Pumping and storing breast milk

BREAST MILK

Mother’s breast milk is an ideal food for her baby. It is unique because it contains all the nutrients necessary for the development and growth of newborns and infants. Additionally, breast milk protects the baby from infections by containing components not found in formula milk, such as protective factors, hormones, enzymes, growth factors, and essential fatty acids. Breastfeeding also offers numerous benefits for the mother’s mental and physical health, both during the postpartum period and in the future.

Already during pregnancy, colostrum is produced in the breasts. Although the amount is small (excreted in drops), it contains everything the baby needs in the first days of life—energy, vitamins, and protective antibodies. Colostrum production increases during the first few days of a child’s life (days 3 to 5). This fluid is translucent, yellowish or slightly bluish, and sticky, preparing the baby’s delicate digestive system. It also has a laxative effect, helping the baby eliminate the meconium (the primary stool).

Expressing breast milk and stimulating milk production should begin within two hours after delivery if the mother’s condition allows (but no later than six hours after birth). From days 3 to 14 after giving birth, transitional milk is produced in the breasts, and by two weeks postpartum, the milk becomes mature or full breast milk.

The composition of breast milk changes both throughout the day and during a feeding session. Early milk, or foremilk, is more watery and contains higher levels of protein, lactose, and other nutrients. In contrast, colostrum is fattier and serves as the main source of energy. Therefore, it is important to empty the breasts sufficiently and regularly; the duration of pumping may vary from person to person.

Breastfeeding may not always be possible due to the health conditions of the mother or child. In such cases, expressed or pumped breast milk should be preferred when feeding the child, as pumping aids in milk production and increases overall supply.

Premature infants can also receive donor breast milk with the parent’s consent, especially if the mother’s own supply is limited. Donor breast milk provides protection against intestinal inflammation, reduces the risk of late-onset sepsis (blood poisoning), and leads to fewer feeding problems for premature newborns. Once the mother’s breast milk supply is sufficient, donor breast milk should be discontinued, allowing the infant to solely receive the mother’s milk.

Breast milk testing is conducted in the department if necessary. Bacteriological and virological examinations of the mother’s milk may be required for very premature babies or if there is a suspicion of mammary gland inflammation. Additionally, tests can assess the caloric content and composition of the breast milk collected throughout the day.

If you are taking any medications, please inform the staff in the department where your child is being treated.


PRESSURE AND PUMPING

Breast milk can be expressed either manually or mechanically using a pump. There are various types of pumps available, including manual and electric. Choose the method that works best for you. During your hospital stay, you will have access to both electric and manual breast pumps in the ward.

To enhance pumping and stimulate breast milk production, consider the following tips:

  • drink warm tea before pumping;
  • warm the breasts and perform a light breast massage;
  • think about your baby while pumping;
  • view pictures or videos of your baby during the sessioon;
  • if possible, pump in the presence of your child;
  • engage in skin-to-skin contact with your child (kangaroo care) if their condition allows;
  • stay with your child as much as possible and participate in their care;
  • eat a balanced, varied, and nutritious diet;
  • ensure adequate hydration by consuming at least 1.5 liters of water per day;
  • try to rest or sleep during the day whenever possible.

It is important to pump or express milk 8 to 12 times a day (averaging around 10 times) to achieve the necessary volume of breast milk. While you don’t need to pump at specific times, ensuring that the total number of pump sessions is sufficient throughout the day is essential. If you notice a decrease in milk supply, increase the frequency of pumping. For personalized recommendations related to pumping, please consult with the staff in the department.


MANUAL PUMPING

Use manual pumping when the amount of breast milk is low. Before you start, follow these steps:

  • drink a warm beverage to help stimulate milk flow.
  • Warm the breast slightly using a warm shower, gel pack, or a similar method.
  • Give a gentle breast massage to encourage milk secretion.
  • Next, ensure your hands are thoroughly washed and choose a clean container to collect the breast milk.
  • Find a private space and a comfortable position for pumping.
  • To begin manual pumping, place your thumb and forefinger about 3 cm away from the nipple on the breast, forming a “C” shape with your hand, and ensure that the nipple is centered between your fingers.

The typical duration for manual pumping averages around 10 minutes per breast (10+10 minutes total) or until you have collected the desired amount. During one feeding session, you can switch between breasts every 5 minutes to stimulate milk production on both sides.

USING A BREAST PUMP IN THE HOSPITAL

  • Wash your hands and dry them with a paper towel before handling pumping accessories and before pumping.
  • The equipment necessary for pumping breast milk (including the breast pump, breast pump hose and funnel, bottles, and detergent) is provided by the department where your child is being treated.
  • It is important to choose the right size funnel. If necessary, a midwife or lactation consultant will provide recommendations.
  • A clean bottle is required for each pumping session.
  • Breast milk is easily contaminated and perishable, so it is crucial to clean and disinfect surfaces. This will be managed by the hospital staff. It is also important to pump in the designated area—in the kangaroo chair with your child in the ward.
  • After each pumping session, wash the breast pump funnel with hot water and dish soap, rinse it, and let it air dry in the designated area.
  • The breast pump hose and funnel must be changed every 24 hours.
  • The pumps in the department allow for pumping both breasts simultaneously.


USING A BREAST PUMP AT HOME

  • Check the breast pump user manual for specific instructions.
  • Before the first use of the breast pump and after each use, it is essential to wash all pump accessories with hot water and detergent (use a special detergent if possible) and rinse them well. Sterilize the accessories once a day by boiling them for 3-5 minutes or using a sterilizer, then let the accessories dry.
  • A clean bottle is required for each pumping session. Wash breast milk storage bottles with hot water and dish soap, rinse well, and boil them once a day for 3-5 minutes before letting them dry.
  • In a home setting, it is important to monitor the cleanliness of surfaces where breast milk and its accessories are handled.
  • Wash your hands thoroughly and dry them with a paper towel.
  • Start pumping milk.
  • The pumping duration can last 10-15 minutes on each breast or until you have obtained the desired amount of milk.

BREAST MILK STORAGE

  • In one pumping session, milk from both breasts can be collected in a single container. Breast milk collection bags, which can be purchased at pharmacies or well-stocked grocery stores, can also be used for storage.
  • If the amounts of breast milk are small, milk pumped at different times can be combined, provided that the freshly pumped breast milk is cooled to refrigerator temperature before pouring. Remember to mark the time of the first pumped milk on the container! Breast milk collected at different times can be stored in one container for up to 24 hours and then frozen if necessary.
  • Do not add freshly pumped breast milk to frozen milk!
  • On each bottle or collection bag, write the child’s name, the date of milk pumping, the time, and the department where your child is being treated.
  • Milk should be stored in the refrigerator or freezer in areas where the temperature is most stable (near the back wall of the refrigerator, not on the shelves inside the door) and separated from other foods. If possible, use a separate drawer for storage.
  • If there is more milk than the baby can consume, the excess milk can be frozen and used later if needed.
  • When freezing milk, fill the container or bag only 2/3 full, as breast milk expands when frozen.
  • Milk that has been standing for more than 24 hours must not be frozen!
  • Freshly pumped breast milk can be stored:
    • at room temperature (+25°C) for up to 4 hours
    • in the refrigerator (+4°C – +8°C) for up to 24 hours
    • in the freezer (-18°C or colder) for up to 3 months
    • in the freezer (-24°C) for up to 6 months
  • When thawing frozen breast milk at room temperature, the milk must be used within 2 hours.
  • When thawing frozen breast milk in the refrigerator, the breast milk must be used within 24 hours.

BREAST MILK TRANSPORT

  • Freshly pumped, cooled, and deep-frozen breast milk must be transported in a closed cooling bag or container with cooling elements (ice packs, frozen gel bags, etc.).
  • Estimate the transport distance and the time of year, and add the appropriate cooling elements accordingly.
  • If you do not have the opportunity to stay with your child in the hospital, please calculate the amount of breast milk needed for your child in collaboration with the department staff.


CONSULTATION

The condition and needs of each child are different, so the team in the department, in collaboration with the midwife-lactation consultant, will help you prepare a suitable feeding plan for you and your child.

Compilers: Triinu Kangro, Anni Anastasia Pilvar, Karolin Köörna, Jekaterina Kalamees, Marrit Kanna, Olga Nikiforova, Kertu Lepla, Mari Kallastu, Gerli Mänd
2024