for artificial milk. For babies that are mixed fed (breast milk and artificial milk) I advise parents to use the above calculations to good effect.

For more information on feeding your baby from a feeding device, read Katherine’s complete guide Your breast fed baby and expressed breast milk

All of the supplementary feeding methods detailed below should ideally be demonstrated to parents by a Lactation Consultant, Midwife or other competent Breastfeeding specialist, who should in most situations, is able to provide the necessary equipment or give you advice on where to purchase it.

Finger feeding

Using a feeding tube attached to your finger with tape, the other end of the tube can be connected to a syringe or placed in a bottle or other container. Baby learns to suckle as they would at the breast, in that the tongue and jaw move in a similar way to Breastfeeding, in addition the milk is mixed with salivary amylases in the mouth assisting with digestion. There is little risk with this method of baby aspirating milk into their lungs.

Feeding tubes are usually available from community midwives, Lactation Consultants and other Breastfeeding specialists. The ideal size is 6FR. The tubes can be cleaned by flushing them with a syringe and warm soapy water, then flushed with clean water and then hung on the racking of a steam steriliser. Alternatively they can be cleaned with sterilising solution.

This method is particularly effective for mothers wishing to minimize the possibility of their baby acquiring the preference the milk flow that a bottle teat may provide. It may sometimes be necessary to adjust the position of the end of the NG tube on the finger to prevent damage to baby’s mouth; some babies prefer to have the tube attached to the side of the finger.

Ensure that baby is swallowing milk and do not allow it to pool in their mouth as this could cause them to gag or choke. The flow can be controlled by either raising or lowering the syringe or bottle, don’t forget to give baby winding breaks!

Syringe feeding

This can undertaken by directing the milk a tiny amount at a time to the inside of the cheek, the parent’s finger can also be placed in the mouth with the tip of the syringe similar to finger feeding. Follow the safety tips as for finger feeding.

Spoon feeding

Hold baby in an upright position, the spoon can be held to the baby’s bottom lip and baby laps the milk out of the spoon, this may not be suitable if your baby is tongue tied as they may have difficulty extending their tongue over the gums to lap the milk. Avoid pouring the milk into baby’s mouth as this can result in gagging, choking or aspiration.

Cup feeding

The milk is placed in a special baby feeding cup or something similar like an egg cup, and baby is fed as above as in spoon feeding. It is important to observe the safety tips described above, and again this method may not be suitable for Tongue-tie babies.

Supplemental nursing system

This is a device where the milk is placed in a bottle or syringe that can be hung around the mother’s neck. A fine tube is connected from the bottle and can be taped to the mother’s breasts or her finger.

This device has a valve system so that the baby only gets the milk in the bottle when they suckle. The tubes can also be attached to the parent’s finger or attached underneath a nipple shield for babies that need the palate stimulating prosthetic effect of this.

The bottle is usually made of soft plastic that can be squeezed gently during the course of a feed to simulate breast compression and or milk let downs. Don’t forget to offer baby winding breaks.

A note on the use of nipple shields
You may find the use a nipple shield helpful if;

• The nipples are flat or inverted (nipple shields offer a prosthetic effect stimulating baby’s palate, enabling them to suckle)
• Baby is tongue tied
• The nipples are damaged or painful

The use of nipple shields is advisable as a temporary measure for the above reasons, however when using them it is important to get the right size for you, by the diameter of the nipple not the length. The images above demonstrate how they should be applied, it is not necessary for the nipple to reach right to the end of the teat.

When using a nipple shield it is important that baby breast feeds and it not just sucking on the end of the nipple shield. To do this, ensure good Breastfeeding technique and that baby’s cheeks are in contact with the breast, you should not be able to see the teat of the nipple shield moving in and out of baby’s mouth. For more advice on positioning your baby correctly for Breastfeeding with or without a nipple shield please read my Problem Free Feed download.

Bottle feeding

Breastfed babies suckle, bottle fed babies suck.

When babies breastfeed they have to get the nipple in just the right place in their mouth, exert negative pressure (suck), move their tongue in a rhythmic wave like motion, form a collection of milk (bolus), coordinate the swallow without inducing gagging, breathe, initiate milk let downs and cope with variations in flow. All at the same time! They have acquired a specific neural pathway to achieve this when they breastfeed.

Bottle feeding is different; the tongue moves in a different way, and flow is largely controlled by the teat opening size. When a breastfed baby is offered a bottle they need to acquire a new neural pathway, this can take time.

Some babies may leak or dribble milk from their mouths whilst bottle feeding. This can be due to inadequate tongue mobility as a consequence of the presence of a tongue tie. It may also be due to baby over excursioning (bringing their jaw down too far whilst feeding). Feeding baby in a more upright position and supporting the chin with your index finger or rolled muslin to prevent over excursion can help.

When using expressed breast milk a smaller bottle i.e. 160 mls is preferable, as it presents a smaller surface area for the fat to stick to the inside of the bottle, (the fat sticking to the inside of the bottle means that the baby doesn’t get this important part of the feed). Bottles with valve systems that enable the baby to exert a similar negative pressure in the mouth similar to when they breastfeed may be beneficial.

Some mothers find a banana shaped bottle angle easier for some babies to feed and ensure that the breast milk is always in contact with the teat.

Whilst Breastfeeding use a slow flow teat, once baby is competent with this, you may progress to faster flow teats. Baby is ready for faster flow teats if they are sucking too hard on the teat causing it to collapse and deflate.

For more information on feeding your baby from a feeding device, read Katherine’s complete guide Your breast fed baby and expressed breast milk

Compressing the breasts during pumping without causing the pump to lose suction will assist in milk ejection. You can find some more information at Dr Jack Newmans website on breast compression and watch videos on Breastfeeding.

If you are using an electric pump it will have a pre-set suck programme, if you are using a manually operated pump I find that mothers are able to express more effectively if you mimic the action that baby would use, i.e. 4-6 short partial depressions of the pump handle followed by one full depression of the handle during which the milk will stream, repeat until the milk no longer flows readily.

If you need to initiate a milk supply or need to express most of your baby’s milk requirements, a double electric pump is best, these can be easily hired. You may find some useful information on hiring at the National Child Birth Trust or call to find a NCT breast pump agent for your area on 0300 330 0770. You can also visit Medela and Ameda Pump Rental for more information.

Storing breast milk

To save valuable time it is only necessary to sterilize your breast pump once every 24 hours, provided you cover the pump funnel with some paper towel or cling film or put it in a clean air tight container and store the pump in the fridge between expressing. Decant the milk into your chosen storage container before expressing further milk. Ensure you label your milk carefully with the date and time and amount.

Good resources on expressing and storing your breast milk and frequently asked questions can be found at the below links:

• Breastfeeding Network – Expressing and Storing Breast Milk Download
• Breastfeeding Network – Expressing and Storing Breast Milk FAQs
• Kelly Mom – Milk Handling/Storage

When to express

• Expressing immediately after breastfeeds means that there is minimal impact on the potentiality for milk at the next feed. Expressing between feeds or too close to the next feed can often mean that the supply available to baby is compromised.
• You will usually be able to express more in the earlier parts of the day, this is normal, and is a result of fluctuating milk producing hormones.
• If you would like to give your baby some expressed breast milk at either their or your bedtime, express the amount you need in the morning, you may need to express after two consecutive feeds during the day to get enough for the bedtime or ‘dream’ feed.
• You may also need to express at the time that baby is given the expressed milk feed, as they will be missing a breastfeed, if you don’t do this you may experience engorgement and / or a reduction in milk supply.

There are some very useful resources available at Kelly Mom

For more information on feeding your baby from a feeding device, read Katherine’s complete guide Your breast fed baby and expressed breast milk

If your baby is finding it hard to adjust to the new way of feeding, here are some tips:

• Give the bottle at the end of feed when baby is sleepy
• Dip the teat in the breast milk
• Trial different types of teats available
• Warm the teat and milk, avoid using a microwave, using your own body heat is best, put the bottle inside your top!
• Some babies may need to use a nipple shield for a few days to transition from breast to bottle
• Give the baby a bottle whilst in a sling
• Try a cup, or supplemental nursing system
• Offer the bottle whilst baby is in their usual Breastfeeding position
• Try a bottle that is soft and can be squeezed to simulate let down
• Disguise the bottle by wrapping it in muslin

For more information on feeding your baby from a feeding device, read Katherine’s complete guide Your breast fed baby and expressed breast milk