If you don’t know my story here is a brief summary – I am a nurse and midwife. When I had my daughter 5.5yrs ago, I had been working in NICU for 7 years, and as a midwife for just under a year. I thought I knew everything about breastfeeding and expressing that there was to know. But she taught me that I didn’t. And the journey I went on lead to me to exclusively express and then start up my business 2 years later. You can read my story here.
The reason mothers choose to exclusively express can vary – their baby might be unable to take milk directly from the breast (ie they are premature, or unwell), their baby refuses to directly breastfeed, they don’t want their baby to feed directly but they still want to give their baby breast milk, and many others. Exclusive expressing can be a viable option for some families, but there are some health professionals, and even lay people, who will tell you that it can’t or shouldn’t be done for a number of reasons.
Here are 5 of the most common myths I have heard about in regards to exclusive expressing, and the truth
Myth 1 - You can’t maintain your supply just with expressing
About a year after I finished my journey I happened to be walking past a room on a postnatal ward where I was working as a midwife. A mothercrafting nurse was telling a mother that she could not exclusively express as her supply would diminish after 3 weeks. I backtracked to the room and, very kindly, told the nurse that she was wrong, that I had exclusively expressed for almost 9 months, and that I had not only maintained my supply I had increased it. I then told the mother that I was part of a Facebook group where there are literally thousands of mothers exclusively expressing, some for over a year or more. The mother later stopped me in the corridor and thanked me for clarifying and supporting her – she didn’t want to directly breastfeed but she wanted her baby to get breast milk.
It is true that some people may not respond to certain pumps or expressing at all, but generally speaking the majority can express – either with a hospital grade pump*, a manual pump, or by hand (click here for a good video on how to hand express properly - ignore that it says 'for the first milk', the technique is same regardless). If you’ve tried one and not been successful, then I suggest you try another – not all pumps are made the same, and what works for one may not work for someone else.
*An electric pump that is not considered "hospital grade" might not be sufficient for maintaining your supply long term. Click here for an article on the difference between pumps
Ideally you need to do at least 8 sessions in 24hrs – if you’re doing anything less and your output is dropping or not increasing to an acceptable level then you need to go up to at least 8 sessions in 24hrs before you can say that you can’t express enough (note that this doesn’t have to be every 3hrs, you can do a few sessions close together so that you can space others out).
You also need to be draining the breasts – breasts are never truly empty (think breasts are factories not warehouses), but a well drained breast will make more milk, faster. If you just take small amounts out your body will not know that you want to make more.
For the majority of exclusive expressers, if you maintain 8 sessions in 24hrs and you are at an output you are happy with, you can start dropping sessions from 12 weeks post partum. I recommend dropping 1 session per week. This should give your body enough time to adjust to the new number. If you find your output dropping you may need to go back up a session. Also, you may find that you need to express for long at each session to get the same amount. Most EEp’ers will find their ‘magic number’ – the minimum number of sessions they can do in 24hrs to maintain their supply – somewhere between 3 and 5.
You might also want to check what size flanges you are using – click here for a guide of how to measure your flange size. Using the wrong size can affect comfort and output. There are also variations on regular flanges such as Lacteck BabyMotion flanges, Pumpin Pal flanges, or inserts that reduce the diameter and soften a regular flange.
Myth 2 – Expressing causes oversupply
Sorry, which one is it - you won't be able to maintain your supply or you'll get an oversupply??
Expressing AND breastfeeding may cause an oversupply - this is why it is recommnded to not express unless absolutely necessary before 6 weeks if you are also feeding directly. And you might develop an oversupply if your body responds well to expressing - but there are things can do to reduce it necessary. It can be important to keep the 8 sessions in 24hrs though....
So often I hear mothers saying “I used to have an oversupply, so I was only expressing 3, 4, or 5 times a day, and now at [6 to 12 weeks] my output has dropped dramatically”.
At the start of your milk making journey your hormones will drive supply. But somewhere between 2 and 12 weeks (it varies for everyone, and even pregnancy to pregnancy) hormones stop driving supply and if you’re not removing milk often your body will think it doesn’t need to make that much.
Remember above when I said that ideally you would be draining the breasts 8 times in 24hrs – this is why. You may start off with an oversupply at the beginning, when hormones are driving it. But then your hormones ‘go away’ and it becomes about demand and supply, and if you’re not demanding it your body won’t supply it.
If you do have an oversupply and you don’t want to be producing so much what you can do is not drain the breasts, but stay at 8 sessions/24hrs – eg if you’re getting 200mls/session and you only want to get 800mls/day, then express 8 times but only until you get 100mls out. You might find at some point that you need to express for longer at each session to get the milk out – this is mostly likely a sign that your hormones have stopped driving supply.
Myth 3 – If you don’t directly feed your baby you won’t bond with them
I really hate this one – like, I REALLY HATE IT! I was told this one by a child health nurse. I was already feeling incredibly guilty about the fact that my baby didn’t want to feed from me and that I couldn’t make enough. Then to be told that I wouldn’t bond with her was almost the proverbial straw…..
There are many ways you can bond with your baby, and lactation consultants are always telling fathers/partners that they don’t need to be feeding their baby to bond with them.
Expressing does usually mean that you have be sitting in one spot, holding the pump on, which can make it difficult to hold your baby at the same time. But here are some things I used to do to
* Sit on the bed and have her propped up on a pillow next to me
* Sit on the floor and have her in the bouncer
* Sit cross-legged and put her in my lap
* Baby wear when you go out or around the house
You can also get handsfree expressing bras or the Freemie Handsfree Collection Cups to help have your hands free to tend to your baby.
Another tip is to store your pumping parts in a clean container in the fridge between uses (note that this should only be done if your baby is term and healthy) and wash once or twice a day in hot soapy water. This will save you some time, so you can spend it with your baby
Myth 4 – if you’re freezing excess milk your baby won’t like the taste, so there’s no point
This myth most likely comes from some evidence that some mother’s milk goes ‘sour’ after being stored and babies can refuse to drink defrosted milk. High lipase is usually blamed, but the truth is we don’t actually know what causes it. And while some babies may refuse to drink it, others might have no issues with it. You’ll only know which category your baby falls into by trying it.
If you are freezing milk it is recommended that you defrost some and test it before you store too much. If you find that your baby does refuse to drink it you can scald it before freezing it (some mothers say they need to scald it as soon as they’ve expressed it, others say that can refrigerate it for a day or so, so you might need to test it out). And if your baby does refuse all of it you could donate it.
Myth 5 – Frozen milk loses its nutrients and/or milk changes composition over time, so its not worth storing milk to feed later
While there is some truth to this, its not the whole truth, and it doesn't make the milk 'bad'.
Some vitamins and immunological properties are lost when you freeze milk, and yes, breastmilk does change over time.
But the fact is any breastmilk is good. Otherwise we wouldn't use previously frozen and defrosted milk in NICU. The WHO also lists the recommendation of milk options as – milk from the mother either directly or expressed, milk from another mother either directly or expressed, pasteurised donor milk, formula. If you’ve got it, then use it.
Note – If you are not quite making enough to feed your baby all breastmilk, or you are making ‘just enough’ then please do not feel guilty about not having a freezer stash. There is no biological reason to have a freezer stash and you are doing an amazing job. Remember parenting is not a competition!
If you need help with expressing, breastfeeding, or parenting in general then I highly recommend finding good support in your community. If you are in Perth I am available for lactation consultant appointments and also co-host monthly ‘open house (see the Facebook page for more information).