Written by Alison Baum

EXCLUSIVE EXPRESSING, WRITTEN BY ALISON BAUM

The founder and director of Express Yourself Mums

THIS ARTICLE IS REPRODUCED WITH THE KIND AND DIRECT PERMISSION OF ALISON BAUM. PLEASE VISIT WWW.EXPRESSYOURSELFMUMS.CO.UK FOR MORE INFORMATION ON ALISON’S WORK

Editor’s introduction
I wrote this article when David was about 10 months old. He is now three and a half and doing better than I ever imagined. I ended up having to express again for my second son Joshua but I’m thrilled to say that Joshua is now Breastfed.

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If your baby can’t breastfeed for medical reasons he or she can still benefit from your milk. In fact the benefits of breastmilk are particularly important if your baby has medical problems. If your baby is not well enough, strong enough or for whatever reason cannot breastfeed, expressing is the answer. It is something that you can do, a difference that you can make.

Unless you had warning of a problem through scans or prenatal diagnosis you may well be in shock and you will most likely be very stressed. Try and focus your energies in to the positive decision to give your baby the very best - your milk.

Before you read this article I would start by reading the ‘how to express’ article as this will give you the overview of the different types of expressing, and the crucial issues of hygiene, which are all the more important if you have a premature or sick baby.

But your situation (like mine) is different from Mums of ‘normal’ babies. With ‘normal’ babies the baby stimulates the breast to make milk; expressing is something the mother may start some weeks later to give the Mum more flexibility to be away from her baby. But for us the only way to ensure that our milk continues to flow is to express.

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Needing Support

The effort involved in exclusive expressing is not to be underestimated, and the more support you have the better. Whenever my husband wasn’t at work we would sit together, me expressing, him feeding David. And it was great to have family support for the huge amount of sterilising that exclusive expressing generates. I invested in 2 spare collecting sets, so that I didn’t have to sterilise after each express. I washed and rinsed my collecting sets straight away and then left them in a washing up bowl until I, or someone else had time to put a load or two into the steam steriliser.

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Setting goals

I knew from the beginning that I wanted to take David through his operation, (which was booked for when he was six and a half months old), on my milk. But I didn’t know if this was practical or feasible, so with my husband we set a goal to express for 3 months. Once I’d made it to 3 months I knew I could make it to six and a half months. But to be safe I worked hard to stock up the freezer with my milk so that if, for whatever reason, I had to stop I would have two weeks supply for David post-op. In the end I kept going until a month and half after his operation, but at seven and a half months I introduced some formula. David is now nine months old and I have now completely stopped expressing, but once a day he gets a bottle of my milk from the freezer.

I was extremely lucky. It could be put down to double-expressing and massage wearing the halterneck. But then the truth is that some women make more milk than others, and it could be that I’m just a natural cow! Don’t be panicked by my goals, every woman is different. The truth is that any milk you can give your baby is better than none, and that none is more important than the colostrum in the first week or two. So play it by ear and see how you get on.

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In the beginning

You should start to express as soon as possible after delivery, preferably within the first six hours and certainly within the first 24 hours. You should continue to express every 2-3 hours during the daytime and at least once at night. Basically you should express as often as a new-born baby would normally be fed at the breast.

I was so determined to get my milk supply going that I tried too hard. I used the ‘industrial’ (i.e.: big and powerful) electric pump on the ward and when I wasn’t getting enough milk out I ‘turned up the volume’. I ‘over did it’ and got cracked nipples and got very upset thinking I had ‘blown it’. But I hadn’t!

The key is not to expect to get very much milk out at the beginning, the milk doesn’t come in for two to five days. Although volumes are small in the beginning, it is important to collect all of the rich colostrum. Colostrum is high in immunoglobulins - it is so precious, like gold dust - it just looks like custard! Because the volumes of colostrum are so small at the beginning some people recommend hand expression at the beginning and using a sterile syringe to collect it, as it maximises the volume collected minimises waste in tubes and funnels and ensures that the baby gets most of it.

At the beginning David was being fed by a naso-gastric tube and the doctors had ‘prescribed’ that he be given 25 mls every 4 hours. But I was only making 5 or 10 mls an ‘express’ at the beginning. I knew about the idea of donor milk, but I didn’t know enough, I didn’t realise the rigorous screening milk donors go through before they can donate their milk to a milk bank. If I had known what I know now I would have requested that David be given donor milk until my milk came in, but instead for the first three days everything I expressed for him was supplemented by formula to make the volume up to what the doctor had prescribed. (Most milk banks are usually only able to supply premature or sick babies with donor breastmilk but some do make it routinely available for babies who require supplementation on the postnatal wards.)

I was lucky enough to be in one of the relatively few British hospitals with milk banks. I just wish I had known more about the safety of donor milk as I could then have ensured that David never had any formula. I was emotional, confused and wasn’t provided with the information I needed to make an informed decision.

The more I’ve learnt about milk banking, the more impressed I am with the work of the United Kingdom Association for Milk Banking (UKAMB) which is why I decided to make UKAMB one of the charities you can choose from when ordering products on this website. For more information on Milk Banking read the excellent article written by Gillian Weaver the Chairperson of UKAMB.

I have the charts from David’s first few weeks’ of feeding and I remember how proud I felt when from day four all the milk he was getting was mine!

Hand-expressing is important and useful (see the main article on How to express). But if your baby can’t breast feed and you are to keep your milk supply flowing then you will probably be spending many hours over the next days and weeks attached to an electric pump. It is difficult to decide whether to rent or buy a pump. Until recently it was only the “hospital grade” rental pumps that were up to the rigour of exclusive expressing. But in recent years both Ameda and Medela, the two main electric breast pump companies in the UK, have started retailing excellent pumps. These are available to buy on this website and if you plan to express for more than a couple of months it can work out cheaper to buy a pump than rent one.

I would also thoroughly recommend that you buy or rent a pump with the facility to double-pump. I’ve explained the benefits of double-pumping in my article on how Express Yourself Bras was born, and also in my article on How to Express page.

The benefits of double-pumping are all the more relevant if your baby can’t breastfeed so I will summarise again here. Double-pumping has been shown to stimulate the production of the breastmilk hormones, oxytocin and prolactin and to increase milk yield. The other key thing you can do to increase the volumes you produce is to massage your breasts both before and during an express. I did both these things for months before I happened upon the scientific paper which showed that both double-pumping and massage increased milk yield.

You are going to spend many hours over the next weeks and months expressing so you might want to buy an Easy Expression Halterneck Bra or Easy Expression Bustier so you can get on with other things while you express. I found that being able to talk to friend on the phone, or being able to read a book while I expressed made me feel connected to the world during what was a very difficult time. Part of me feels uncomfortable mentioning my product in the middle of general advice on expressing, but I can honestly say the Halterneck made such a difference (It helped so much that I set up Express Yourself Bras to allow other women in the UK to benefit from the Halterneck). It allowed me to massage and empty my breasts each time I expressed which stimulated my breasts to make more milk so I was always ahead of the game.

As to which double-pump to buy. I would say there are a number of choices, see the products pages for them all, however I do have two firm favourites.
i) The Lactaline by Ameda which is extremely good value, small, portable and robust and has a control for intesity of suck and rate of suck which can help with the let-down.

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How often should I express?

In the first few months it is crucial to express as often as you can, they say 8-10 times a day, basically as much as you would be feeding a demand fed newborn. Bu as long as you double pump and fully empty your breasts everytime, I believe you can get away with 7 or 8 expressing sessions in 24 hours as long as one of these sessions is in the middle of the night. In these first few months the night express is essential as your milk producing hormones are highest at night.

If you are expressing because you have a very premature baby then hopefully within two or three months they may be getting strong enough to begin to attempt to breastfeed. (34 week babies could be breastfeeding within a week or so it all depends on the degree of prematurity and whether there are other things going on with your baby).

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In for the long-haul!

If, however, like me your baby can’t breastfeed for a long time, for example because of a cleft palate, then the only way they will continue to get your milk is if you continue to express. After 3 months I dropped an express and went down to 6 or 7 times a day. I had my Mum saying sleep was more important, and I should drop the night express. But everything I read told me how important the night express is so I stuck with it. When David was five and a half months old I finally dropped the night express. At first it was difficult as I’d wake up too full and have to express in the wee small hours of the morning. Eventually I got into a pattern where I’d do my last express at 11.00pm and my first one in the morning at around 6.30 or 7.00 am - I would consistently make almost half a litre!

In retrospect I could have dropped the night express sooner, perhaps at four months as by then my boobs were well and truly in milk production mode. But I would play things by ear, see what works for you. The key thing to remember is that no decision is irreversible - say you drop an express and you feel that your supply has dropped below what you need for your baby, then just embark on an intensive programme of expressing more often for 3 or 4 days to get the supply back up.

By 6 months I dropped down to 5 or 6 expresses in 24 hours. I was still making over a litre and a half a day.

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Stopping

I had no idea how difficult this would be! Having spent many months worrying about not making enough it didn’t cross my mind how long it would take to stop!

As an exclusive expressor your situation is totally different to a breast-feeding mother who stops in tandem with her baby. It is down to us to train our breasts to gradually make less and less milk. It took me 6 weeks to stop and I think I rushed it too much, I was engorged and uncomfortable a lot of the time. I had a goal - to be down to two expresses in 24 hours by the time I went on holiday. I dropped an express every week, ie: went from 6 to 5, 5 to 4 etc every week. I would have been better off giving myself 10 days on each ‘regime’ before dropping another express.

NB: I did have my breasts in major ‘milk production mode’ as I had been double-expressing, emptying my breasts every time I expressed. It might well be that you have an easier time of stopping than I did. But if you do get engorged, a warm shower is great. I would regularly have to do a bit of hand-expressing in the shower to take ‘the pressure off’ before being able to express with the pump.

The other mistake I made was to continue double-pumping. I now realize that double-pumping is so good at keeping the hormone levels up and keeping the breasts in milk producing mode that I would have been better off single pumping. The other key to stopping is to start expressing for a set amount of time rather than expressing until you’ve emptied your breasts. Once I limited myself to 10 minutes an express things did get easier, but it took time.

Before I embarked on my program of stopping I asked a breastfeeding counsellor about going ‘cold turkey’. She said absolutely not, it would be a big mistake, it would be very painful, and I could well end up with mastitis. Experiencing how hard and painful it was to drop from eg: 4 expresses a day to 3 made me realize how right she was!

I finally cracked my reduction of milk production when I went on holiday. I was by now just down to two expresses a day. I left my double-electric pump at home and just took a hand-pump, it just wasn’t as efficient for me, and it helped me reduce my milk production.

As I explained at the very beginning of ‘How to Express’, making milk is all about supply and demand, the same principals work to help you stop. If you regularly don’t empty your breasts and let them get a bit engorged, they should gradually, with time, ‘learn’ to make less next time. Once you’ve taught them that amount, then by dropping another express you can take your milk production down a notch.

It has been several weeks since I finally stopped expressing, but to my surprise I still have milk. I kept trying to get David on the breast until only last week, when I managed as usual to hand-express into his mouth. Unfortunately he still doesn’t have a suck, and is totally disinterested.

I hope that you have more luck than me getting your baby on your breast. But even if you don’t get them feeding on your breast, you will know that you have done the best you can for them, in giving them your milk. Good Luck!

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I wrote this article when David was about 10 months old. He is now three and a half and doing better than I ever imagined. I ended up having to express again for my second son Joshua but I’m thrilled to say that Joshua is now Breastfed.

I have recently come across a superb book “Exclusively Pumping Breast Milk - a guide to providing expressed breast milk for your baby” by the Canadian mother and author Stephanie Casemore who exclusively expressed for her son for a year. This 150 page book goes into so much more detail than I can cover on this website. Lactation Consutants and infant feeding advisors who have seen the book have raved about it. I am delighted to bring the book to the UK. You can buy it from the shopping section.
If you have any articles or stories you would like to share with us, whether you are a professional or a mother with experience of any of the subjects included on this site and would like to contribute we would love to hear from you.