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4 More Myths About Exclusive Expressing

I have had to add 4 more myths since reading an awful article on BabyGaga....I'm not going to link it, but suffice to say it is a load of mummy shaming rubbish (with a lot of half truths at best). You can read the first 5 myths here.

Truth about exclusive expressing

1. Expressing can cause damage to your breasts

I did hear this one a few times during my journey and as a health professional I thought it made some sense - if you put something mechanical that pulls on tissue too hard, for too long it theoretically could cause damage. What I often hear now is 'I was told to not express for more than 20mins because it can cause damage'....but in the 5.5years I have been a part of the EE community I have yet to hear of anyone complain about permanent breast or nipple damage from exclusive expressing.

And yeah it can cause short term damage, just like a bad latch with direct feeding can cause damage....If expressing is causing you damage then double (and even triple) check your flange size (here is a guide) - using the wrong size flange can cause damage and excessive pain, and a lot of people seem to automatically think that bigger is better - its not! Please please please check your flange size.

As I dropped sessions I had to express for longer, and once I got down to 5 sessions I was doing around 45mins each session. I can tell you that my breasts are absolutely fine. And I know there are some who exclusively express for multiple children - if it caused damage I highly doubt they would go back for more

The advice regarding vacuum settings seem to range from 'turn it up to where its comfortable' to 'don't go past xx level' - I say go to where its comfortable, but if its comfortable at the highest settings then maybe come down a few steps - going hard and fast won't necessarily make your sessions shorter. You need to find the settings that work best for you

But keep in mind that I don't there is anyone who says "Oh yay! I love expressing sooo much!"

Exclusive expressing should not cause excessive pain or damage

2. Milk won't change/add antibodies because the baby isn't latching directly

We all probably know that milk changes its composition over time to meet the needs of the growing baby. However, the truth is that researchers don't know exactly how the body knows to change things - is it just that milk changes over time or does the body somehow recognise what is going on with the baby and changes accordingly?

We know there is some truth to the second way - when babies are sick the body will add antibodies to fight off the illness. But again researchers aren't sure exactly how the mother's body knows - is it just because she is around her baby that it knows (eg kissing them or breathing in any droplets they sneeze/cough out), or are there receptors on the breast that 'take in' the baby's saliva and 'read' what is there

I can remember a few times that I had an overwhelming urge to lick my daughter - like, actually lick her! I didn't - I'd kiss her instead - but I do wonder if it was my body saying 'hey we want to know what's going on with the baby'.

One of the questions in the practice exam I did for the International Lactation Consultants Exam was 'a mother breastfeeds her baby at day care before they go home for the day. The carers note that the baby doesn't get as sick as the much as the other babies, even those who are also breastfed. What is happening?' The answer was along the lines of 'the mother is spending extra time at the daycare and therefore her body is picking up what viruses/bacteria the baby is being exposed to'

Another example that the body can adapt without the mother and baby directly feeding - I was called around to help on another ward recently (I work in NICU as a midwife/IBCLC). While we were standing at the fridge were the milk is stored the nurse pulled out a bottle of bright blue expressed milk and said 'what on Earth is this?!'. I smiled and said 'does that baby have viral or bacterial illness?'. She looked at the name and said 'yes, he has viral bronchitis. He's quite sick'. I said 'you need to feed that milk to him, its magic'. I went onto explain that the milk that is blue is high in antibodies and obviously the mum was producing them because her baby is sick. The baby had not been feeding directly, yet the body knew to make milk with antibodies.

Some EE'pers also give the advice to get your baby's saliva on your finger and rub it around your areola occasionally - there's no evidence that this helps, but there's nothing wrong with doing it either.

In my opinion (which is based on 15 years as a nurse, 7 years as a midwife, and 3.5 years of doing this business) just being around your baby - kissing them, letting them sneeze in your face occasionally - will tell your body everything it needs to know.

3. Pumps grow mouldy

Yes, you can get mould in the motor of your pump - that is why you should use a closed system pump, not an open system. If there is no barrier between the flange and the pump (ie the tubing can get milk in it and transport that milk into the motor of the pump - there are some pumps that have a barrier between the tubing and the pump.

You do not need to sterilise pump parts (that comes from the Association of Breastfeeding Medicine) unless your baby is sick, premature, or has a medical condition that could lower their immunity. Parts should be inspected regularly to make sure they are clean and in good working order. Most pump companies will recommend changing the valves every 6-8 weeks if you are exclusively expressing, but this is more about the function than cleanliness.

Closed syste pumps, like the Spectra breast pumps, won't get mould in them

4. Expressed milk can grow bacteria and make your baby sick

About a year ago research was published that said expressed milk grows bacteria and that can potentially make your baby sick. I felt physically ill when I read it. Once again there seems to be this need to find things wrong with expressing/not feeding directly. I can understand the need to make sure we are doing the 'right' thing - but before you publish research like this please make sure you've done a good quality study (eg, how did they store the milk that was expressed? Would the bacteria ACTUALLY make a baby sick? And if this is true why do we feed expressed breastmilk to the sickest and smallest of babies?).

Have a look at the picture below - those are petri dishes filled with bacteria. In the middle is a drop of breast milk. The clear area is where the breastmilk has 'destroyed' the bacteria. So while EBM may contain bacteria, the antibodies can fight it off.

And let me just point out that formula can also contain bacteria - this is why it is recommended to add the powder to water that is 70oC and why the WHO recommends liquid formula over powder.

Breast milk kills bacteria in petri dishes

When in doubt I always look at the WHO information and they give the following hierarchy of feeding milk to babies:

  1. Milk directly from the mother

  2. Milk expressed from the mother

  3. Milk directly from another mother

  4. Milk expressed from another mother

  5. Pasteurised donor milk

  6. Pre-made liquid formula

  7. Powdered formula, either made up for each feed or stored for up to 24hrs

Numbers 2 and 4 out of 7 options are expressed breastmilk - again I stress that if there was anything that bad with it a. The WHO wouldn't recommend it, and b. we wouldn't recommend giving it to the sickest babies in NICU's around the world.

The fact is, direct breastfeeding is not always possible or desirable - expressing can be a reasonable, and safe, alternative.

If you are in Perth Western Australia and need help with breastfeedng, I would love to help you. I can provide breastfeeding support, to help you sort out isues, and postnatal midwifery care, to help prevent issues -



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