When and how often to express breast milk

When one should start expressing causes confusion for both mothers and healthcare professionals. Moms are often told not to express before 6 weeks. But many don’t realize that expressing sometimes form part of the care plan for a specific breastfeeding difficulty, and at other times is something a mom does for convenience or for building a freezer stash.  This means that there are many grey areas, and that you need to find the option that will work for your unique situation.

Before you start:

• Read our articles on whether you really need a breast pump and how to choose a breast pump. To reach the desired results you need to express with the correct pump for your situation.
• You also need to express using the correct flange size – use our printable download if you need guidance.

Below is a break-down of our suggestions for when and how often to express for all the specific scenarios.

Expressing breast milk for occasional use 

If you are not planning to return to work and just want to express milk for occasionally being away from baby, you may well manage with a hand pump or with hand expressing.

• Don’t do this type of expressing before baby is 6-8 weeks old; your body needs to settle and establish your supply. You should also not give baby a bottle before this age as it can still interfere with baby’s latch (called nipple confusion).
• You can experiment with when to express. Remember though that you will work in sessions between your baby’s usual feeds, so you probably won’t get out lots of milk in a session and you may need a few expressing sessions to make up one feed.
• You can try expressing for a few minutes after baby’s normal feeding.
• If your baby takes only one breast at a feed you can express on the other side.
• Alternatively, express first thing in the morning before baby wakes up (your body will make milk again when baby needs her first feed for the day).

Expressing breast milk for going back to work 

The rules here are basically the same as for expressing for the odd event away from baby. Add these considerations:

• It is a good idea to start expressing occasionally from 6-8 weeks as you need to get used to your pump and to expressing (remember it is a skill that you need to practice).
• However, you should start expressing more dedicatedly around 2 weeks before returning to work, working in more regular sessions.
• Don’t loose hope if you don’t express a lot in a session; remember that you will get out a lot more if you are back at work and expressing in a time your baby would have fed.
• NOTE: All of the above is with the assumption that you will be starting work when baby is 3-4 months old. If you are going back a lot earlier (6-8 weeks) you will need to start expressing before 6 weeks. If you are going to be away from baby from so early on you will be more likely to struggle with getting out enough milk than with an oversupply. In fact, starting off with a slight oversupply will probably be helpful in the end.

Expressing breast milk if your baby is not latching and drinking 

There are many reasons why baby may not be able to latch. It may also be that baby is in NICU or have other medical complications that will make it necessary for you to express milk. Read our article on newborns not latching for more guidance. You will also really benefit from seeing a lactation consultant.

In short, if baby is not latching at all you will have to express every 2-3 hours in the day, and at least 1-2 times per night to stimulate milk production and to empty your breasts. This type of expressing will need to start within 2-3 days after birth. This will be part of the care plan until the latching difficulties can be resolved.

Some moms end up doing exclusive pumping, meaning that baby will never feed from the breast directly, but will get breast milk that mom has expressed in a bottle.

Expressing breast milk to if baby is struggling with latching and weight gain 

If your baby is not latching well, or has failed to gain weight well and have enough nappies, you may need to express extra. This is both to stimulate supply and to get extra breast milk to feed baby.

If this the case you should definitely see a lactation consultant for assistance. With the right information and support it is usually possible to save breastfeeding. You should not decide for yourself what the problem is and how to deal with it. As there are many factors to consider it is also not easy to give general guidelines that will fit all moms and babies. The following may be recommended:

• First let baby feed from the breast, and then express extra with your pump for 5-10 minutes for extra stimulation and to empty the breast. Try to do this after as many feeds as possible during the day (note: not easy to do as it takes A LOT of time and effort, so simply do your best).
• Keep the milk that you express for a top-up after the next feed. If possible someone can give baby a top-up while you express for the next session.
• Never give these top-ups with a bottle. Rather feed baby from a syringe while letting him/her suck on your finger, or use a feeding cup. If baby is already struggling to latch a bottle will worsen the situation.

Lastly, your lactation consultant may also discuss with you the need for medication to boost supply. However, note that proper stimulation and emptying will be the most important part of the solution; medication on it’s own won’t be worth much. There are many factors to consider when taking prescription medication to boost supply.

Should you express for engorgement?

Here is where things become more complicated. If your breasts are full and engorged, you need to empty it. Preferably baby should do this by latching and sucking, and you should feed on demand, feed on the fullest side first and allow baby to come off the breast spontaneously when he is done.

The problem is that a poor latch is often the underlying cause for severe engorgement (remember some level of engorgement is normal in the early days of feeding; read our article on engorgement for tips on managing this phase). A baby that does not latch well will struggle to empty the breast. And if baby is already struggling to latch, it will be even more difficult if the areolas are hard and tight.

Signs that latching may be the cause of your engorgement:

• Your nipple are painful during feeds; in severe cases they may be cracked and bleeding.
• Baby struggles to stay on the breast and keep slipping off.
• Your breasts don’t feel emptier after baby has fed.
• Baby feeds for short periods and then fall asleep (speak to your doctor or midwife if baby seems sleepy).
• Baby feeds for long periods, yet don’t have enough wet or dirty nappies and don’t seem to get satisfied.

If this is the case the same guidelines apply in my opinion as expressing for a baby that is not latching well. Your engorgement now is not because of an oversupply, but because baby is not emptying it well. And if baby is not latching correctly he will also not stimulate your milk production adequately.

The first goal should obviously be to fix the latch, but in the meantime, you should express extra to empty your breasts and to ensure a proper supply for once the latching issue is sorted.

Your baby also needs enough milk, which he may not get if he is not latching well (especially if he also doesn’t have enough wet and dirty nappies), so you can give baby some expressed breast milk extra after feeds with a syringe or a feeding cup (to prevent nipple confusion).

So to provide an overview.

If baby is latching and sucking well, and you still experience some engorgement:

• Express only when it is really full and sore, and then only enough to relieve the worse pressure.
• You can also do one session where you thoroughly empty your breasts, as this will increase blood supply and lymph drainage, and may help you provide the turning point for the situation.
• Don’t constantly express extra after and between feeds as this will overstimulate further.
• Consider hand expressing rather than using a pump.

If baby is not latching or sucking well:

• If your breasts are too hard for baby to latch, try to express a little bit before the feed to soften the areolar area so that baby can latch more easily.
• Express after baby has fed to properly empty your breast.
• Use the expressed breast milk to give your baby as an extra top-up with a syringe or feeding cup.
• See a lactation consultant to help you sort the latching difficulty and to help you set the way going forward.