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Common Concerns During the Early Weeks of Breastfeeding

How Can I Express Some of My Breast Milk?
Many new lactating mothers will need to express some milk in the early weeks of nursing, for example, to relieve uncomfortable engorgement if the baby doesn't empty her breasts adequately. I believe all breastfeeding women should be taught hand expression. In this way, even if they have no pump or can't use their pump effectively, they can still express some milk. After all, you always have your hand with you!

Hand Expression
Hand expression takes practice, so be patient with yourself. Always wash your hands before handling your breasts or collecting expressed milk. For best results expressing milk, first gently massage your breasts, going from the outer areas toward the nipple. A good time to practice learning how to express is when your milk is letting-down. Warm compresses or a warm shower are useful in starting milk flow. Place your thumb above your nipple and your first two fingers below, positioning them about one to one and a half inches behind the base of your nipple. Your fingers should be situated over the milk sinuses, or dilated milk ducts, beneath your areola. Next, press your thumb and fingers back toward your chest wall. Then gently roll your thumb and fingers together (as if you were simultaneously making thumb and fingerprints). The rolling motion will extract the milk pooled in the dilated ducts beneath your areola. Lean forward slightly and collect your dripping milk in a clean cup or other widemouthed container. Try to avoid letting your milk roll over your fingers as you collect it. Repeat the push and roll motions until milk stops flowing. At first you might obtain only a few drops with each compression, but soon you should be getting sprays from several duct openings. Rotate your thumb and finger positions around your nipple to empty milk from all the lactiferous sinuses.

Manual Breast Pumps, Battery-Operated Pumps, and Small Electric Breast Pumps
Many breastfeeding women purchase a breast pump to remove some milk when their breasts get engorged, to occasionally express milk when they must miss a feeding, or to collect extra milk to leave for their baby if they must be absent. A dizzying variety of breast pumps are available for purchase, including simple hand pumps, battery-operated types, and small electric options. Each has its own unique features and price range. Women have varying success using different types of breast pumps, making it difficult to generalize about which is the most effective, comfortable, or convenient in each category. Thus, I suggest you review several pump options with a lactation consultant who can help guide your decision. Before purchasing one of the smaller breast pumps, however, consider whether a hospital-grade rental electric pump would better suit your needs.

Hospital-Grade Rental Electric Breast Pumps
It is generally agreed that the most effective, efficient, and comfortable breast pumps available are the hospital-grade rental electric pumps equipped with a double collection system that empties both breasts at once. In addition to being fast and comfortable, these pumps are remarkably effective in maintaining and even increasing your milk supply. Many of them offer fully automatic cycling and feature a control mechanism to allow you to regulate both the speed at which the pump cycles and the amount of vacuum it generates. A hospital-grade electric breast pump can be extremely helpful in many situations, including the following: to relieve severe engorgement; to maintain your milk supply when you work outside the home or when your baby cannot nurse due to prematurity or illness; to increase a low milk supply; or to pump after ineffective nursings (for example, if your baby has a sucking problem). You must purchase your own set of collection containers, in addition to paying the pump-rental fee. The rate is more cost effective when you rent the pump for longer periods than at a daily rate. Most women agree that the effectiveness, convenience, and comfort of these pumps make them well worth the expense. In many instances, such as premature birth, the cost of the pump rental is covered by insurance when your health care provider documents that breast milk is medically necessary for your baby's health. Hospitals, lactation consultants, La Leche League, Nursing Mothers Counsel, WIC clinics, and physicians' offices also can refer you to a pump-rental outlet.

What If My Baby Needs Supplemental Milk?
Despite all the admonitions you will hear about not giving a breastfed baby any supplemental milk, the fact is that some newborns do not obtain sufficient milk by breastfeeding. If your baby has lost excessive weight after birth or has not started to gain an adequate amount of weight, your baby's doctor might prescribe extra milk feedings. Your baby's welfare must be your top priority. Meeting your baby's nutritional needs will indirectly help your breastfeeding, as a well-nourished baby will nurse better than an underweight infant.

My first preference is to pump the mother's breasts after nursings and try to obtain high-fat residual hindmilk for the baby's supplement. If the volume of breastmilk is inadequate, then some quantity of infant formula (or screened, processed donor breast milk where it is available) might be necessary to correct your baby's underweight condition.

If bottle-feedings are not desired, other options exist for feed-ing supplemental milk to babies, including the SNS device, cup, spoon, or dropper. I certainly don't recommend giving supplemental milk without a valid medical indication. On the other hand, I cannot condone withholding essential nutrition from a baby who is being underfed. Obviously, whenever supplemental milk is prescribed, ongoing efforts should be made to keep the baby breastfeeding as effectively as possible, to increase the mother's milk supply, and to ultimately return to full breastfeeding.

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From Dr. Mom's Guide to Breastfeeding by Marianne R. Neifert. Copyright © 1998 by Marianne R. Neifert. Used by arrangement with Plume, a member of Penguin Group (USA) Inc.

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