Expressing can decrease pain if:
- The nipples are tender.
- The nipples are damaged and can also speed healing.
- The breasts are overfull.
1) Problems created by expressing for pain
Expressing to control pain can have negative effects:
Ideally, you continue to breastfeed for some feeds and expressing for others so that your baby does not reject the breast.
2) Considerations when deciding to express to control pain
To decide whether to express or how often to express, consider the following:
- How effective are you at expressing?
- How much pain do you have?
- If you have nipple damage, how severe is it?
- How quickly is the pain settling?
- Can you express enough milk for all of the baby’s needs?
- What type of milk will be used for replacement feeds?
- What feeding tools will be used for the baby?
3) How to express to control pain
For every breastfeed you miss, it is extremely important to express. Skipping feeds and not expressing can cause many problems.
a) Expressing once each day for supplements or replacement feeds during the evening fussies
Babies feed frequently during the evening fussies and mothers may find that this is also when they experience the most pain.
Some will choose to express in the morning, when there is more stored milk present in the breast, and use this to supplement the baby during the evening.
b) Expressing for some feeds
If you want to express more than once a day, consider establishing a pattern such as expressing for every second feed or two out of three feeds for a day or two. After that, you can gradually decrease the expressing and increase the feeding as your pain allows.
c) Expressing for all of the baby’s feeds
If you choose to only express and temporarily stop breastfeeding, resume breastfeeding as soon as it is tolerable.
If you stop breastfeeding entirely for a day or more, your baby may not return to the breast. Most babies are flexible, but some aren’t. Also, breastfeeding is generally more effective than expressing, and occasional breastfeeding can help maintain your milk supply and prevent problems caused by overfull breasts.
d) Expressing on one side
If there is only excess pain on one breast, you can express occasionally or at every feed on one side but continue breastfeeding routinely on the healthy side.
This can result in the milk supply decreasing on the expressed breast and increasing on the breastfed side:
- If there is only a slight or moderate difference, mothers should resume routine breastfeeding and the difference should settle in a few weeks.
- If there is a marked difference, once mothers return to breastfeeding, they should start feeds on the weaker side until the supply is nearly balanced.
- The baby may show a preference for the more active breast.