Pumping, Use and Handling of Breastmilk at the Hospital - - Instructions for Parents

Dear New Mother,

This information sheet is designed to update you with important information regarding pumping breastmilk, the ways in which breastmilk can be used, and how to handle breastmilk. This information is vital to the safeguarding of your health and your baby's health. We note that the information presented here is not a substitute for a medical opinion or for consultation with a professional when necessary.

Wishing you full health!

The Lactation Consultant Team at the Hadassah Medical Center

Why is it recommended to use breastmilk to feed your baby?

Breastmilk is the best food for your baby's growth and development, and contains antibodies and additional components that are vital for your baby. The recommended list of priorities for feeding your baby: 1. Fresh breastmilk 2. Refrigerated breastmilk 3. Frozen breastmilk 4. Breastmilk combined with breastmilk from the Milk Bank (in special cases) 5. Breastmilk combined with infant formula. Pumped breastmilk, under any conditions, is always preferable to infant formula.

Does pharmacological treatment affect pumped breastmilk?

Most medications are permitted for use during breastfeeding, and there are no concerns that they will be transferred to or harm the breastfeeding baby. If you are under treatment with medications, consult the attending team to make sure that the medications are safe to use while breastfeeding.

What is the goal of pumping breastmilk?

The main goal of pumping breastmilk is to stimulate the breast and extract the breastmilk. These actions cause an increase in the production of the breastmilk, and maintains optimal amounts of breastmilk, enabling optimal milk supply.

What are the reasons that pumping is performed?

Separation between the baby and mother - It is extremely important to pump on a regular basis, in order to avoid negative effects on your baby and on your breastmilk production

To increase the amount of breastmilk - when the amount of breastmilk is not enough for the baby's needs. Breastmilk is produced based on supply and demand; the faster the breast is emptied, the more milk will be produced.

To put aside pumped breastmilk to feed the baby with later.

Preparation of a stock of breastmilk with which to feed with baby when the mother goes back to work / school.

How can breastmilk be extracted from the breast?

Manual compressions - The most common way to extract breastmilk. It is recommended to start manual compressions within the hour after the birth, if the baby does not breastfeed immediately after the birth. This method is especially recommended for the first few days after the birth, but can be used throughout the breastfeeding period.

Mechanical pumping - Beginning on the second day after the birth, pumping using a manual or electric breast pump can be started. Most breast pumps are designed for personal use and are not meant to be shared by more than one user (i.e. they are designed for a single user). Avoid borrowing a pump that is not designed to be shared by multiple users (i.e. not a multi-user pump).

When can pumping of the required amount be achieved?

The production of breastmilk and the amount produced is a process that develops gradually. During the first few pumping sessions, single drops may be pumped, which steadily increase. It is expected that several sessions will be required before you achieve the required amount. Pumping is an acquired skill that requires practice, coaching, and belief in yourself.

What are the actions that should be performed when preparing to pump?

Ensure proper hand hygiene and maintain the cleanliness of the pump parts throughout the process. This, in order to prevent contaminations that can impact your baby's health, and the transfer of infectious agents that reduce the quality of the milk you pump.

There is no need to clean the breast or the nipple area before pumping. In contrast to breastfeeding, which is a natural process, the secretion of milk occurs differently during pumping, and effort must therefore be invested to activate let-down while pumping. Increasing the levels of oxytocin helps let-down happen.

Below are some things that can assist let-down:

A quiet and pleasant environment, a calm and optimistic atmosphere, warm compresses for the breast before and during pumping.

Breast massage before and during pumping increases the amount of milk expressed from the breast.

Pumping both breasts at the same time (double pumping).

Pumping during the early morning hours - during these hours, most women have a higher amount of milk, and it is therefore recommended not to skip pumping in the morning.

Proximity to the baby, and if the baby is not present - sniffing one of the baby's clothes, or sometimes, it is enough to simply think about the baby while pumping.

In order to prevent rubbing of the nipple during pumping - position the center of the flange tunnel over the nipple. The nipple should move forward and backward easily at the edges of the flange tunnel without rubbing against them. Friction between the nipple and the flange tunnel indicates incorrect sizing - consult a lactation specialist.

At what intensity should you pump?

The right intensity is different for every woman. Start at a low intensity, and increase gradually. In case of discomfort, reduce the pumping intensity slightly and stay at this intensity. Do not pump at a high intensity setting or at an intensity setting that causes pain. Pumping at a high intensity setting will make it difficult for the baby to breastfeed when direct breastfeeding becomes possible. The flow of milk does not begin immediately; be patient.

At what frequency and how long should you pump?

The frequency at which you pump determines the amount of milk produced to a greater extent than the duration of the pumping sessions. Try not to skip pumping sessions. If you are short on time, a short pumping session is better than skipping a pumping session. Pump before going to bed at night and after getting up in the morning, and up to 6 times during the day. 5 hours of sleep at night is the optimal amount of time between the pumping sessions. Larger intervals between sessions may make it harder to produce the amount of milk required for the baby. Milk can be pumped during, after, and between breastfeeding sessions.

Even if your baby has not started to feed yet, it is recommended to pump according to these instructions, in order to maintain your milk production. During the first two weeks after the birth, pump at least 8 times per day, 15 minutes from each side (even if no milk comes out). During this period, your breasts are "calibrating" to produce a plentiful supply of milk. Always pump from both sides, no matter what amount of milk the baby is being given.

Is breastmilk expected during the first few pumping sessions?

During the first few pumping sessions, no breastmilk is expected to be obtained. However, even when there is no breastmilk being expressed, pumping plays a central role in the body's ability to increase milk production. After breastfeeding has been established, pump until the flow of milk stops.

To increase the production of milk - add a pumping session after each breastfeeding.

To treat congestion, pump until relief; pumping more will make the congestion worse.

In most cases, the amount of milk obtained when pumping does not reflect the amount of milk in the breast or the amount that the baby breastfeeds directly from the breast; therefore, it is not recommended to pump in order "to see how much milk you have".

How should pumped breastmilk be stored?

When you finish pumping, transfer the breastmilk to a designated container for the storage of breastmilk. Mark the container of breastmilk with the mother's inpatient label, noting the date + time the milk was pumped. Keep the milk from each pumping session in a separate container. Breastmilk pumped during different sessions can be combined only after all of the different portions have reached the same temperature in the refrigerator. The temperatures will equalize after one hour in the refrigerator. The date and time of pumping noted should be the date and time of the earliest sample among the samples combined. The properly labeled milk should be placed in the refrigerator / freezer as soon as possible.

The use of pumped milk requires double identification by the parent and a staff member, or by two staff members - both after the pumping session and before the milk is given to the baby; this, to ensure that no mistakes are made in which the breastmilk is given to the wrong baby. The identification process includes checking the ID number, the name, and the date and time of the pumping session.

What is the order of priorities when using breastmilk?

It is preferable to use the breastmilk when it is still fresh, with no refrigeration. During the refrigeration process, the value of anti-inflammatory factors decreases. Milk that is not immediately used should be transferred to the refrigerator. If it will not be used during the next 72 hours, it is recommended to freeze the milk as soon as possible, and within 24 hours of having been pumped. Milk should be frozen in 100 ml portions in order to make thawing easier and avoid throwing out milk. Mark the date and time of the pumping session before freezing the milk.

Breastmilk can be thawed ahead of time by taking it out of the freezer / refrigerator. Do not thaw the milk by soaking it in warm water / warming it in the microwave / boiling it. Milk will be considered thawed when there are no more ice chunks in it. Note the time at which the milk was removed from the freezer and the time at which it thawed on the ID label.

Do not put thawed milk back in the freezer. Breastmilk that has been thawed in the refrigerator without being warmed can be used for 24 hours. After 24 hours, any remaining breastmilk should be discarded. Fresh or thawed milk that has been warmed can be used for up to one hour after being warmed. Extra milk left over after feeding - should be discarded and should not be returned to the refrigerator.

How should the pump set be cleaned?

Maintaining good pump set hygiene is critical. Utensils that are not clean enough can have a negative effect on the quality of the pumped breastmilk.

Do not wet the tube that connects to the breast pump; getting it wet may damage the pump's engine.

Cleaning should be performed using a personal brush, water and soap after every use.

Dry on a clean paper towel, separate from other utensils.

Disinfection (after cleaning with soap and water) should be performed at least once per day according to manufacturer instructions, or by pouring boiling water on the components of the pump set and letting them soak for 5 minutes. Then, they should be taken out and left to dry on a clean surface, separate from other utensils.

The information in this publication is intended for education only and does not constitute a medical opinion and under no circumstances does it replace professional medical advice. All rights reserved to Hadassah ©. Do not photocopy, duplicate and use commercially without written approval from Hadassah. 2020