Most common questions asked about expressing and breastfeeding

This is a time of change for you and your baby. Well done on finding the best solution of you so that you can continue on your wonderful breastfeeding journey.

First steps towards breastfeeding and working

• Discuss your breastfeeding requirements with your employer well in advance of your return to work. This will assist you to come to the best options for expressing your breast milk.
• You will require a private room (not the toilet area) with a comfortable chair, a refrigerator where you can store expressed breast milk, somewhere to store an electric breast pump or manual breast pump, and time to express milk during lunch break and other breaks if necessary.
• Breast pumps are the most efficient way to express quickly and easily at work. You may like to opt for pump where you can express both breasts at the once time. Medela Swing Maxi and Freestyle pumps are excellent for this situation. –remember that double pumping has much more than time saving benefits – it can increase the amount you achieve by up to 18% and is also higher in protein – much more beneficial for your baby
• If you are without electricity, hand pumps are also effective- they just take a little longer. Look at the different ranges available: The Medela ‘Harmony’ hand pump has the option to first stimulate and then express your milk. There are other options available too.
• If possible, you may be able to have your baby brought to you at work. Talk about this with your employer. Discuss the possibility of breastfeeding during breaks and lunchtime, and flexible work hours and breaks.
• Be aware that expressing may seem difficult at first but most working mothers say they improve very quickly, and the benefits are worth the initial effort.

Breastfeeding and expressing and storing breast milk

Breastmilk must be stored correctly to keep it free from germs, which can make your baby ill. Safety suggestions include:

• Use clean hands and clean equipment.
• Express into clean containers. These may be glass or plastic containers or sealable plastic bags.
• Label each container with the time and date the breast milk was expressed.
• Refrigerate the breastmilk within one hour of expressing.
• Freeze excess breastmilk.
• Keep the milk cold on the commute home. For example, pack the milk in an esky with a freezer brick.
• Don’t use a microwave to thaw or reheat breastmilk. Thaw or warm it by putting the bottle or bag in a container of hot water. Then test the milk on the side of your wrist – it should feel about the same temperature as your skin.

Consider all your options and remain positive and determined

Many women successfully combine breastfeeding and paid work.

Congratulations on breastfeeding your twins.

Generally, when everything is going well, your body will be able to provide sufficient breast milk to feed your twins. Breast milk production and supply is directly related to how much the breast is stimulated to produce breast milk.

Mother of twins are encouraged and supported to breastfeed this can be tandem feeding or feeding your babies separately it’s what works. You may like to feed twins on particular sides or change the baby’s breast side every 24 hours. This encourages stimulation of both breasts and helps your babies’ to feed comfortably.

When you babies feed, messages are sent to your brain to release hormones which stimulate your breast to produce breast milk. Breast feeding twins enables this to happen simultaneously at each breast. This will help keep your supply increased.

Join your local multiple birth support group or association to link in with other mums. They will be a great help to you and can share ideas with you on breast feeding twins.

You will be guided by your health professional about your twins’ growth and feeding requirements.

Breast milk is the best for your baby and you. Breastmilk is the one and only natural, complete and complex nutrition for human infants. Just as importantly, breastfeeding promotes a wonderful bond between mother and baby.

Once your breast milk supply is established, breast milk looks thinner and more watery than other types of milk. Your breastmilk contains all the nutrients needed for healthy development of the baby. Breast milk is never “too thin”. Mature milk changes during the length of a single feed to exactly suit the needs of your baby.

The milk that flows at the beginning of a feed is low in fat and high in lactose, sugar, protein, vitamin, minerals and water. As the feed goes on, the milk changes to contain more fat and less sugar. Just think how amazing this is!

Many of the components of breastmilk have unique immunological benefits which help protect the newborn infant. Antibodies from the mother pass to the baby and provide an extra protection that only breastmilk can do.

All in all, breastmilk is the perfect food for your baby, it provides the right amount the baby needs, with just the right ingredients, at the right temperature and offers extra protection that no other milk can do.

Each person’s need to express is individual and unique. Going out to a function and missing breast feeds, particularly if your baby feeds every 2-3 hours, will mean you will need to express breast milk. The main reason is to prevent milk stasis which could lead to mastitis.

Breast feed your baby shortly before you leave, if you can, which enables your baby to be satisfied and emptying your breasts. When you return home, if your baby feeds overnight, you may wish to breastfeed before going to bed.

There are three methods of expressing – hand expressing, hand pump or electric pump. Your choice depends on your reason for expressing, cost, duration of expression and personal preference.

Choose the best pump for you, thinking about how often you will need to express e.g. hand pumping is efficient and quiet but takes a little longer than using a electric pump. You may choose a pump which has batteries eg: Medela’s Swing. Just in case there isn’t any power available.

If you can, organise prior to the event, a place where you can express in comfort and privacy. This will make you feel more at ease and relaxed. Pack a small bag with your breast pump and equipment (make sure you pack the bottle tops!), breast pads and a cooler bag with ice block to store your milk at the right temperature until you get home.

Remember, relax and have a great time. This is an opportunity for you to socialise and spend time with your family and friends!

Most of the time, breast refusal is temporary and your baby will go back on the breast and feed well. There are lots of different reasons a baby may refuse to feed. These can be baby or mother problems. These vary for each person and can be quite different.

A few tips to try are:

• Be as patient and calm as you can, even though you may be feeling frustrated or impatient. Forcing your baby to feed is likely to make the situation worse. If your baby has just been refusing the breast and is upset, distract them by doing something completely different – a walk outdoors, looking at toys, singing a nursery rhyme. When they have settled down try to breast feed again.
• Try using a different feeding position: your baby tucked under your arm (football hold or lying down on a bed next to your baby with no body contact. Just a small change may make all the difference.
• Feeding your baby while you are both in the bath may help. You may want to have someone available to help you lift your baby in and out of the bath.
• Try breastfeeding baby after their bath when warm and relaxed. A gentle massageafter the bath for a short time may relax your baby and then offer the breast.
• Anticipate your baby’s waking time and try a breast feed while still sleepy – you may get in a couple of extra night feeds this way.
• Make sure you are relaxed and comfortable. Play your favourite relaxing music, use a comfortable chair or go to a different room or outside to feed.

If you continue to have problems, please seek advice and support from your health professional.

Mastitis can occur any time during your breastfeeding. However it usually occurs in the first few months after both.

If you feel unwell, flu like symptoms, have a fever and/or you have a tender sot I your breasts. Always check your breasts for any signs of redness, lumps or a painful area, look in the mirror as this will help you are the underside of your breasts.

Importantly, you must continue breast feeding: your baby will help drain the breast.

• Feed off the affected side first for every feed in the next 12-24 hours.
• Check your attachment and positioning of your baby.
• Treat grazed and cracked nipples. (See answer above)
• Apply warm compresses to your Brest during a feed and gently massages the affected area.
• After feeds apply cool compresses. This might be a wet face washer kept in the fridge, a cool pack wrapped in a small towel or a packet of frozen peas wrapped in a small towel
• Sometimes having a warm shower after a feed where you can gently massage may help to release the blockage
• You must rest. Put yourself to bed and have the baby in their cot next to you.
• Mild analgesics: paracetamol may be taken. Please do this under the guidance of your healthy practitioner or pharmacist.
• If your baby isn’t feeding off the infected side for any reason it is important that you drain the breast by hand expressing or pumping – it is helpful to remember that due to possible swelling your breast shield sizing may have changed – with mastitis it is often helpful to go up a size to aid drainage and then go back to your normal size once the issue has resolved

If you have flu like symptoms or feel unwell, you will need to see your GP as soon as possible so they can prescribe antibiotics for you

There a couple of types of engorgement. The first occurs in the early days post birth: physiological and the other after 7-10 days after birth: pathological.

In the first few days after birth, your breast milk will change from colostrum and increase in amounts until your milk is in. Sometimes, your breasts can become swollen with fluid. This can be uncomfortable but it will go away.

• Let your midwife know you are having problems with full breasts and engorgement
• Continue to feed your baby. Their suckling will drain the breast.
• Apply cool, compresses to your breasts during and in between feeds The coolness will reduce the swelling and will help your milk flow a little easier
• Loosen your bra and make sure it’s not cutting in.
• You may need to drain the breast by expressing once using a pump, to empty your breasts completely. – it is helpful to remember to keep the setting lower than usual if you are just draining the breast for comfort  Gentle massage during your expressing will give some relief too.
• You will more than likely have to reconsider your breast shield sizing – it can be very beneficial for comfort and drainage to go up a size in breast shield and then back down to your usual size once the issue has resolved
• If you are having problems getting your baby onto the breast because the fullness of the nipple is taken up by the breast you may like to drain the breast slightly using hand expression or a pump on a low setting for a few minutes only
• If the feeling of intense fullness or pain occurs after the first 7-10 days then this could be a pathological engorgement, caused by the breasts not being drained properly. Usually this occurs due to problems with breast drainage and blocked ducts.
• Check your baby’s positioning and attachment at the breast.
• Change the baby to a different feeding position e.g. the football hold for a couple of feeds
• Gently massage your breasts during feeds and then under the shower to relieve symptoms.
• Apply cool compresses in between feeds to aid in soothing.
• Frequent feeding will ensure milk flow continues but ensure the latch is good by getting the advice from a health professional.
•  Unrelieved, prolonged engorgement leads to lowered milk supply and possible mastitis.
• Seek advice from your Medical Practitioner, Child and Family Nurse, Lactation Consultant or ABA counsellor.

There are many options to assist in increasing your breast milk supply is low. Sometimes mothers believe they have low supply, when in fact this is not the case, as your breast milk supply has adjusted to meet the demands of your baby. Have a look at the section on ‘Is My Baby Getting Enough’ to assist you with your decision making.

For women experiencing low supply, it’s important that you contact and visit your supportive maternal and child health nurse, lactation consultant, ABA counsellor or GP for assistance.

The following tips may help you to increase your milk production:

• Milk production follows the system of supply and demand – the more milk is drained from the breast the more milk will be produced.
• Although they vary greatly, many new babies need 8–12 or more feeds in 24 hours. Babies generally feed less often as they get older.
• You should increase the frequency of feeds. Try to breastfeed every two hours during the day and every three hours during the night for a few days.
• Check the positioning and attachment of your baby. Ensure your baby is well positioned and correctly latched-on baby can stimulate the breast adequately.
• Let your baby finish the first breast before switching to the second breast. Some babies may take up to 20 minutes or longer to drain a breast and obtain all the calorie-rich milk. Let your baby decide the length of the breastfeed.
• You may find it helps to change sides several times during a feed. This is called switch feeding. As soon as you realise your baby slowing down in sucking and swallowing, remove the baby carefully from you breast and switch to the other side. Some people find that this encourages the baby to suck more strongly and stimulates a good let-down reflex.
• Get enough rest. A few days of rest with the baby and nothing else to do but resting and breastfeeding can be very efficient.
• Additional expressing and pumping might be appropriate. Ask your health professional or lactation consultant about pumping or hand expressing.
• You may wish to consider double pumping – double pumping alone produces 18% more milk, increases the protein content of your milk and is of course time saving if you are having to pump on a regular basis
• If it is necessary to give a complementary feed, use a cup, Soft-Cup Advanced Cup Feeder ( it is advisable to seek advice prior to using a cup feeder)  or bottle. The Medela ‘Calma’ feeding device is a great idea as the baby uses the same sucking action as on the breast.
• Power pumping is a great way to increase supply – This is where you pump for 10-12 minutes, then rest for 10-12 minutes and repeat this for an hour once a day
• Help your milk to let-down quickly. Relax and enjoy feed times. Try to remove distractions (turn your phone off, put a ‘do not disturb’ sign on your door), then settle with baby into a comfortable chair. Breathe deeply, relaxing each part of your body separately as you may have learned to do at antenatal classes. Have a drink on hand, a book or a magazine, listen to the radio or watch TV.
• Babies vary greatly in the amount of sucking they seem to need. There is no need to worry if your baby is contented with a fairly short feed. Some babies however love to continue sucking long after the flow of milk has dwindled to a trickle. This is fine too. Your baby will let you know how long his feeds need to be.

One of the most important actions is to ensure your baby is positioned and attached correctly to the breast. Seek help from your midwife, MCH nurse, lactation consultant or ABA counsellor can assist you with feeding.

Here are some tips you might find helpful:

• Ensure your baby’s mouth is wide open, line the nose to the nipple and bring the baby to the breast.
• Take your time attaching your baby. If it hurts take you baby off the breast by routing your finger in the corner of their mouth and gently breaking the suction.
• After a feed, leave off your bra and breast pads and allow tour nipples to air.
• If this is not possible due to leakage then try hydrogel pads (Medela’s are great) these are soothing and use moist wound healing.
• Gently rub on a little expressed milk to your nipples.
• Another idea is to apply pure lanolin ointment (try Medela-Purelan)
• If your feeds are too painful, you may like to rest your nipple(s) for 12-24 hours and express your breast milk. There are a number of pumps available to purchase. Ranging from hand pumps to double pumps. Also, you can hire pumps. The Medela website has a location guide to help you find the nearest store to you who hire out breast pumps.
• For some women contact nipple shields are helpful. It’s best to get someone to check your feeding and breasts prior to getting these.
• If pumping make sure that you have the correct size breast shield as this may also cause severe nipple damage if too big or small. If you are unsure or your nipples are sore during pumping please seek advice

All mums want the best for their baby especially their baby feeding well and growing.

As a mum you need to trust your instincts especially in the early weeks after birth. Think about the following relating to your baby which will help you with your concerns

My baby is:

• Feeding well at the breast and is generally settled after breastfeeds.
• There are 5-6 wet nappies (disposable nappies) everyday.
• Passing yellow/light brown stools a couple of times per day.
• Skin is clear with good tone and their mouth is moist.
• My baby is gaining weight and growing in length and head size.

Observe your baby’s cues as these will help you recognise when they are hungry, tired, settled and content.

Your breasts may be fuller prior to a feed and feel softer afterwards.

Breast milk has all the nutrients, energy and right components for your baby. There is no need to give your baby water or any other drinks when breastfeeding, even in hot weather, you may just need to feed more often.

Seek advice from your maternal and child health nurse, lactation consultant, ABA counsellor or GP if you are concerned.

Medela has a product for all the needs of a breastfeeding mother: from a convenient manual breastpump for occasional use to a double electric breastpump for daily pumping with a lot of extra features.

Choosing the right product means aligning mothers’ needs with the features and benefits of the breastpump.

The following questions can help to find the right products for each mother:

• How often do you intend to pump?
• Do you pump mainly at home or on the go (work, etc)?
• How important is it to save time while pumping
• Do you have special issues such as — Preterm baby- Flat/inverted nipples- Breast infection- Sore nipples- Low milk supply

There may be many reasons why direct breastfeeding is not possible. For example, a premature baby, illness or a temporary relief from breastfeeding challenges such as sore nipples. Perhaps there are lifestyle issues such as returning to work or simply a well deserved evening out with partner or friends. However, this does not mean that the baby cannot benefit from the unique goodness of breastmilk. In order to support mothers during this time, Medela has developed a wide range of products. From pumping to feeding, Medela’s products are designed to mimic nature and support the breastfeeding experience.

Many mothers are afraid about ‘not having enough milk’. In most cases this fear is unwarranted.

Breastfeeding professionals list the signs that indicate your baby is getting enough:

• One or two wet nappies during the first few days, while the baby is receiving colostrum.
• Six to eight wet cloth nappies(5 – 6 wet disposable nappies) per day (24 hours) on the third or fourth day when the milk “comes-in”.
• At least two to five bowel movements every 24 hours for the first several months, although some babies will switch to less frequent but large bowel movements at about 6 weeks.
• The baby nurses frequently averaging at least 6 – 10 feedings per 24-hour period.
• Baby’s swallowing sounds are audible as he is breastfeeding.
• The baby should gain at least 120 – 210 g per week after the fourth day of life.
• The baby will be alert and active, appear healthy, have good colour, firm skin, and will be growing in length and head circumference.

Reference: Australian Breastfeeding Association (ABA)

Please be aware that not every fussiness means hunger.

Yes – breast milk is produced on a supply and demand basis – the more you pump the more you supply.  For example if your baby is feeding at the breast on a regular basis but you pump after each feed your breasts will make more milk. This essentially can be stored for future uses but if not needed there is no need to pump – unless indicated for low supply or should you wish to store milk for future occasions EG returning to work or nights out.

• Research has shown that if your baby isn’t going to the breast, for example they are in SCN or you wish to pump exclusively then the earlier the better. 1-6 hours following birth is the recommended.  We would also recommend that you learn how to hand express first as this is a valuable skill to learn.
• As soon as you are aware that your supply may be going down – please consult your health professional
• When you are ready – e.g. going back to work  you may wish to start expressing a few weeks before to store breast milk for your caregiver to give
• If you anticipate needing to give your milk by other means – e.g. a night out etc

• The amount will vary depending on your circumstances – e.g. the length of time postnatal,- at first you will get only small amounts of colostrum and then it will increase  it also depends on whether you are pumping after feeds as well as  other variables.
• Generally you should pump until your supply slows down – there is a marked slowing of milk ejections and your breasts feel emptier.
• It is helpful to remember that milk supply changes throughout the day also and a slowing or reduction towards the end of the day is normal.

As soon as you feel ready or have an indication to start.

• This will depend on your expected usage – and your circumstances
• Going home after baby is born – we would recommend that you hire our professional grade  Symphony pump until your supply is established
• Baby in SCN – we would recommend that you hire our professional grade  Symphony pump
• Health issues that may affect your supply – we would recommend that you hire a professional grade pump
• Low supply issues – we would recommend that you hire a professional grade pump
• Pumping occasionally – we would recommend  The Harmony
• Pumping often and prefer to single pump – The Swing
• Pumping frequently and prefer to double pump because of the benefits – The Swing Maxi
• Pumping all feeds  – The freestyle

-May be because of various reasons
– You may not be using the correct pump for you
– You may have the wrong size breast shield
– You may not have the vacuum at the correct level
– You may not have your nipple centred correctly in the shield and be blocking ducts
– Your supply may be reduced
– Your machine may be faulty or need servicing – please consult the manual
-We would recommend that you consult a health professional or your LC

1. The wish to exclusively pump and maintain supply
2. Increase supply or induce lactation
3. A premature infant in NICU or SCN/ special needs baby
4. Health issues that may compromise supply eg Polycystic Ovarian Syndrome
5. A supply that is yet to be established – the first 8-10 weeks
6. Mother has experienced some issues and has had advice regarding pumping from a professional.
7. Wants to try pumping and see if she is successful before committing to buy.
8. Mother is happy with the results she has achieved with the hospital grade pump and doesn’t see any reason to change.
9. Mothers needs are short term.
10. Bub has special needs or is unable to feed at the breast for any reason and the mother will need to exclusively pump to enable her to feed her baby breast milk.
11. Has been recommended by LC/Professional
12. Has been using it in hospital
13. Needs to increase milk but doesn’t want a personal pump
14. Only want to use it for a few weeks
15. Wants to try out expressing before buying personal pump