Feb 01

How To Make Milk

Your body starts making first milk (colostrum) immediately after delivery, so if you don’t start breast stimulation right away your body thinks there is no baby to feed.

Because of this, it is very important to send your body the message to make milk.

Without stimulation your milk will either not come in or it will be lost and once your milk production is shut off its really hard to get it back.

Start pumping or using your hands to express milk (either is fine) as soon as possible after birth, even in the first hour.

If your milk starts to come in and your breasts are full it is very important that the milk is expressed.

A full breast sends a powerful message to the breast and brain to stop milk production.

Going more than 4 hours, or sleeping all night without pumping can shut off your milk supply.

If you are sick or just had a C-section, it’s hard. This is where your partner can help-even 5 minutes of pumping by your partner or support person (with them doing all the work) is a great start.

Watch this great video about ‘Colostrum For Your Premature Baby’.

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How Much Milk Should I be Making?

600 mLs a day- 20 ounces – by the end of the second week is a good goal.

If you pump 6 times a day that means your goal at the end of the second week is 100 mLs each time you pump.

There are mothers who make much more than this especially if they have twins or triplets

Some women who have premature babies do not make this much milk. Making 200-300 mLs (7-10 ounces) of milk a day will be plenty for the first weeks in the NICU.

Keep pumping and ask for help to see if you can increase your milk supply.

What Is Best, A Pump Or Hand Expression?

Around the world, mothers of premature or sick babies do not have pumps, they use their hands to express milk for tube feedings and to maintain their milk supply.

This can be very effective if it is done every 2-3 hours. However, expressing milk by hand 8-12 times a day can be exhausting over the many weeks or months of a NICU baby hospital stay.

We recommend that mothers use a hospital grade breast pump and pump 6 times a day.

Research has shown that a good quality electric pump that empties both breasts at the same time will lead to higher milk volumes than a single sided pump or hand expression alone.

You might think that making a little bit of milk when your baby is only drinking a small amount would be plenty.

You should try and get your milk supply high in the first 2 weeks after birth and maintain that high volume until baby goes home.

This will allow you to not lose your milk supply, save up some extra for baby, and have a good milk flow for when baby is ready to learn how to breastfeed.

Hand expression is a good skill to use though. Especially in the first days, using hand expression may produce more of the valuable colostrum than a pump.

After your milk is in, using your hands either during pumping or after pumping to empty your breasts can also lead to a higher milk production (watch Dr. Jane Morton’s video link below).

The milk expressed after pumping is particularly high in fat and great for little baby brains.

Lastly, you may occasionally get caught away from home with no pump and full breasts. Hand expression can save you from that uncomfortable situation- one that can also lead to low milk production.

In time you will find the right combination of pumping and hand expression that works for you.

Ask other mothers in the NICU, or those who have had a NICU baby for advice too.

Check out Dr. Jane Morton’s video about hand expression.

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How Do I Get A Pump?

The hospital staff should be able to help you get a pump before you go home after delivery.

DO NOT GO HOME WITHOUT A PUMP– you may lose your milk!

Consider renting a pump for a week while you figure out how to get one for the rest of the baby’s time in the hospital.

Your insurance may cover your cost to rent or purchase a pump.

WIC provides pumps to mothers with NICU babies- call them before you go home if you have WIC.

You can always use your hands to express milk, but doing this 6 times a day is a lot of work.

Click here if you need help getting a pump through your insurance.

How Often Should I Pump?

You will hear a lot of misinformation and controversy about how much mothers should pump when baby can’t breastfeed.

Basically, you want to pump enough to make sufficient milk for when your baby is ready to go home.

This means that you should aim for about 600 mLs (20 ounces) of milk a day by the end of the second week.

Here are the basics:

Pump 6 times a day – every 4 hours.

Sleep is important, but to bring your milk in you should pump at least once between 12 midnight and 6 a.m. when your milk hormone levels are the highest.

Keep track of your milk volume every time you pump.

Add up your 24-hour total milk volume every day so you know what you produce.

Keep track of your volumes either on an app or on a written log book.

In the first few days following delivery, if your breasts feel very full, you might pump more often to empty your breasts.

Full breasts signal the brain to stop producing milk, so emptying your breasts will help with your milk production.

The number of times you pump is more important than the length of time you spend doing it.

Pumping milk is a lot of work, but your effort will pay off later when you have a good milk supply.

Check out this wonderful video about ‘Finding Support When You Have A Premature Baby’.

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Download our log book here.

How To Pump

Wash your hands (no need to wash your breasts, a daily shower is adequate).

Get comfortable.

Take a minute to massage your breasts.

Center the breast flanges on your nipples.

Hold the flanges gently, so you’re not pushing them into your breasts.

Start the pump at a low suction and increase it slowly as you figure out what is most comfortable for you.

Pump both breasts at the same time.

Pump for about 15 to 20 minutes.

Pay special attention to your flow of milk- once it is in. When it slows down and your breasts feel softer, you’re done.

Some pumps have special pumping patterns for making milk- ask the nurse to help you. Once you are making more than 20 mLs of milk be sure to use the normal pump pattern.

Check out this great video about ‘Producing Breast Milk’.

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Check out this great video to see how mothers around the world express their first milk.

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Lisa Stellwagen MD, FAAP  Professor of Clinical Pediatrics at UC San Diego Health
Special Thanks To Global Health Media Project For Sharing Their Important Work Around The Globe.
The above hand expression video was developed by Jane Morton, MD and produced for educational purposes only.  Reproduction for commercial purposes is prohibited. See more at: http://www.med.stanford.edu/newborns/professional-education/breastfeeding/hand-expressing-milk.html
‘Colostrum For Your Premature Baby,’ ‘Finding Support When You Have a Premature Baby’ and ‘Producing Breast Milk’ videos include families at Boston Medical Center and were funded by the W.K. Kellogg Foundation. For questions or comments about video, contact Dr. Meg Parker, Margaret.parker@bmc.org