Expressing milk

Close up of woman in a bra demonstrating hand-expressing using a model of a false breast held against her chest

Hand expressing can be useful:

To express colostrum or milk to give your baby, if they are unable to feed from the breast.
To relieve fullness or engorgement of the breast or blocked milk ducts.
To stimulate your breasts to produce more milk.
Some women find using a breast pump easier, some prefer hand expressing and some do both. Using a pump in the early days is not an effective way to collect small volumes of colostrum.

How to hand express

Have a clean sterilised container to hand before you start.
Cup your breast and place your thumb and finger about 2-3 cm from the base of the nipple.
Using your thumb and the rest of your fingers in a C shape, gently squeeze this area – this shouldn’t hurt.
Release the pressure and then repeat again and again, building up a rhythm. Avoid sliding your fingers over the skin. At first, only drops will appear, but just keep going as it will help build up your supply. With practice and a little more time, milk will flow freely.
When the flow slows down, move your fingers round to try a different section of your breast and repeat. When this happens again swap to the other breast. Keep changing breasts until the milk is dripping very slowly or stops altogether.
If the milk doesn’t flow, try a gentle breast massage, cuddle your baby or someone you love, smell your baby or loved one, or gaze into their eyes – this will help to release the hormone oxytocin (the “love hormone”) which releases the milk in your breasts.

Storage and use of expressed breast milk:

Expressed breastmilk can be kept for 4-6 hours at room temperature.
You can store expressed breast milk in a sterilised container in the fridge for up to five days, or in a freezer for up to six months.
Frozen milk is best defrosted slowly in the fridge. Expressed breast milk can be given straight from the fridge or warmed up by placing the bottle in a jug of warm water.
Once defrosted, use within 12 hours and do not refreeze. Dispose of any unused milk following a feed.

How to express breast milk

Breastfeeding network expressing guide Maximising milk production with hands-on pumping

18th August 201815th June 2021

Signs of good feeding/Needing support

Use the following charts and related links to determine how well your baby is feeding.


Sign of good feeding	Signs that you need to support
`Regular wet and dirty nappies (see section on nappy content)`	Minimal/no wet and dirty and nappies
`Day 3-5 less than 8-10% weight loss`	Day 3-5 weight loss of more than 8%
`At least 8 feeds in 24 hours (from day 3 onwards)`	Less than 8 feeds in 24 hours (from day 3 onwards)
`Good skin colour, alert and good tone`	Newborn jaundice in combination with reluctance to feed and unusual sleepiness
`Baby feeds for 5-30 minutes at most feeds`	Feeding consistently for less than 5 minutes or more than 40 minutes
`Initial rapid sucks changing to slower sucks with pauses and swallowing (may be less audible until milk comes in)`	Rapid sucking pattern or noisy feeding (clicking)
`Baby calm and relaxed during and after feed, content after most feeds`	Baby comes on and off during feeds, or does not latch on at all, becoming unsettled after feed
`Nipples not painful during a feed, breasts feel comfortable following feeding`	Nipples sore or damaged, breasts very full, hard, lumpy or painful

Many breastfeeding problems can be resolved with adjustments to positioning and attachment. If you have signs suggesting that you may need support it is essential to seek help straight away. Many sources of support are available 24 hours.

Help with breastfeeding Nappy content

Newborn nappy content Effective breastfeeding in the early days Positions for breastfeeding Attaching during breastfeeding UNICEF UK Baby Friendly Initiative, Breastfeeding assessment tool

18th August 20188th August 2023

Help with feeding your baby

Baby yawns while resting on mother's chest

If you have any problems with feeding your baby (including painful nipples or breasts, your baby not feeding as well as before) ask for help as soon as possible. Most breastfeeding problems relate to difficulties with positioning and attachment. A medical practitioner or infant feeding specialist may tell you that your baby has a tongue tie. Tongue-tie is a condition present at birth that restricts the tongue’s range of motion. With tongue-tie, an unusually short, thick or tight band of tissue tethers the bottom of the tongue’s tip to the floor of the mouth, so it may interfere with breastfeeding. Someone who has tongue-tie might have difficulty sticking out their tongue. Tongue-tie can also affect the way a child eats, speaks and swallows. Sometimes tongue tie may not cause problems. Other cases may require a simple surgical procedure for correction. Read the information in the Related links below. Your community midwife team works seven days a week, and you can request additional visits or telephone consultations if needed. Breastfeeding is the healthiest way to feed your baby. If you decided not to breastfeed or have stopped breastfeeding, it is possible to restart. This can be difficult because your milk supply will naturally reduce once you are not breastfeeding, but it can increase again to meet your baby’s needs. Look for skilled support to help you. If your midwives are no longer visiting you, ask for help from your Health Visitor, your Children’s and Family Centre or try a local baby feeding support group (your midwife or Health Visitor can give you details). Alternatively, especially out of hours, you can call the following telephone helplines provided by trained volunteers (they can help with breastfeeding or bottlefeeding problems): The National Breastfeeding helpline: Tel: 0300 100 0212 (9.30am-9.30pm) The NCT Breastfeeding line: Tel: 0300 330 0771 (8.00am-midnight) La Leche breastfeeding helpline: Tel: 0345 120 2918 (8.00am-11pm)

Contact my maternity unit

UNICEF UK Baby Friendly Initiative, Support for parents Global Health Media breastfeeding videos Breastfeeding in the early days La Leche League GB Association of Breastfeeding Mothers Start 4 Life Breastfeeding Network – find a breastfeeding group Find a private lactation consultant Tongue tie Finding a tongue tie practitioner

18th August 20181st September 2021

When to breastfeed

Baby wrapped in fleece blanket held in midwife's hands

Offer a breastfeed to your baby whenever he/she shows early cues that they are ready to feed, such as:

wriggling
rapid eye movements
hand to mouth movements
sucking their fingers, fist or blankets
rooting (turning head to the side and opening mouth)
hand waving
slight murmuring noises.

You can also breastfeed when your breasts feel full, when it is convenient for you (for example, when you want to go out) or when you want a rest or cuddle with your baby. To make sure your baby is getting enough milk, aim for at least 8 feeds in 24 hours from day 3 onwards, but most babies will breastfeed more frequently than this. Babies do not always feed at regular intervals and may feed very often with short gaps in between feeds, followed by periods of longer sleep. Frequent feeding is normal, especially when your milk starts to come in – meaning your supply changes from the first colostrum to mature milk.

How often should my baby breastfeed?

In the first 2-3 days many babies do not breastfeed very often, however, try to offer the breast as often as possible, to see if they might be ready to feed. In the first 24 hours, healthy term babies may feed 3-4 times. Babies who are at risk of low blood sugar due to maternal diabetes, being small or premature will need to feed more frequently, 8 to 12 times in 24 hours. After the first 24 hours and for at least for the first six months of life, all babies should feed at least 8 to 12 times in 24 hours. Feeds are likely to be at different time intervals and for different lengths of time. The introduction of solid food starts around six months of age, when the baby shows signs of readiness. Feeding should be responsive, meeting the emotional needs of mother and baby. There is no wrong reason to feed and your baby cannot be over breastfed. As a guide aim for:

first 12 hours at least 2 feeds in total
first 24 hours at least 3-4 feeds in total
day 2 at least 6-8 feeds in 24 hours
day 3 onwards at least 8 feeds in 24 hours.

These feeding patterns should be accompanied by regular wet and dirty nappies. See both these topics:

Nappy content

Signs of good feeding/Needing support

If you are concerned about your baby’s feeding contact your midwife, health visitor or local infant feeding group or helpline for advice and support. See:

Help with feeding your baby

Explore maternity units

The benefits of responsive feeding BFI happy baby leaflet

18th August 20181st September 2021

Value of breastfeeding

Close up of baby latched onto mother's breast

Breastfeeding has health benefits for you and your baby. For your baby, it provides nutrition, protects against ear infections, chest infections, allergies and diabetes to name just a few. Breastfeeding is about closeness and comfort as well as nutrition. Benefits for you include a reduced risk of breast or ovarian cancer and osteoporosis.

An introduction to breastfeeding video Human milk – what’s in human milk? Start4Life Drugs factsheet

18th August 201824th July 2023