Breastfeeding: Pumping & Storing Breast Milk

To establish milk supply and help your baby learn how to breastfeed, it is recommended that you place baby to the breast for the first 2-4 weeks after birth! 

Regular emptying of the breast is key to building your milk supply. If you are not able to empty your breasts by breastfeeding, you can express the milk by using your hand (called hand expression) or using a breast pump. 

It is important to keep in mind that pumping is not a requirement of breastfeeding. Some mothers feel they need to pump to increase their milk supply early on. But if baby can remove milk from the breast, pumping is not necessary. In fact, pumping can be discouraging in the first days as you aren’t making a large amount of milk because the baby does not need a lot of milk per feeding.  

Pumping can be beneficial after breastfeeding is well-established and mom needs to be separated from baby.   

Collecting Breast Milk

Collecting Your Milk

• You can collect (express) your breast milk when you are unable to nurse your baby. 
• Relax and think about your baby. This will allow milk produced in your breast to flow to your nipple, also known as “let down,” and will increase the amount that you are able to express. “Let down” is necessary at each feeding. 
• To help your milk flow, place a warm washcloth on your breasts or massage your breasts for a few minutes. Massage from several starting points, always working from your chest towards your nipple and being very gentle!

Why Pump Breast Milk?

• Allows you to offer your baby the benefits of breast milk even when you are apart 
• Allows other caregivers to help in feeding & offers you a little freedom 
• Relieves and prevents breast fullness, engorgement, and infection 
• Provides nutrition for premature babies or babies that can’t feed at the breast 
• Increases milk supply
• Provides all the nutrients and antibodies of breastfeeding if you do not feel comfortable putting your baby to your breast or nursing in public 

Three Ways to Express Breast Milk

1. Hand expression
2. Manual pump
3. Electric pump

Hand expression is cheapest and helps ease fullness, but if you are going to be pumping often, a good electric pump will probably be more efficient. 

Keep in mind that any type of pumping is not as good at removing milk as putting baby to breast. Your baby will receive more milk when he or she nurses than you will be able to pump! 

Tip: Some women find it helpful to nurse on one breast while they pump on the other. 

1. HAND EXPRESSION

Begin by washing your hands and use a clean wide-mouthed container to collect your milk.

To start, gently massage your breasts for a short time to encourage let-down or flow of milk. (Watch this video on breast massage).

Position your thumb on one side of your breast and 2–3 fingers on the other side, about 1–2 inches back from the nipple.

Press your breasts gently inward towards the wall of your chest. Compress your thumb and fingers together. Make sure you’re not just pinching your nipple. This will both hurt and not be effective at getting milk out.

Release and repeat; catch drops of milk in the container as they appear.

When milk flow stops, rotate thumb and fingers to another position around the nipple. Repeat the process until the breast is drained. Express milk the same way from the other breast.

When done expressing, pour breast milk in a clean bottle or storage container. Practice in the shower with hot water running on your breast—this works well if trying to soften engorged (extra full) breasts.

Watch this short video on hand expression! Or this one!

Images from CDC.

2. MANUAL PUMPING

Manually operated breast pumps are used most often when pumping is only needed once in a while or for a short amount of time. Manually pumping takes practice. 

The manual pump does not stimulate hormonal levels well; therefore, it may be difficult for women to maintain an adequate milk supply if using the manual pump frequently in place of putting the baby to breast. 

It is called a manual pump because it is not electric, and a mother must manually compress or pump the handle to create suction. The manual pump is best used for resolving temporary breastfeeding issues such as normal engorgement, healing sore or cracked nipples, oversupply, plugged ducts, and/or weaning baby from the breast. Another common reason is if mom is occasionally separated from her infant. If a mom is routinely separated from baby, an electric pump will be much more efficient and timesaving when expressing milk. 

3. ELECTRIC PUMPING

The WIC offices in South Dakota offer hospital grade breast pumps. These pumps are also referred to as ‘multi-user pumps’ because after returning the pump they are cleaned and sanitized and can safely be provided to another mother (just like in the hospital). These pumps mimic a baby’s nursing rhythm and have been known to generate more milk in less time. Hospital grade pumps are good for moms that depend exclusively on pumping to bring in and maintain milk supply (for example, if you are the mother of a premature infant). 

If you are planning on returning to work or school and have a long-term breastfeeding goal, WIC offers breast pumps that are more portable and are single user (meaning it is brand new and you get to keep it!). 

Picking what kind of breast pump you want to use can be a big decision. Consider cost, quality, portability, and how you plan to use it. Your WIC staff can help you make the decision. No matter which pump you pick, remember that it is very important to follow the instructions provided with your pump! If you can receive a pump through the WIC office, staff will teach you how to use and care for your breast pump. 

Medicaid Breast Pump Issuance

South Dakota Medicaid now manual and single user electric breast pumps when ordered by a physician, physician’s assistant, nurse practitioner, or certified nurse midwife for any breastfeeding mother. 

Breast pumps are covered under the mom’s Medicaid coverage and can be provided after 28 weeks of gestation. Coverage is limited to one manual breast pump per year, per family or one single-user electric breast pump per family, every 3 years. 

Storing Breast Milk

• Always wash your hands with soap and water before pumping and/or preparing bottles. 
• Store your milk in a sterile bottle (hard plastic or glass) or disposable breast milk freezer bag. 
• Put enough milk for 1 feeding in each bag/bottle. Do not overfill. Consider freezing various amounts (1oz, 2oz, 4oz) to accommodate larger feedings as well as any snacking your baby might do. Leave an inch or so of space at the top of the container because milk will expand as it freezes. 
• Milk pumped on the same day can be combined before freezing. 
• Do not add fresh, warm breast milk to frozen breast milk. 
• Label the bag or bottle with the date the milk was expressed and your baby’s name if you are providing milk for daycare. Talk with your daycare provider about storage guidelines for human milk. 
• Store milk in the back of the refrigerator and freezer where temperatures remain more constant, NOT in the door. 
• If you don’t have a refrigerator or freezer close by when you collect your milk, store your pumped/expressed milk in an insulated cooler bag with frozen ice packs. Breast milk can be stored in a cooler with ice packs for approximately 24 hrs before freezing or using. 
• Milk can be safely thawed:
• • In the refrigerator overnight
  • Under running warm water
  • In a container of warm water 
• Do not boil or microwave breast milk. Microwaving breaks down nutrients and creates hot spots which can burn your baby’s mouth. 
• Do not refreeze thawed breast milk. 
• When thawing your milk, gently swirl the milk (don’t shake) to mix. 
• • It is normal for breast milk to separate or to look slightly blue, yellow, or brown. This does not mean it has gone bad. 
• Sometimes breast milk that has been stored in the freezer or refrigerator will have a “soapy” smell or strange taste. This is due to changes to the fats in the milk and flavors from nearby foods. These changes are not harmful to your baby. 
• Breast milk changes with the age of your baby to meet his or her needs! Try to use fresh breast milk when possible because it best meets your baby’s needs; when using frozen milk, rotate the milk so that you use the oldest breast milk first. 
• Discard unused milk left in the bottle within 1-2 hours after baby is finished feeding.

USDA Breast Milk Storage Guidelines

Storage times and temperatures may vary for premature or sick infants; check with your doctor.

Clean & Disinfect Your Pump

Pumping your milk is one way to provide breast milk to your baby. However, germs can grow quickly in breast milk or breast milk residue that remains on pump parts. Following these steps can keep your breast pump clean and help protect your baby from these germs. If your baby was born prematurely or has other health concerns, your baby’s health care providers may have more recommendations for pumping breast milk safely. 

Before Every Use

• Wash your hands well with soap and water for 20 seconds. 
• Inspect and assemble clean pump kit. If your tubing is moldy, discard and replace immediately. 
• Clean pump dials, power switch, and countertop with disinfectant wipes, especially if using a shared pump.

After Every Use

• Store milk safely. Cap milk collection bottle or seal milk collection bag, label with date and time, and immediately place in a refrigerator, freezer, or cooler bag with ice packs. 
• Clean pumping area, especially if using a shared pump. Clean the dials, power switch, and countertop with disinfectant wipes. 
• Take apart breast pump tubing and separate all parts that come in contact with breast/breast milk. 
• Rinse breast pump parts that come into contact with breast/breast milk by holding under running water to remove remaining milk. Do not place parts in sink to rinse. 
• Clean pump parts that come into contact with breast/breast milk as soon as possible after pumping. You can clean your pump parts in a dishwasher or by hand in a wash basin used only for cleaning the pump kit and infant feeding items. 

Cleaning Pump Parts

BY HAND

• Place pump parts in a clean wash basin used only for infant feeding items. 
• Do not place pump parts directly in the sink. 
• Add soap and hot water to basin. 
• Scrub items according to pump kit manufacturer’s guidance. If using a brush, use a clean one that is used only to clean infant feeding items. 
• Rinse by holding items under running water, or by submerging in fresh water in a separate basin. 
• Air-dry thoroughly. Place pump parts on a clean, unused dish towel or paper towel in an area protected from dirt and dust. Do not use a dish towel to rub or pat items dry. 
• Clean wash basin and bottle brush. Rinse them well and allow them to air-dry after each use. Wash them by hand or in a dishwasher at least every few days. 

IN DISHWASHER

• Clean pump parts in a dishwasher if they are dishwasher-safe. Be sure to place small items into a closed-top basket or mesh laundry bag. Add soap and, if possible, run the dishwasher using hot water and a heated drying cycle (or sanitizing setting). 
• Remove from dishwasher with clean hands. If items are not completely dry, place items on a clean, unused dish towel or paper towel to air-dry thoroughly before storing. Do not use a dish towel to rub or pat items dry!

SANITIZE

• For extra germ removal, sanitize pump parts, wash basin, and bottle brush after they have been cleaned. Items can be sanitized using steam, boiling water, or a dishwasher with a sanitize setting. Sanitizing is especially important if your baby is less than 3 months old, was born prematurely, or has a weakened immune system due to illness or medical treatment. 
• Sanitize using boiling water:
• 1. Place disassembled feeding items into a pot and cover with water. 
  2. Put the pot over heat and bring to a boil.
  3. Boil for 5 minutes.
  4. Remove items with clean tongs.
  5. Place items on a clean, unused dish towel or paper towel to air-dry thoroughly before storing.

Sources: CDC: How to Keep Your Breast Pump Kit Clean & How to Clean, Sanitize, and Store Infant Feeding Items