Expressing after 6 weeks when breastfeeding is going well
Cordelia Uys, March 2021
Reasons for expressing in the first 6 weeks
a) If your baby isn’t able to feed from the breast
If you would like to breastfeed, but for some reason your newborn is not able to feed directly from the breast, for example due to being born premature or unwell, or because breastfeeding is painful and causing damage, hand expressing initially, and then, from the moment your mature milk comes in, double pumping regularly with a hospital grade double pump, will allow you to establish and maintain your milk supply. Please see my article What to do if your newborn isn’t latching:
https://www.cordeliauys.co.uk/what-to-do-if-your-newborn-isnt-latching
b) If your baby needs supplemental feeds
Similarly, double pumping after breastfeeds in the early days can be very helpful for increasing milk supply if a newborn needs supplemental feeds. Please see my article How to protect your breastfeeding journey if your baby is receiving supplemental feeds:
Reasons for waiting for 6 weeks before starting to express
However, if breastfeeding is going well, the recommendation is to wait approximately 6 weeks before doing any pumping. To understand why, it is helpful to understand how milk production works.
How your milk supply is established
When your baby is born, your breasts have no way of knowing if you have had one, two, or more babies, or how big your baby is. The majority of mothers are capable of exclusively breastfeeding twins or even triplets as long as milk is removed from both breasts at least 8 times in 24 hours. If your baby is being breastfed responsively and nursing effectively, he or she will be programming your breasts to make exactly the right amount of milk for his or her individual needs, since milk production works on a supply and demand basis.
It takes 6 weeks for the prolactin receptors in your breasts to work out how much milk your particular baby, or babies, require.
After 6 weeks, your supply settles down, and although it will increase if your baby nurses more often, for example during a growth spurt, it becomes harder to significantly increase your milk output, and therefore pumping is less likely to cause oversupply.
Early pumping can create oversupply and put women at risk of blocked ducts and mastitis
If your baby is exclusively breastfed and gaining weight as expected, pumping before 6 weeks could cause you to produce significantly more milk than your baby needs. When a mother is overproducing, her baby can struggle with the fast flow and suffer from abdominal discomfort. Oversupply can also put women at increased risk of blocked ducts and mastitis.
I was once contacted by a mother whose maternity nurse had encouraged her to pump after every feed from the first week of her baby’s life. At 4 weeks, she was producing so much milk that unless she pumped from both breasts after every feed, she got painfully engorged. She was finding it almost impossible to leave the house. Obviously, this is an extreme case, but it is not unusual for new mothers to experience issues caused by pumping in the early days.
Problems caused by the Haakaa (or other silicone pumps)
In the past few years, the Haakaa pump has become increasingly popular. Unfortunately, removing milk from one breast with the Haakaa, while feeding on the other side, can cause significant problems, especially in the early days. Please see this article for more details:
There is no need to express if you don’t want to
Even after 6 weeks, you don’t have to express if you don’t want to. Sometimes mothers are told they need to start pumping so that their baby will learn to take a bottle. This is probably a good idea if you will regularly need to be separated from your baby for more than 2 or 3 hours a day earlier than 6 months, but otherwise, it is perfectly possible to exclusively breastfeed, without any need to introduce a bottle.
From around 6 months, babies can drink water or milk out of a cup or beaker if their mother is not around. It is also worth bearing in mind that the early introduction of a bottle is no guarantee that your baby will continue taking one. It is not uncommon for a baby to take a bottle early on, and then one day suddenly refuse to.
Many women don’t like the idea of being separated from their baby and are happy to take the baby with them to the hairdresser, or when having lunch or dinner with friends. I have an architect friend who regularly took her baby with her to meetings with English Heritage, and who breastfed her baby during the meetings, without anyone batting an eyelid.
Here’s an article I’ve written about mothers who choose not to pump or give bottles:
https://www.cordeliauys.co.uk/breastfeeding-without-pumping-or-giving-bottles
The advantages of expressing after 6 weeks
On the other hand, there are many mothers who like having some expressed milk available so that someone else can feed their baby, allowing them some time to themselves, and so they don’t have to take their baby with them whenever they go out.
If you are away from your baby for more than a couple of hours, you might need to pump while away, or once you get home, if your baby isn’t ready to nurse.
Risks of giving formula
If you would like to give your baby a bottle, giving expressed milk is preferable to giving formula, since there are short and long-term impacts of supplementing breastfed babies with formula. Please see the article Supplementing with formula for more details:
https://breastfeeding.support/supplementing-with-formula/
If you would like to express after 6 weeks
Which pump to use?
Here’s an article that might be helpful in deciding which pump to use:
https://sarahoakleylactation.co.uk/choosing-a-breast-pump/
The advantages of double pumping
My recommendation would be to buy (or hire) a double pump because double pumping allows you to get the same amount of milk (or possibly more) in half the time.
A pump with a closed system is preferable
I would also strongly recommend getting a pump with a closed system. If a pump has an open system, over time, there is a risk of mould growing in the motor and then entering the expressed milk, so it is considered risky for women to lend or pass on a pump with an open system.
In addition, when using a pump with an open system, it is recommended that the same woman uses a new pump for each of her babies.
More details about open and closed systems can be found in this article:
https://kellymom.com/bf/pumpingmoms/pumping/buying-a-used-or-new-pump/
The Ardo Calypso, which can be a bought as a double pump, has a closed system:
https://www.ardobreastpumps.co.uk/shop/calypso-double-breastpump/
All hospital grade pumps have a closed system, including the Spectra S1, which is more affordable than most hospital grade pumps:
https://spectrababy.co.uk/products/spectra-s1-hospital-grade-dual-expression-electric-breast-pump
Several mothers I’ve spoken to have had a very positive experience with the Baby Buddha pump:
https://www.cordeliauys.co.uk/information-on-the-baby-buddha-pump
Make sure the breast shields (flanges) fit you properly
Please note that a correct breast shield fit is fundamental; when breast shields don’t fit, women can experience pain and damage, and pumping will be less productive. Pumping should never hurt; if it does, it is either because the breast shields don’t fit, or because the suction/vacuum is too high.
How to tell a correct breast shield fit:
During a very interesting talk for the Gold Lactation conference in May 2022, Jeanette Mesite Frem stated that many people should actually be using a flange size a lot smaller than the standard sizes provided by pump manufacturers. If used with a little lubrication from some coconut oil, apparently a smaller flange size will increase milk yield quite substantially. Jeanette said lanolin or vaseline are too sticky.
She suggested measuring the diameter of the nipple and then trying sizes of that diameter, 2mm bigger and 2mm smaller and seeing what happens. This is totally different to what is suggested currently which is to measure the nipple and add 2-5mm.
(This is what pump manufacturers currently suggest: https://www.verywellfamily.com/ways-to-tell-if-your-breast-pump-flanges-fit-2758354 )
Many pump manufacturers have 21mm as their smallest size, but the following inserts can be used with Spectra and Medela pumps and come in smaller sizes:
https://www.amazon.co.uk/s?k=maymom&crid=2YUWQJ1DVODQI&sprefix=maymom%2Caps%2C89&ref=nb_sb_noss_1
Please make sure you don’t cause any damage or hurt yourself; if it doesn't feel right, stop and try another size.
Replace your pumping parts every few months
It’s a good idea to replace pumping parts (collection bottles, valves, tubing etc) every few months are they can wear out and make pumping less efficient.
Pumping technique: maximising your milk production with hands on double pumping
Have a look at this video on double pumping from Stanford Medical School; massaging your breasts while you are pumping will make a difference to the volumes you are able to produce:
You might also find some helpful suggestions in my article on the let-down reflex:
https://www.cordeliauys.co.uk/the-letdown-reflex-1
Pumping bra for hands-on-double pumping
You can create a pumping bra using an old exercise bra that you don’t mind sacrificing. This will allow you to have your hands free to massage your breasts while double pumping. It is also possible to buy pumping bras online, but these are often too tight, with less ‘give’ than a regular bra, and can therefore cause blocked ducts.
Here is a photo of a client wearing a sports bra she turned into a pumping bra:
Sterilising:
If your baby is full-term and is in good health, you only need to sterilise the pumping equipment once in 24 hours. After each usage, wash the pumping equipment and bottle carefully with hot water and washing up liquid, then rinse well and put to dry on some clean kitchen paper.
N.B. Bottles used to give formula need to be sterilised after each usage.
Storing breastmilk:
Breastmilk is safe at room temperature for approximately 6 hours.
Here is detailed information on storing breastmilk:
https://abm.me.uk/breastfeeding-information/expressing-breast-milk/
You can add newly pumped milk to milk already stored in the fridge on the same day, but only after it has cooled down in the fridge for at least 30 minutes. Never add warm milk to cold milk, as this encourages the growth of bacteria.
Breastmilk storage bags
You can store breastmilk in the fridge in bottles, but when freezing it, you might want to use storage bags, as these take up less space. Many companies make breastmilk storage bags.
Make sure to allow some space at the top of bags or bottles for the expansion that happens when milk is frozen.
Labelling expressed breastmilk
When storing your breastmilk in the fridge or freezer, make sure to always label it with the date so that if there are several batches, you can use the ‘oldest’ first.
When to pump?
If you would like to pump in order for your baby to have a daily bottle of expressed milk, the recommendation is to pump once a day, on both breasts, at roughly the same time each day, shortly after having breastfed your baby.
Many women choose to pump in the morning, as they tend to produce greater volumes at that time, but it is fine to pump whenever works best for you.
When you first start expressing after your baby has nursed, you might not be able to pump very much, but after a few days, your breasts will get the message that they need to produce more milk at that time.
Alternatively, several times a day, you could do a short amount of pumping after breastfeeding your baby.
By pumping immediately after a feed, there is a better chance of your breasts having time to produce more milk before your baby’s next feed.
Do I pump from one breast or both?
It is usually a good idea to pump from both breasts, as this will allow you to collect more milk, and to stimulate both breasts equally.
Pumping from one breast while your baby feeds on the other
Rather than pumping after a feed, some women find it convenient to pump from one breast while their baby nurses on the other side. This tends to allow them to collect milk more easily, since the baby’s suckling stimulates the let-down reflex more effectively than a pump. (This is because oxytocin, the hormone that causes the let-down reflex, is stimulated most powerfully by love, and although many women find their pump useful, few love their pump).
The concern about pumping while nursing is that your baby might then want to feed from the second breast, in which case, there won’t be much milk left for them. Pumping while nursing tends to work best for women whose babies usually only take one breast per feed.
How long to pump for?
How long to pump for depends very much on your supply and how efficient your pump is; most women pump for somewhere between 10 and 30 minutes. It is not recommended to pump non-stop for longer than 30 minutes as this can cause nipple soreness.
How much will milk will I get?
Women vary enormously in the volumes they can pump. Some women can get 60ml in 5 minutes from one breast, whereas others will need to double pump for 30 minutes in order to get 60ml from both breasts. It is important to bear in mind that the volumes you can pump are not an accurate reflection of the volumes your baby gets at the breast, as babies are much more effective at removing milk than a pump.
N.B. As babies get older (6 months plus), some women find that the volumes they can pump decrease. This is not usually because their supply has decreased, it is just that some women become less responsive to pumping over time.
Feeding your baby
The critical importance of paced bottle feeding
When a baby is held in the traditional, reclined bottle feeding position, a combination of gravity and the baby’s sucking reflex means it is easy to persuade them to drink more milk than their tummy can comfortably fit. This puts them at risk of overfeeding, and gets them used to a fast flow, which in turn means they are likely, sooner or later, to reject the breast, which usually has a much slower flow.
Therefore, whenever giving a baby a bottle, it is crucially important to use the paced bottle feeding method, as this will protect your breastfeeding journey.
This film explains paced bottle feeding:
https://www.youtube.com/watch?v=OGPm5SpLxXY
What type of bottle?
The type of bottle and teat you use is not as important as making sure that whoever is feeding your baby always practises paced bottle feeding. However, it is easier to practise paced bottle feeding with a bottle that is not too big or too fat. Look for a bottle that has around a 150ml maximum capacity, and one that resembles Kate Moss in shape, rather than Beyoncé. Here’s an article about which bottles to use for breastfed babies:
https://breastfeeding.support/best-bottle-breastfed-baby/
Volumes of milk
Here is a page from the website kellymom.com with some guidance on how much expressed milk a baby might need: http://kellymom.com/bf/pumpingmoms/pumping/milkcalc/
Please bear in mind that between 4 weeks and 6 months, your baby’s maximum stomach capacity is around 120ml - 150ml.
Responsive feeding - be guided by your baby
The beauty of paced bottle feeding is that your baby will be able to indicate when they are full much more easily. It is normal for babies to drink different amounts at each feed. It is very important not to try to coax your baby to drink more than they can comfortably fit, or their ability to self-regulate might be impacted, putting them at risk of future overweight and obesity.
When to give the bottle?
It is important to think carefully about when your baby is going to be given the bottle, because at first, your breasts probably won't be used to going much longer than 3 or 4 hours between breastfeeds.
The Feedback Inhibitor of Lactation (FIL)
Whenever breasts get hard and full, a negative feedback mechanism kicks in, telling them to stop making milk. This means milk production slows down when breasts are full and speeds up when breasts are emptier.
In the early weeks, if a mother goes longer than 3 or 4 hours without breastfeeding or pumping, unless she has a very large breast storage capacity http://www.nancymohrbacher.com/articles/2014/1/17/infographic-on-breast-storage-capacity.html the FIL will kick in, giving her breasts the message to reduce milk production. You want to avoid this happening, or your milk supply could be affected.
In addition, when breasts get very full, mothers are at risk of developing blocked ducts and mastitis.
Don’t let your breasts get uncomfortably full
If you experience uncomfortable fullness and cannot breastfeed or pump, to avoid getting blocked ducts, it is a good idea to hand express just enough to stop that ‘bursting’ feeling.
One mother’s experience
Here is an article a new mother called Jemma wrote for me about how she managed expressing after 6 weeks.
I started expressing milk when our baby Alexander was nearly 7 weeks old. I express at around 9pm every evening from both breasts and my husband, Jeremy, feeds Alexander from the bottle at 11pm. Alexander then sleeps to between 3 and 4am, when I breastfeed him and he then wakes again between 6 and 7am. Sometimes I also express after I have fed him first thing in the morning and this milk goes towards filling our freezer!
We had several reasons for deciding to start expressing: the first and most pressing was to give me a bit more sleep! I am able to go to bed after expressing in the evening and sleep through till Alexander wakes for his middle of the night feed. As Alexander got bigger, it also gave me a bit of flexibility to be able to pop out for a couple of hours, dipping into the freezer supply to keep him going until my return.
Jeremy usually comes home after Alexander has gone to bed so the 11pm feed has become a precious time for the two of them to spend together each evening. Sometimes Alexander is awake and sometimes it is a ‘dream feed’ but either way Jeremy gets to give him a cuddle! Of course, dads have plenty of other ways than feeding to bond with their babies, but we have found this, given Jeremy’s working hours, to be an added bonus.
It wasn’t easy at first to get Alexander to accept the bottle. It took Jeremy a couple of weeks of gentle persuasion and perseverance, but we got there in the end. (Please see Wendy Lever’s article ‘Help – my breastfed baby won’t take a bottle’ in the links below).
I waited until almost 7 weeks before starting to express because I wanted my milk supply to be well established, and I wanted Alexander and me to get used to breastfeeding, hopefully reducing the risk of nipple confusion. However, we didn’t want to wait too long in case Alexander then refused to take a bottle.
I did have some concern that I might cause my breasts to become engorged through expressing. To avoid this, when I first started, I would actually express at 10pm rather than 9pm so that there was less of a gap between when I was pumping and next breastfeeding Alexander. As I got more used to it, I gradually brought that time back to 9pm so I could have an earlier night if I wanted to. In the mornings I have always had lots of milk, so this is why I am able to express after Alexander finishes feeding. As he has got bigger, I have found that I am not always able to express as much milk in the evening as he could drink. Expressing in the morning has therefore been a useful way to ‘top up’ his evening bottle.
Expressing is boring! I can’t say that I look forward to doing it each day but the benefits it brings have really benefited our new little family.
The importance of increasing gaps between breastfeeds and/or expressing gradually
Please note that Jemma made sure to increase the length of time she was going between expressing and breastfeeding gradually. It is generally recommended to increase the gaps by no more than 15 minutes each day or two, in order to avoid getting blocked ducts and mastitis.
Similarly, if you decide to stop expressing, you will need to do so gradually, in order to avoid getting blocked ducts.
As your baby gets older, your breasts will be able to go longer between breastfeeds (or pumping sessions) without putting your supply at risk, or causing blocked ducts, but it is still safest to increase the gaps gradually.
Night feeds and prolactin (the hormone that makes milk)
Jemma was still breastfeeding sometime between 3am and 4am, which is good, because a nursing mother’s prolactin levels are highest at night, and therefore breastfeeding in the middle of the night is particularly important for maintaining milk supply in the early months.
Expressing is tedious and can be stressful
Before having their babies, parents-to-be tend to think that expressing will make life easier. In particular, many believe that if partners can give a bottle of expressed milk at night, the nursing mother will be able to get more sleep. However, many women find pumping hard work, and decide that direct breastfeeding, both at night and during the day, is easier and more convenient. Mastering the side-lying position tends to make night feeds much less exhausting.
One mother’s experience of pumping:
My husband wanted to give our daughter a bottle of expressed milk in the evening (so he could bond better with her, so I couldn’t refuse). But for my own sake, I wished I didn’t have to do it because I needed three or four pumping sessions to get him that one bottle of milk. It was so stressful to me and I was always worried that I wouldn’t be able to get it. Plus I had to pump while he was giving her the bottle, so half of my day was centred around that one bottle of milk. The day I packed my pump for storage was the day I exhaled. Removing that pressure and focusing on our breastfeeding journey was such a relief! I was able to work from home, so lots of times I would latch her in a sling or on a very carefully propped feeding pillow at my desk and she would be feeding there while I did my calls and worked on my laptop. While I managed to create a little supply of frozen milk, we ended up disposing of it as we never used it. At 26 months we still breastfeed - it has been such a blessing for us after such a rough start that we are enjoying it every day it lasts.
The side-lying position for breastfeeding at night
I encourage all new mothers to learn how to breastfeed in the side-lying position. In this position, many women find breastfeeding at night is not as exhausting as they anticipated, especially if their baby falls back to sleep while breastfeeding next to them.
You can also use the side-lying position if you’d like to nap with your baby during the day.
Here’s my article on the side-lying position:
https://www.cordeliauys.co.uk/in-praise-of-the-sidelying-position
This video explains how to achieve side-lying position: Side lying Breastfeeding How To - YouTube
When bed-sharing, it is important to follow these safety guidelines:
Co-sleeping with your baby: advice from The Lullaby Trust - The Lullaby Trust
Your partner settling your baby after a feed can be more helpful than giving a bottle
When breastfeeding is going well, what can be more helpful than another person feeding your baby, is having someone who will settle and/or change the baby after you’ve finished breastfeeding, so you can go straight back to sleep.
Partners bonding with baby
There are many ways that partners can bond with their baby that don’t involve feeding: massage, rocking, cuddling, baby-wearing, bathing, co-bathing, nappy changing and playing with the baby, to name just a few.
So much is written about bonding via breastfeeding, that it’s common for new fathers to believe that they need to feed their baby to bond with them, but bottle feeding is different from breastfeeding. When a mother and baby are breastfeeding, the mother produces bonding hormones that influence her emotions and are transmitted to her baby via her milk. Interestingly, recent research has shown that fathers release high levels of dopamine (a feel good hormone) while caring for their baby and in particular while playing with their baby:
https://www.bbc.co.uk/tiny-happy-people/science-of-fatherhood/zvnhjsg
You need to be organised
When expressing, you need to be organised and also have an idea of what time your baby will want to feed; quite a few babies will not have developed that kind of rhythm by 6 weeks.
Expressing adds a layer of complication to the process of breastfeeding which is the opposite of how breastfeed works when a mother and baby are in tune with each other and can cause difficulties for some women:
I remember stressing out over paced bottle feeding, asking my partner how long it was taking for our baby to finish the bottle, arguing with him that it needs to take longer, and then pumping more for the next day, merging different bags I managed to collect through the day, cleaning and sterilising the bottles, marking the freezer bags - OMG!!!
Many women find expressing helpful and convenient
On the other hand, if you are careful and understand how breastfeeding works, you will probably be fine, and expressing might allow you to get a bit more sleep and give you some flexibility and peace of mind if you need to be separated from your baby.
Links:
https://www.cordeliauys.co.uk/what-to-do-if-your-newborn-isnt-latching
http://www.nancymohrbacher.com/articles/2014/1/17/infographic-on-breast-storage-capacity.html
https://www.wendyleveribclc.com/single-post/2018/05/31/help-my-breastfed-baby-wont-take-a-bottle
Co-sleeping with your baby: advice from The Lullaby Trust - The Lullaby Trust