This page covers: choosing a breastpump, when and how to pump, how and how long to store expressed milk, ways to feed a baby, preparing a bottle, and bottle-feeding.
Do you need to pump?
Some babies are rarely, if ever, bottle-fed. They are only nursed at the breast. This might mean baby is always with mom, but it doesn’t have to. This is possible if mom and baby’s other caregivers have flexible schedules, such as when mom works from home with another caregiver responsible for some of baby care who brings the baby to her for feeds, or when mom has someone else who can provide care if she needs to go out to do something. For example, if she needs to go to the store sometime in the afternoon, she just waits till baby is ready to feed, gives a feeding, and then can leave the baby with a caregiver for a couple hours before he will need to eat again.
However, most women find it helpful to be able to bottle-feed at times.
If you only need a bottle on a rare occasion, it may work to hand express. To collect this milk, lean over a cup as you express, and let the drops fall into the cup.
To hand express: Cup your hand in a C-shape, with the thumb above the areola and the first two fingers about 1 – 1.5 inches below the nipple. (The other fingers are held slightly away from the breast.) Push your hand straight back toward your rib-cage, then roll your fingers forward toward the nipple, expressing a few drops of liquid. Rotate the thumb and fingers to milk other reservoirs, using both hands on each breast. Avoid: squeezing the breast, sliding hands over the breast, and pulling on nipple or breast.
Find a video on hand expression here: http://newborns.stanford.edu/Breastfeeding/
Choosing a Pump
Manual pumps (like the Avent Isis): These are a good choice for someone who needs to pump up to 5 – 10 times a week. Cost around $45.
Electric pumps: If you expect to pump several times each day, you will want an electric pump. With a manual pump, you can only do one side at a time, and you must use your hand to pump. With an electric, you can do both sides at once, and you can either use a bra / bustier / pump holder of some sort to hold the pump in place, or prop them in some way, and do other things (like type on a laptop!) while you pump.
You can buy a pump (like a Hygeia Enjoye) for $200 – 350. (I like the Hygeia, because it’s designed to be multi-user. I had a friend who was having a baby a year after me, so we bought one together, splitting the cost – we each bought our own “pump kits” / “personal accessory sets” but this saved us a fair amount of money.) Or you can rent a “hospital-grade” pump (like the Medela Lactina) for $50 – 60 a month. The rental pumps are a little more effective, so are generally recommended for mothers of preemies or multiples who need to get their milk supply up as much as possible as quickly as possible.
Learn about health insurance coverage for pumps here.
When to Pump
- Starting to Pump: Most lactation consultants recommend, if possible, that families focus on breastfeeding from the breast only for the first month or so, until mom’s milk supply is up and baby has mastered feeding from the breast. Then at one month, you can add in pumping and feeding expressed milk.
- First few times: When you begin pumping and introducing the bottle, you can simply pump when convenient for you. That may be at the end of a feed (you’ll still have milk available even if baby has just nursed a long time) or in between feeds. Pumping an ounce or so would be enough. You can then offer that to baby. Those first few times, we don’t expect baby to take a full meal from a bottle, we just want them to test it out.
- It may work best to pump when your breasts feel fullest. This could be first thing in the morning, or it could be in the early evening. Some women pump while baby is nursing on one breast.
- Stocking Up: Once you’ve got the hang of it, you can start pumping more. If you are able to, it’s best to try to get some milk in the freezer before you go back to work / school so there will always be some milk available. Again, you can pump after a feed, or between feeds, whenever is convenient for you. (I don’t recommend middle of the night pumping. I’ve worked with some women who did it, but then increased their overnight milk supply to the point that they had some uncomfortable nights.)
- Pumping while separated from baby: Once you’ve gone back to work or school, you want to establish a habit of pumping anytime you will miss a feeding, i.e. whenever baby gets a bottle. Making sure that you express the same amount of milk as baby takes in will help to maintain your milk supply.
How to Pump
- Always wash hands before expressing. Wash pump and collection bottles after each use. (Note: some women are not able to wash their pumps at work: they store the pump parts in the cooler / refrigerator with the milk, rather than at room temperature, in between pumps to reduce bacteria growth.)
If you’re in a hurry, or lack privacy, you may skip some of the steps below. But, if you’ve got time and privacy, they are all ways to maximize your milk supply.
- Make yourself comfortable first, ideally in a private, uninterrupted, warm area.
- Relax with some slow deep breaths. Some people find it helps to look at baby’s picture.
- Jiggle or gently shake breasts while leaning forward. Gravity helps the ejection reflex.
- Gently brush fingertips across nipples before pumping. Massage the breasts in small circular motions, then stroke the breast area from the top of the breast to the nipple while pumping. (see video here of massaging while pumping)
- Pump. (To see pumping in action, check YouTube videos for “how to pump milk”). There’s not a set time recommended for pumping, but many women choose 10 – 20 minutes. Over the course of the pumping session, you will see there are some times where there is less milk flowing, then volume will increase again, then taper off, that is normal. You’ll also see changes in the consistency of the milk. Early in the session, it may be a pale bluish white and watery looking (like skim milk) and later in the session, it will be thicker, creamier, and yellower (like half-and-half).
Storing Breast Milk
After pumping, transfer milk to whatever storage container you’re planning to use: bottles, or plastic breast milk storage bags or other containers. Choose either glass containers, or a high quality plastic that is designed for storing breast milk… a lower quality plastic might break down and leach chemicals into the milk.
Store in 2 – 4 ounce quantities. Small amounts thaw and warm up quickly, and baby is likely to take in at least this much at each feeding. If you’re planning to freeze the milk, don’t fill the container all the way, since the milk will expand while freezing. Some women freeze milk in ice cube trays, and then transfer the cubes to plastic bags, so they have 1 ounce servings ready to thaw.
Always label the milk with date and time pumped. Rotate the stock of breast milk so you are using the oldest milk first, to ensure that all milk will be consumed within its safe range.
Storage times: Milk will keep at room temperature for 8 hours, in the refrigerator for a maximum of 8 days, and (if the milk was frozen within 24 hours of pumping) in the freezer for up to 3 months. It is better though, to use the milk as soon as possible to maximize nutritional benefits.
When pumping at work, it is best to refrigerate as soon as possible. If the milk sits at room temperature for 4 hours, think of that as having used half of its shelf life… that milk should only be kept in the fridge for 4 days at the most.
When you take milk out of the refrigerator, you will notice that it has separated into layers: pale bluish white near the bottom, and thick creamy yellow at the top. This is normal! It doesn’t mean it’s gone bad – it’s just separated, because it’s not homogenized like the milk you buy in the store. Just shake it to reintegrate the fat.
Feeding Expressed Milk
There are lots of ways to feed expressed milk to a baby: bottle, spoon, cup, finger feeding, tube feeding, and supplemental nursing system. Look here for info on all these options.
If you’re starting to offer expressed milk to a one month old baby, you’ll likely just use a bottle. But, if you need to start supplemental feedings in the first few days or weeks of life, you may choose not to use a bottle due to the chances of “nipple confusion.” A premature baby may not be able to manage a bottle, so might need to use one of the other options.
Preparing a Bottle
There are several kinds of bottles and nipples on the market, each “scientifically designed” for babies. Buy one bottle each of two or three different brands, and find out which one works best for your baby. Then you can buy more of that brand.
Warming Bottles: Babies can drink milk at room temperature, or warmed to body temperature. Place the bottle in a container of hot water, or under warm running water from the sink to warm it. Test the temperature by dotting a little milk on the inside of your wrist. If it is comfortably warm, but not hot, it’s ready for baby.
For frozen milk, thaw overnight in the refrigerator, or place it in a container of warm water (replacing the water as it cools off), or hold it under warm running water. Once milk has thawed, serve immediately, or refrigerate and use within the next 24 hours; don’t re-freeze.
Don’t use a microwave to heat baby’s milk. They can cause hot spots that are hot enough to burn baby’s mouth. They also damage some of the nutrients and antibodies in the milk.
Introducing a Bottle
If breastfeeding is a priority to you, it is generally recommended that you wait to introduce a bottle till breastfeeding is well established: baby’s latch is good, mom is comfortable with nursing, and her breast milk supply is established. This is typically when baby is 3 – 5 weeks old. (If a supplement is medically necessary before breastfeeding is established, you can use medicine droppers, spoons, etc. as discussed above.)
The reason to wait to introduce a bottle is that some babies develop “nipple confusion” and have a hard time switching back and forth between breast and bottle. In the early weeks, if given both options, they may choose the bottle, and you may have a difficult time continuing breastfeeding.
If you do intend to use bottles at some point, it is best not to wait more than 12 weeks, as some older babies will develop a strong preference for mom, and will not learn to use a bottle as easily.
For the first several bottles, many women find it works best to breastfeed for a while first to ease hunger, so baby is calm and ready to learn a new skill. Then they give the bottle. Others find it works best to offer it when the baby is hungry and willing to take anything.
It is best if someone other than mom introduces the first several bottles. (If mom tries, baby may refuse the bottle, since the breast is right there.) To learn how to bottle feed, look at videos on YouTube or parenting sites.
For baby’s health,the best thing is breastmilk from the breast. Next best is expressed milk from the baby’s own mother. Then expressed milk from other mothers. Then a cow’s milk-based formula, then a soy formula. Think about what the baby was biologically designed for, and then how many steps you are away from that.
That said, sometimes supplemental feeds are necessary.
If at some point, you do choose to introduce formula, ask your pediatrician for recommendations. You can also look at websites from the manufacturers to find out more, but remember that information may have a bias. For more info on choosing a formula, see http://www.askdrsears.com/topics/feeding-eating/bottle-feeding/choosing-formula
Formula comes in three forms: powdered is cheapest and takes the least storage space, but you must mix it with the correct amount of water. If you buy concentrated, that’s also mixed with water. Ready-to-serve is the most expensive, and the bulkiest, but requires no preparation. For more on preparation, look here. For lots more on formula, read this.
It is generally possible to mix breastfeeding, expressed milk, and formula. For example, mom nurses whenever she and baby are together, baby is bottle-fed expressed milk at other times, and formula on occasion. Another example: some moms breastfeed once or twice a day at home, and baby is given formula at other feedings.
Before using them for the first time, you should sterilize bottles and nipples by placing them in boiling water for five minutes. After that, it is generally not necessary to sterilize, you need only wash them in hot, soapy water. Buy a bottle brush for cleaning milk out of the bottom of the bottles, and out of the crevices in the nipple. Squeeze water through the nipple holes to make sure they are cleared out. Rinse well, and let bottles and nipples stand in a rack to dry.
When babies drink from a bottle, their saliva can contaminate the milk remaining in the bottle. If it’s breastmilk in the bottle, and baby doesn’t finish it, you can put it in the refrigerator for an hour or so, then reheat once and serve (if baby doesn’t take it all now, dump it out.) If it’s formula in the bottle, you should dump it out and clean the bottle after each feeding. (The reason for the difference is that breastmilk has anti-bacterial properties that slow the growth of any bacteria. Formula does not.)
How Much to Bottle Feed
If your newborn is only getting an occasional bottle, plan on offering 2 – 4 ounces. If a baby is bottle-fed full-time, he would take in 2 – 3 ounces of breast milk or formula per day for every pound he weighs (e.g. 20 – 30 ounces a day for a 10 pound baby.)
Burping a baby
Breasted babies don’t always need to burp after nursing, as they may not take in much air. Babies almost always need to burp after a bottle. To learn about burping and spit up, click here.