4. Expressing Milk
It is possible to provide all of the baby’s nutritional needs via breast milk expression. It is not easy – the amount of time consumed could be likened to breastfeeding twins or triplets. There are many strategies that can be used to simplify this – the most important of which is getting off to a good start. Studies show that frequent pumping sessions in the first 48 hours, will initiate a more abundant milk supply1,2,3, . It is still possible to produce an abundant supply with a less than optimal beginning – there are many strategies for increasing milk supply.
If the baby is not latching well, then milk expression should be begun as early as possible. Hand expression appears to be particularly efficient in the early days. Colostrum (the yellowish, highly concentrated milk produced in late pregnancy and the first days after birth, and very precious food) can be hand expressed into a plastic spoon or small cup (or one person can express while another suctions the drops of colosturm with a needleless syringe) and this can be fed directly to the baby. Hand expression alternated with pumping with a double electric pump, is also considered useful1,2,3.
Once the milk supply increases (the milk ‘comes in’) then it may be useful to switch to an electric pump. Hand expression continues to be useful in adjunct to electric pumping. Dr Jane Morton’s work on ‘hands on pumping’ shows just how useful a combination of double electric breast pump, massage and hand expression can be1,2,3 .
Once milk supply increases, needleless syringe, cup or spoon may become impractical for feeding and a bottle may be preferable (if the baby is not managing with an at the breast supplementer) The parenting websites in the links sections have information on bottles available. There is a wide variety of bottles available worldwide and parents often discuss the pros and cons of these on cleft forums and Facebook groups. An IBCLC lactation consultant can also advise you on bottle feeding.
Long term milk expression is quite an undertaking. Seeking support and encouragement from other parents may be useful. There are groups of breastfeeding mothers and parents on-line (ep’ers – exclusive pumpers) that are a useful source of information.
Further reading ‘Maximising supply’
1. Morton J et al. ‘Combining hand techniques with electric pumping increases milk production in mothers of preterm infants’. Journal of Perinatology 2009;29:757-764
2. Ohyama M, et al. ‘Manual expression and electric breast pumping in the first 48 h after delivery’. Ped. Internat. 2010;52:39-43.
3. Morton J. (video) ‘Hand expression’ http://newborns.stanford.edu/Breastfeeding/HandExpression.html;