How to express breast milk and avoid nipple trauma

As a Postnatal Doula my role is to help support new parents, but not parent for them. I want to empower parents so that when I leave, they have stepped into their new role with confidence. One of the things I help with in my visits is breastfeeding and how to express breast milk.

I see so many women struggle with expressing milk because they haven’t been educated on how to effectively express. The reality is it isn’t always as simple as popping a powerful pump on the breast, switching it on, and letting it do the hard work! Just as with learning to breastfeed, I feel women should be supported in how and when they chose to express milk.

How and why to express breast milk

There are two ways to express your breasts

• Pumping with a hand/manual or an electric pump 
• Hand expressing 

There are many reasons you may want to express your milk

• baby born premature – providing your milk to baby in NICU 
• to use in older baby’s food or for a drink 
• if you want or need someone else to feed the baby for whatever reason 
• to donate breast milk to others 

This list is not finite just a few ideas !

Every person will have her own reasons for wanting to express but the most important thing to know is that the output you get from expressing, especially if it’s low, does NOT necessarily mean you have low milk supply.

The role of hormones

Breastfeeding is a hormone response where baby being at the breast stimulates the pituitary gland which secretes hormones oxytocin and prolactin, responsible for encouraging milk production. When you decide to express it’s important to remember the hormones involved in breastfeeding are the same for expressing. This will be a very valuable piece of information to remember especially if you may need to express while you are away from your baby.

When you decide to express it’s important to remember the hormones involved for breastfeeding are the same for expressing

A few facts

Prolactin is produced at night so breastfeeding at night really helps to keep your supply up until your body produces milk in response to baby’s needs (our bodies are very clever that way!). Many women feel they are able to pump more milk at night, and you can see why!

Oxytocin is released when the mother expects a feed, as well as when your baby is suckling at the breast. This reflex becomes associated with your sensations and feelings such as touching, smelling, or seeing your baby, or hearing your baby cry… and this is when you may experience some leaking. When pumping, it can be helpful to have your baby or an item of their clothing close by in order to stimulate Oxytocin and help in the production of milk.

How to make sure pumping works for you

Whatever pump you chose to get (manual or electric) you want to make sure the flange on the pump (the part that fits over your breast) is the right size for you. In some cases it can be too small for you and may cause nipple trauma, or it could be too big and won’t be effective in helping to encourage milk production. 

Pumps usually come with various different settings – speed/vacuum pressure etc. Your aim when expressing is to mimic your baby at the breast. For that reason, having the pump on the highest settings might not encourage much milk production as it’s too much pressure and not encouraging the fabulous hormone response made by the baby when they are suckling at the breast.

Whatever pump you chose to get (manual or electric) you want to make sure the flange on the pump (the part that fits over your breast) is the right size for you.

The most effective way to create milk production is to have rhythmical stimulation and to think about how your baby nurtures at the breast so as to encourage a letdown response. Expressing should always be GENTLE and in tune with what baby would do. In line with that, avoid any thoughts of ‘extracting milk’ and try not and obsess over the volume of milk you’re getting as this will only create more stress for you, which hinders the oxytocin and the letdown response.

How to effectively hand express milk

Hand expressing follows the same principles as pumping in relation to hormone release. To encourage milk production you are aiming to mimic what the baby does at the breast. So try thinking about how the baby nurtures, first of all, to get the milk flowing through the ductal networks, and then think about how they start to use the suck/ swallow reflex.

To encourage milk production you are aiming to mimic what the baby does at the breast

When hand expressing it’s better to use the pads of your finger and thumb rather than the sides of your finger as your breast tissue is so delicate and you want to avoid bruising. Placing your finger and thumb where the skin and areola meet and using the rhythm of the baby when they are feeding. Gentle pressure, slow and consistent rhythm will encourage the hormone response, which will then allow the milk to flow. You can gradually move your finger and thumb around the outside of areola as you go as you may experience a little tenderness staying in the same spot.

The hormone response is important as it will help to avoid damage to your breasts or nipples and ultimately create a pleasant experience (as possible) which will help you when you need to express and aren’t with your baby.

I hope this information is interesting and valuable to you. It’s something I feel very passionate about as I believe if people are more knowledgeable about expressing then they can have a more enjoyable breastfeeding experience.