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 of
the breast.

Demo / practice

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 mothers 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 donors breastmilk
If baby cannnot be fed at the breast
> mothers own milk, if not available:

;
> donors milk

-Wet nursing
-Donors 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 babys

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 mothers
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 37C 4 hours
= 15-25C 8 hours
= Below 15C 24 hours

refrigerated = 2-4C 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 Seora de la Leche y
Buen Parto