The Need for Expressing Milk

There are many situations in which expressing breastmilk is useful and important to enable a mother to initiate or continue breastfeeding. In this articleExpressing milk is useful toStimulating the prolactin reflexHow to Stimulate The Oxytocin Reflex?Practical help for motherHow to Prepare A Container For Expressed Breastmilk (EBM)Expressing milk is useful to:Relieve engorgement;Relieve blocked duct or milk stasis;Feed a baby while he is learning to suckle from an inverted nipple;Feed a baby who has difficulty in coordinating suckling;Feed a baby who refuses, while he learns to enjoy breastfeeding;Feed a low-birth-weight baby who cannot breastfeed;Feed a sick baby, who cannot suckle enough;Keep up the supply of breastmilk when baby is sick or when the mother has mastitis, sore nipple or has to leave breastmilk for her baby when she goes out to work;Prevent leaking when a mother is away from her baby;Help a baby to attach to a full breast;Express breastmilk directly into a babys mouth;It is a good idea for all mothers to learn how to express their breastmilk, so that they know what to do if the need arises.The most useful way for a mother to express milk is by hand. It needs no appliance, so she can do it anywhere and at any time. With a good technique, it can be very efficient. It is easy to hand express when the breasts are soft. It is more difficult when the breasts are engorged or tender. So it is good to learn how to hand express soon after delivery.Many mothers are able to express plenty of breastmilk using rather strange techniques. If a mothers technique works for her, we let her do it that way. But if a mother is having difficulty expressing enough milk, she may like to learn a more effective technique. Before one learns expression of breastmilk it is important to know other ways to stimulate hormones necessary for milk secretion (prolactin) and for milk flow (oxytocin).Stimulating the prolactin reflexMothers may stimulate nipple and areola to help in prolactin secretion. This is done with a gentle stroke on breast, light touch with fingers on the areola and by gently rubbing nipple between thumb and index finger. Prolactin reflex may not work as well when a mother stimulates her nipple and areola as it does when a baby suckles.Stimulating the oxytocin reflexThe oxytocin reflex may not work as well when a mother expresses as it does when a baby suckles. The mother should know how to help her oxytocin reflex otherwise she may find it difficult to express her milk.*From: ‘Infant and Young Child Feeding Counselling Training Course’ developed by Breastfeeding Promotion Network of India (BPNI) and International Baby Food Action Network (IBFAN), Asia. How to Stimulate The Oxytocin Reflex?In the absence of hospital staff, a supportive friend or a relative or a Malishwali (Masseure) can help stimulate this reflux. The mother is helped psychologically by:Building her confidenceReduce any sources of pain or anxietyHelping her to have good thoughts and feelings about the babyPractical help for motherSit quietly and privately or with a supportive friend (Some mothers can express easily in a group of other mothers who are also expressing for their babies). Hold the baby with skin-to-skin contact if possible (She can hold her baby on her lap while she expresses. If this is not possible, she can look at the baby. If this is not possible, sometimes even looking at a photograph of her baby helps).Take a warm soothing drink. The drink should not be coffee.Warm her breasts. For example, apply a warm compress, or warm water, or have a warm shower.Stimulate her nipples. She can gently pull or roll her nipples with her fingers.Massage or stroke her breasts lightly.Some women find that it helps if they stroke the breast gently with finger tips or with a comb. Some women find that it helps to gently roll their closed fist over the breast towards the nipple.Ask a helper to rub her back. - The mother sits down, leans forward, folds her arms on a table in front of her, and rests her head on her arms. Her breasts hang loose, unclothed. The helper rubs down both sides of the mothers spine. She uses her closed fist with her thumbs pointing forwards. She presses firmly making small circular movements with her thumbs. She works down both sides of the spine at the same time, from the neck to the shoulder blades, for two or three minutes.Fig.2511: A helper rubbing a mothers back to stimulate the oxytocin reflexHow to Prepare A Container For Expressed Breastmilk (EBM)Wash the cup with soap and water. (Mother can do this the day before.)Choose a cup, glass, jug or jar with a wide mouth.Pour boiling water into the cup and leave it for a few minutes. Boiled water will kill most of the germs.When ready to express the milk, pour the water out of the cup.