Breastfeeding is the ideal food during the first six months of the baby’s life; and also from then on, accompanied by other foods, up to two years or more (according to the wishes of the mother and the baby). The usual thing is to do direct breastfeeding (for the baby to suckle at the breast), but sometimes it is necessary to express milk for certain reasons. And manual removal is one of the ways to do it.
Why express milk?
As we have mentioned, it is usual for the baby to suck directly from his mother’s breast. However, in some situations we need to express milk. Some of the most common would be:
– During the first few days, to relieve breast engorgement and make it easier for the baby to latch on.
– When there is mother-child separation , for example, due to a serious maternal illness that requires separate admission from her baby. A very common case of separation of the mother-baby dyad is the return of the mother to work.
– When the baby cannot eat by mouth , for example, very premature babies, serious illnesses or fasting prior to surgery.
To express breast milk there are basically two methods: manually (using only our hands) or by pumping; the breast pump can be manual or electric, and the latter can be simple (a single breast) or double (pumps both breasts at the same time).
When to choose manual expression versus breast pump expression?
Manual extraction is the simplest and only requires learning (no material is needed). All mothers should be taught to express milk manually before leaving the maternity unit after childbirth .
Manual expressing is ideal for removing small quantities , for example for prenatal expressing colostrum or expressing colostrum during the first few days after calving; In addition to the fact that the amounts are small and it is easier to collect manually, the colostrum is of a denser consistency and can cost more to pump. Manual expression is also preferable to relieve engorgement (breast pumping could even be counterproductive in severe engorgement) or for occasional expressions .
How to express milk manually?
The most used technique and the one that works best to carry out manual milk expression is the Marmet Technique , designed by the lactation consultant Chele Marmet. This technique consists of two steps : first, the ejection reflex or milk letdown is stimulated and then the extraction itself is carried out.
1º Stimulate the milk ejection reflex
To do this we will perform a chest massage in three steps:
1. Circle massage
We make a firm pressure with the fingertips towards the chest, with a circular movement without moving the fingers. We are performing this massage covering all the points of the breast, from the outside in, towards the areola.
2. Caresses
We caress or comb the chest with the fingertips from the outermost part towards the nipple, as if we were drawing the spokes of a bicycle. We rub without pressing, as if it were a caress, a tickle.
3. Shake
We lean forward and lightly shake both breasts.
2º The extraction
We hold the breast with the hand in the shape of a C, placing the thumb and the index and middle fingers about 3-4 cm from the nipple (it does not have to coincide with the edge of the areola).
We push the chest towards the ribs without moving the hand. If the chest is very large, we first lift it and then push it towards the ribs.
At that point, we try to gently bring the thumb and index fingers together, joining them towards the nipple but without moving them, they do not move through the skin towards the nipple.
We progressively rotate the position of the fingers to cover the entire chest. In most cases it will be necessary to use both hands to cover the entire circumference.
In the following video you can see the whole process.
How long do we express milk for?
If the expression replaces a feeding (for example, we are separated from the baby), it is usual for the entire process to take 20-30 minutes . We will alternate the stimulation of the chest with the extraction, the periods of extraction being shorter and shorter.
For example:
- stimulation of milk letdown (massage, caresses, shake)
- expressing each breast for 5-7 minutes
- stimulation of milk letdown (massage, caresses, shake)
- expressing each breast for 3-5 minutes
- stimulation of milk letdown (massage, caresses, shake)
- expression of each breast for 3 minutes
If, on the other hand, we express milk to relieve engorgement, the extraction will be shorter, until we are comfortable or the areola is softer and the baby can latch on.
Do I have to take any precautions before the extraction?
Prior to extraction, it is only necessary to wash your hands with soap and water . As for the hygiene of the chest, with the daily shower it is enough. Subsequently, the recommendations for the conservation of breast milk should be followed.
Image | Depositphotos
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