Breastfeeding and expressing milk for your baby at GOSH

We encourage all our new mums to try to breastfeed or, when unable to feed at the breast, express their milk so they can feed their baby breastmilk. This page from Great Ormond Street Hospital (GOSH) gives a few hints and tips on how to breastfeed and express breastmilk when your baby is an inpatient at GOSH.

Why breastmilk is important

Breastmilk is species specific and therefore tailor-made for human babies. It contains water, fat, minerals, vitamins, proteins and carbohydrates. Your milk changes from feed to feed as it adapts to the needs of your baby as they grow and mature. Your milk contains very important factors that are not provided in infant formula such as hormones, enzymes, non-specific protective and immunological factors, essential fatty acids and growth factors. 

Establishing your milk supply

When your baby is born, they may not be ready to feed straight away. While they are getting stronger, you can remove milk from your breasts (called ‘expressing’) so your milk can be given to your baby in another way, for example through a feeding tube. 

Expressing is a skill that can take time to learn; the staff looking after you and helping you to look after your baby can support you with this. For more information, look at the information and videos listed in the useful information section at the end of this page.

Research tells us that a good indicator of how successful breastmilk production will be is by looking at the amount you are expressing at two weeks. Initially you will only see a few drops of the rich first milk called colostrum when you express. This is normal. Colostrum is low in volume and high in concentrated nutrition for your baby. Hand expressing is a technique that is particularly useful to use when collecting colostrum as you are able to collect every drop.

See a rough guide below to help visualise how much breastmilk your baby needs. Some babies will have a smaller or larger capacity.

Breastmilk needs
Day Stomach capacity Amount per feed
One Size of a cherry 5-7mls
Three Size of a walnut 22-27mls
Seven  Size of an apricot 45-60mls
One month Size of a large egg 80-150mls

By expressing regularly (8 to 10 times in a 24 hour period, including at least once overnight), you will notice by day 3 or 4 after birth that your milk will change to a whiter colour, become thinner and increase in volume. This means your breasts are producing mature milk. By two weeks, you should be expressing around 500 – 700mls of breastmilk spread out over a 24 hour period.

If you are expressing less than 350mls of milk in 24 hours by day 6 or less than 500mls in 24 hours by day 10, please ask your midwife or your baby’s nurse for additional help and if there is anyone else available for support. 

If you express more than your baby needs at one time, this spare milk can be frozen until your baby needs it. We will show you how to do this. Staff will discuss with you how much milk your baby will need at different times.

Tips for successful expressing

Early

  • Express (ideally hand) within 6 hours of your baby's birth
  • Early milk is called colostrum and has many health benefits to your baby.
  • By hand expressing into sterile syringes, you can collect every drop of this milk. Ask your nurse for syringes and caps.
  • You will make small amounts but with frequent expressing, your production will increase.

Frequent

  • At least 8-10 times spread over 24 hours
  • Think ‘supply and demand’. The more you express the more your breasts will make.
  • At least one express during the night. You will tend to get more milk if you express when you naturally wake rather than setting an alarm.
  • Go no more than 3-4 hours between expressing

Effective

  • Encourage milk flow to your breasts by stimulating your ‘let down’. You do this by massaging and using light touch in circular movements around your breasts.
  • When expressing you can compress or squeeze your breasts gently. This increases the flow of milk. Double pumping (expressing both breasts at the same time) is also a good time saver and yields more milk.
  • Express for 2-5 minutes after the last drop of milk as this will help increase your milk supply.
  • You are aiming to always have soft breasts. Hard breasts redyuce the milk making hormone. Fully drained breasts make milk faster.

The whole process of expressing (starting from massaging your breasts to finishing expressing) should take around 25 minutes per breast. Double pumping would mean that both breasts would be drained in the time it takes to drain one breast.

If you have any problems with expressing or you are worried about your supply, talk to the nursing staff on the ward looking after you and helping you look after your baby. You can also ask them who else at GOSH can help.

Breast massage technique

  • Gentle breast massage can help your milk to flow and make it easier to express milk. Begin by applying a warm flannel or towel to your breasts. You can stroke the area with gentle feather-like movements (A).
  • Or you can massage your breast with a hand action that rolls the knuckles downwards over the breast (B), beginning at the top of your breast and working towards the areola (darker coloured skin around the nipple), gradually going over the whole breast (C).
  • Don’t forget to include nipple stimulation. The nipple can either be rolled gently between the thumb and forefinger, or the palm of the hand can be gently moved back and forth over the tip of the nipple.
  • Then stroke the area under the nipple and areola with flat hands in an upward movement (D).
  • Massage should feel comfortable, so remember to be gentle. If it is painful, stop and ask for professional advice. It can also be helpful to ask a friend to massage your back before you express, as this can also stimulate your milk flow.

Breast pump information

If you have an expressing pump at home, please bring it with you so you are then able to express whenever you wish.

There are expressing rooms throughout the hospital and you are free to use any that are available. Locations include: Bear, CICU, Eagle, NICU/PICU, and Chameleon.

If you are inpatient on a ward that does not have an expressing room or wish to express at the bedside ask the nurse caring for your baby about the availability of pumps in your area as your ward might have one for use at the bedside. You can also use the expressing rooms in the locations above if you wish. 

Breast pumps can be taken to the bedside but please return them to the expressing room/nurses station after expressing so they can be shared with other mothers. Please wipe down the pump after use with the wipes provided. Ask the nurse caring for your baby for expressing sets and bottles.

Some of our pumps have an additional built in programme called ’initiate’. This programme is designed to help start expressing. This programme runs over a fixed duration of 15 minutes. The programme is intended for use by pump-dependent mothers until they are pumping 20ml or more in total in each of three consecutive pumping sessions OR for a maximum of five days. Pumps containing this programme can be found in expressing rooms on Bear, CICU, Chameleon and NICU/PICU and you can use the expressing rooms in any area even if your baby is not on that ward. Other ward areas may also have pumps with this programme ask your nurse for more information.

Expressing in accommodation or at home

We do not currently offer pumps for use in accommodation or in your own home. We recommend you rent or purchase your own pump and we have pumps available at a discounted rate in our shop and the details below for renting hospital grade pumps at a discounted rate. Please ask your nurse for more info. 

You can rent a yellow Symphony pump directly from Medela via their website www.medelarental.co.uk. Enter code ‘MEDNICU’ at the checkout for a discounted rate while your baby is in hospital.

Expressing vouchers

Expressing and breastfeeding mothers of inpatients at GOSH are entitled to expressing vouchers for use in the Lagoon restaurant. Ask the nurse caring for your baby for the form and see voucher for further details.

Transport of breast milk

It may be useful to buy a cold bag and ice packs to transport your milk to the hospital if you are expressing at home, and to safely transport your milk home when your baby is discharged. On discharge please ask your nurse to check if there is any milk stored in our fridges and freezers.

Breast milk donation

If you have more milk than your baby needs, you may wish to consider donation. You can discuss this with your baby’s nurse. The milk bank we use is Hearts Milk Bank (www.heartsmilkbank.org). Contact them directly for more information on donation by emailing info@heartsmilkbank.org or call them on 01707 358 776 (Monday to Friday from 9.30am to 5pm).

Breastfeeding and medication

Discuss with your nurse, doctor or ward pharmacist if you are on medication and wish to breastfeed. The majority of medications are safe but your medical team can clarify this for you.

Non-nutritive sucking

Non-nutritive sucking allows your baby to practise the skill of sucking and benefit from the comfort of sucking without the need to take any milk orally. This can be particularly useful for babies that cannot have any feed because they are too unwell, have had surgery on their stomach or for babies that are too premature to co-ordinate sucking, swallowing and breathing.

There are two ways babies can try non-nutritive sucking. Your baby may receive their milk via a feeding tube while they suck on a dummy or babies can also learn to suck by practising non-nutritive sucking directly at the breast. This is described as ‘dry’ breastfeeding. This method can be started once your baby’s breathing tube is removed. You will normally be asked to express just before putting your baby to the breast. Your baby will then be able to practise suckling on a drained breast while receiving your expressed milk via their feeding tube.

Both these methods are thought to help your baby learn to associate sucking with a full stomach. Once your baby is able to co-ordinate sucking, swallowing and breathing you could try putting them to a partially expressed breast. This means that you will have expressed a small amount to trigger the let-down reflex so it is easier for you baby to get the milk with less effort. As your baby grows stronger you can then offer the breast without expressing first.

It may also be possible to perform your baby’s mouth care with your breastmilk. Ask the nurse caring for your baby about this and it may be useful to pour a small volume of milk into a separate bottle when you express to be used just for mouth care. 

Compiled by: 
The Neonatal Nurse Advisor in collaboration with the Child and Family Information Group
Last review date: 
January 2018
Ref: 
2017F0695

Credits

Adapted from ‘Establishing your milk supply’ produced by Sheffield Teaching Hospitals and ‘Expressing milk for your baby’ produced by University College London Hospital.

Disclaimer

Please note this is a generic GOSH information sheet. If you have specific questions about how this relates to your child, please ask your doctor. Please note this information may not necessarily reflect treatment at other hospitals.