Session 11

IF BABY CANNOT
FEED AT THE
BREAST
Session Objectives
1. Describe why hand expression is
useful and how to hand express
2. Practice assisting to learn how to
hand express
3. Outline the safe use of milk from
another mother
4. Explain how to cup feed an infant
Step 5

Show mothers how to breastfeed,

and how to maintain lactation
even if they should be separated
from their infants.
Why is it useful for a mother to
know how to hand express?
For breast comfort
To encourage baby to

breastfeed
To keep up milk production

To obtain milk

To pasteurize milk

Why mothers prefer hand
expression to using a pump
 Hands are always with you
 Very effective and quick once
experienced
 Mothers preference – STS
stimulation
 Gentler than pump
 Less cross-infection
How to HAND EXPRESS
The key steps:
- Encourage the milk
to flow.
- Find the milk
ducts.
- Compress the
breast over the
ducts.
- Repeat in all parts
Demo / practice of the breast.
©UNICEF 910164F
Manual Expression

1 4

3
When to express?

How long to express?

o To get colostrum ; 5-10min = a tsp
o To increase production ; 20min/6hrs
o To soften areola ; compress 3-4 times
o To clear blocked duct ; compress until
cleared
o For storage ; 15-30min
Colostrum may only come in drops
Reminders:
 Not touch mother’s breast
 Have PATIENCE and MORE
practice
 Not to squeeze nipple
 Avoid sliding or rubbing breast
 Can express both breast
simultaneously
 Expressing should not hurt
PRACTICUM
- Pair practice learning to hand express

- Remember your communication skills:

“LISTEN, PRAISE, INFORM,

SUGGEST”

-Do not command-

 Use of donor’s breastmilk
If baby cannnot be fed at the breast
> mother’s own milk, if not available:
> donor’s milk

;
-Wet nursing
-Donor’s milk
-Breast Milk Bank
How to feed Expressed Breastmilk
(EBM) to the baby
Naso-gastric or oro-gastric
tube
Syringe or dropper

Spoon

Direct expression into the

baby’s mouth
Cup
 Cup Feeding
For babies who are
able to swallow but
cannot (yet) suckle
well:
-Difficulty attaching
-Attach and suckle
for short time
-Tires easily
-30-32 weeks
gestation
Advantages of Cup Feeding
 Pleasant for baby – no tubes
 Allows use of tongue, taste
 Stimulates digestion
 Coordinated breathing/suck/swallow
 Baby held close with eye to eye
contact
 Baby in control
 Cup easier to clean
 Must be considered a traditional
method
 Disadvantages of cup feeding

 Milk can be wasted

 Term babies can prefer it
 Easier to do
Breast Pump
-Breast pumps are not always practical,
affordable, needs to be sterilized if to
be fed directly, may damage nipple
especially rubber bulb type
-Double pumping increased mother’s
prolactin level, increases volume of
milk
-Check pumping technique if “no flow”
Storing expressed breast milk

- Choose container. Clean it

- Store in several containers
- Label container appropriately
- Use “oldest” milk first
- Frozen milk once thawed
should be used within 24 hours
 Breastmilk Storage
Fresh milk = 25 – 37˚C 4 hours
= 15-25˚C 8 hours
= Below 15˚C 24 hours

refrigerated = 2-4˚C 8 days

Freezer = 1 door ref 2 weeks

= 2 door ref 3 months

(separate)

= Deep freezer 6 months

Summary

 Learn to hand express

 Use of milk from another
 Feeding EBM
 Storing EBM
Nuestra Señora
de la Leche y
Buen Parto