Expressing for the baby’s supplement

When do I express for the baby’s supplement?

A mother can express to provide a milk supplement for her baby or to maintain or increase her milk supply. She should express right after the baby is supplemented or while someone else is supplementing. Expression should only occur when the baby is contented; It is difficult to express when the baby is upset from hunger. Mothers should try to keep the total time for feeding and expressing to less than an hour. Expressing may be time-consuming and ineffective. If mothers are not able to express much milk, it may be because they have never had enough milk, they have a permanently reduced supply, or they have a baby who is feeding well and not leaving much milk behind. 

A) Reasons for expressing

Expressing after or instead of breastfeeding is frequently used to support breastfeeding. Expressing can:

Because of the health benefits for babies, the mother’s milk or colostrum is the first milk choice when supplementing.

1) When expressing is critically important

Regular expressing after each of the baby’s feeds can be critical to maintaining the milk supply if the baby cannot breastfeed normally and regularly and to provide the baby with breast milk.

This includes babies who:

Expressing should continue until the baby can breastfeed effectively.

2) When expressing is helpful

Expressing after breastfeeding can help stimulate the milk coming in if it is late or if the mother is at risk of having a low milk supply.

Temporarily expressing after breastfeeding may be helpful in increasing milk production if the milk supply has always been low or if it is now reduced, even if the baby is breastfeeding well.   

3) When expressing is less helpful

In some situations, expressing may be ineffective and time consuming.

a) Permanently low milk supply

Breastfeeding mothers who have never made enough milk or whose milk supply is permanently reduced and whose babies breastfeed normally, may be unable to increase their milk supply by expressing.

b) Slightly suppressed milk supply

Some mothers may give only small amounts of supplement (one-quarter or less of the baby’s milk) that is not the mother’s own milk but rather other milk types such as infant formula. Mothers may be able to slowly decrease and then stop the supplements without needing to express.

This could include mothers whose milk supply was normal after birth but dropped because of a lack of breast stimulation or because of taking certain medication that have since been stopped.

However, other mothers may choose to express and give more of their own milk until the supplements have stopped.

B) Timing of expressing

If expressing is helpful, mothers should express:

  • If the baby is breastfeeding, right after the baby is breastfed and supplemented.
  • If the baby is not breastfeeding, right after the baby is given a replacement feed.
  • If someone else is giving the supplement, she can express during this time.

This allows the mother to express when the baby is fed, calm, and no longer hungry. It is difficult to express when the baby is unhappy or screaming from hunger.

Mothers should aim to keep the total time for breastfeeding, supplementing, and expressing at less than one hour and to find whatever expressing shortcuts are helpful. The most important short cut is to express both breasts at the same time. This can also increase breast stimulation.

C) How to express

Expressing must be effective and mothers should review their technique if they are not expressing the expected amounts of milk or able to express milk for all of the baby’s supplement.

Expressing for the baby’s supplements:

  • Is best done with a double electric high quality breast pump.
  • May be done with a manual pump. Mothers can use two pumps at the same time to decrease the amount of time needed.
  • May be done with a manual expression instead of, or in addition to pumping.
  • Is ideally done after all breastfeeds.
  • Should not take more than 20 minutes on each breast and is stopped once the milk is no longer flowing.
  • Is not helpful once the milk supply is no longer increasing and the baby can breastfeed normally.

D) Expressed amounts

Ideally, the mother will express for all of the baby’s milk supplement. Expressed amounts will vary. Factors include:

  • How well the baby breastfeeds
  • The mother’s milk supply

If the baby has breastfed well, the baby will not totally empty the breast and expressed amounts are often around 15 millilitres (1/2 U.S. fl. oz.) to 30 ml (1 oz) from each breast. 

E) When expressing is stopped

Expressing needs to continue until the baby can latch and breastfeed normally and the milk supply is optimized.

Expressing is not always helpful; it can be time-consuming and ineffective and may not benefit either mother or baby. Expressing is stopped:

  • Once the breastfeeding problem is fixed and the baby is breastfeeding effectively, growing well, and no longer needs supplements.
  • Once the milk supply is maximized, the baby can breastfeed normally, and the supplements are no longer decreasing. This is usually within three weeks after starting to express.