"It felt wonderful to be able to help other moms and babies in the same way that I had been helped. It has been very special to be both a donor and recipient of breastmilk through the milk bank."
Debbie K. (donor and recipient)
"I urge any mom out there, wondering if donating milk is for them, to think about how many lives can be saved."
Lisa (breastmilk donor) - Kirstenhof
"The generous offer of donor milk came as such a relief to me and, maybe because I no longer felt so stressed, I found that my milk supply increased substantially – in fact, I suddenly found that I had more milk than Luca needed! So I decided to donate the extra milk to the breast milk bank."
Debbie K - donor and recipient. (Plumstead)
“My son was admitted to Groote Schuur Hospital neonatal ward in November 2009. He needed milk.
Edith Medell (mother of baby receiving donor breastmilk) Cape Town
EXPRESSING
1. Introduction
2. Expressing by Hand
3. Expressing Using a Pump
5. Expressing for Your Baby in Hospital
6. Expressing for Your Healthy Baby
7. Expressing for Donation
Introduction
Often it takes time and patience before learning how to express successfully.
It is advisable to only attempt expressing when one is unhurried and in a relaxed state of mind. Expressing should not be a painful procedure.
Always wash your hands before expressing or handling containers or feeding equipment. Breastpumps, containers and feeding equipment should all be sterilised.
EXPRESSING BY HAND
Should your baby be very sleepy, too small or ill to breastfeed, it is recommended that you start expressing colostrum (the first milk) as soon as possible after your baby's birth. Expressing by hand enables you to catch every drop of precious colostrum for your baby. A clean teaspoon or syringe is ideal for this purpose.
After the first day or two, when there is more milk you could express into clean, sterile containers with lids. Wash and dry your hands well. It isn't necessary to wash your breasts or nipples, a daily bath or shower is sufficient. To build up and maintain a good milk supply it is essential to express 8-10 times a day.
To express, sitting in a comfortable chair, perhaps having a cup of tea to relax you and putting a warm cloth over the breasts before expressing can all be helpful. The shower or bath may be a good place when attempting to express for the first time. Massage the breast towards the nipple with soapy hands. If you are not with your baby, perhaps at work, you could have a photo handy or think about your baby.
Place your thumb and index finger behind the areola (brown area around the nipple), at the 6 and 12 o' clock positions. Press slightly backwards then together and forwards as though massaging the palpable breast tissue behind the areola, release and repeat. Develop a rhythm. A wide mouthed sterile container is easiest to express into.
It may take a minute or more before milk becomes visible. Once the flow slows down, move your fingertips to the 3 and 9 o' clock positions and repeat. Change to the other breast when the flow slows or stops and repeat the whole process.
Do not expect an instant result, practise makes perfect. Do keep in mind that babies are able to drink 2 to 3 times more than most moms can express.
EXPRESSING USING A PUMP
MANUAL PUMPS
Hand pumps are meant for individual use only. Second hand pumps should never be used as there is a risk of passing on viruses not destroyed by sterilisation.
Various makes of hand pumps are available (e.g. Medela) and individuals may have their preferences. The bulb-and-funnel pumps are not recommended as they are difficult to clean and sterilise. All parts must be sterilised according to the manufactures instructions.
It may take some time and practice before you are able to express a significant amount.
ELECTRIC PUMPS
Most electric pumps function by suction and milk can enter the motor as these motors are not sealed. Such pumps are strictly for individual use only and should not be shared, hired or bought second hand.
Only electric pumps that have a totally isolated motor, and no connection between any tubing and the motor, are suitable for multiple use (Medela Lactina). Such pumps are available for hire (see "Useful contacts" for details) provided individual users buy their own kit (tubing, piston apparatus and bottles) to use with the pump. The kit can double up for use as a manual or be upgraded to a mini electric pump.
STERILISATION METHODS
Cold Method
Chemical sterilising solutions can be used according to manufacturers' instructions. The sterilising solution container must be washed thoroughly every 24 hours and filled with fresh solution. All objects to be sterilised must be submerged and filled with the solution (e.g. tubing) for a minimum of 15 minutes.
After sterilising, all equipment and containers must be rinsed with boiled water.
Please note: For breastmilk donation, it is recommended that chemical sterilising solutions be avoided if at all possible.
Steam and Microwave Sterilisers
Can be used provided it is recommended by the bottle and pump parts manufacturers. Use strictly according to manufacturer's instructions.
Boiling
Boiling the items for 10 minutes is the method of choice. It is the cheapest and the most effective method of sterilising, provided it is recommended by the pump parts manufacturers.
Ensure that all objects including tubing remain submerged and are filled with water while being sterilised. It is advisable to set a suitable saucepan and lid aside for this purpose. Always use a timer.
EXPRESSING FOR YOUR BABY IN HOSPITAL
YOUR BREASTMILK IS BEST - KEEP IT SAFE!
You are probably aware of many reasons why breast is best for your baby. These multiple advantages include both short and long term benefits for mothers and their babies. Do ask the staff at your hospital for assistance and information about breastfeeding your new baby.
Your breastmilk has even greater value for your baby if he is unable to breastfeed after birth because he is too sick, premature or of low birth weight. The staff at your hospital will encourage, support and show you how best to express your breastmilk for your baby. Most importantly, you need to start expressing as soon as possible and frequently, about 10 times in 24 hours. Don't delay even if your baby is nil per mouth at the time.
Some suggestions:
Expressing by hand:
It is preferable to hand express for the first 12 to 24 hours even if you own a breast pump. This is because the first few precious drops or teaspoons-full of colostrum will be lost in your pump. Rather hand express and collect this colostrum in a sterile teaspoon or small syringe, ready to feed to you baby. (See Expressing by Hand)
Expressing using a pump:
Once your milk supply has increased, you could purchase a pump. The type of pump may depend on how long it will be before your baby is able to breastfeed.
For short term expressing a hand pump may be all you need. It is however essential that you purchase your own new pump and not borrow or buy a second-hand one. While in hospital ask the staff about cleaning and sterilizing your pump and always follow the manufacturer's guidelines.
If your baby is very small and expressing needs to be for longer than a few weeks, you could consider a portable electric breast pump. Most electric pumps function by suction. As these motors are not sealed, it is possible for milk to enter the motor. These pumps are therefore strictly for individual use only and should not be shared, hired or bought second-hand.
Portable electric pumps are also a good option if you are returning to work and would like to continue breastfeeding.
Some hospitals will have a multi-user electric pump (Medela Lactina) available for you to use and Medela Lactina multi-user pumps are also available to hire (see useful contacts page). This is the only multi-user electric pump available in SA. It is essential however that you purchase your own kit (Lactoset) to use with it. The Lactoset can also be used on it's own as a hand pump. It is worth buying your own even if you are offered the option of a kit that has been autoclaved.
When considering how much you want to spend on a pump, keep in mind that few pumps cost more than three or four week's supply of formula.
As stated in the 'Breastmilk Protocol for Premature and Sick Babies in Hospitals and Clinics of April 2002', Prof G. Kirsten Head of Neonatology, Neonatal Intensive Care Unit, Tygerberg Hospital and Prof M. Cotton, Pediatric Infection Specialist Tygerberg Hospital insist that individual user breast pumps or their attachments cannot be shared under any circumstances.
Containers that can be used for storing your breastmilk;
Glass and hard plastic containers with lids are best for expressing into and storing breastmilk. Do label your containers clearly with your name, the date and time of expression. Staff will check these details before giving your milk to your baby. The same can be done if your baby is left with a caregiver or is in a crèche.
Storing your expressed breastmilk:
In a Neonatal Intensive Care Unit, your expressed milk must be refrigerated within 2 hours if not used immediately. It can be kept refrigerated for up to 24 hour but must then be discarded if not used. Alternatively it can be frozen within 24 hours.
A healthy baby's milk can remain out the fridge for up to 8 hours and be refrigerated for 48 hours before being used or frozen. You can safely freeze it for 3 months in a fridge freezer or 6 months in a chest freezer.
Is breastmilk still best after refrigerating or freezing?
Yes it is. Formula milk feeding is associated with a 6 to 10 times' higher incidence of necrotising enterocolitis in very low birth weight (VLBW) infants compared to those receiving breastmilk. Even frozen, donated, pasteurised breastmilk is undoubtedly superior to formula milk.
In 1998 Tygerberg Hospital introduced an aggressive breastfeeding programme that included skin-to-skin care for babies less than 1800gr. Mortality was decreased by 9%, the average hospital stay decreased by an average of 5 days and the overall cost saving to the hospital was R1,000,000. As the programme becomes more entrenched these figures continue to improve. Consequently, many hospitals in both the public and private sector have adopted similar programs.
EXPRESSING FOR YOUR HEALTHY BABY
Expressed breast milk has antibacterial properties and may be stored at room temperature in a clean closed container for up to 6 to 8 hours if kept away from sun and heat. After this time it must be refrigerated. Alternatively, expressed milk could be refrigerated for up to 48 hours before being used or frozen.
Should one be expressingat work for use the next day, it could be kept in a fridge or small cooler bag with an icepack.
Always cool milk in the fridge before freezing. Beforehand, measure what volume each container takes, for example the 100ml level, and fill depending on your baby's needs.
However, should you be expressing for your premature baby in hospital, your expressed milk must be refrigerated within 2 hours if not used immediately. It can be kept refrigerated for up to 24 hours and can then, if not used, be frozen.
Always allow room for the milk to expand once frozen. Seal and label with the date that the milk was expressed. Always use the oldest milk first. Breast milk can be kept for 3 months in a fridge freezer or 6 months in a chest freezer.
Defrosting and warming expressed breast milk
Frozen breast milk should be defrosted by leaving it in the fridge overnight, standing it in a jug of lukewarm water or running lukewarm water over it. Do not defrost or heat it in a microwave or in boiling water as macrophages and nutrients could be destroyed. Milk that has been frozen and thawed can be refrigerated for up to 24 hours but should not be refrozen.
Once defrosted it could be warmed in a jug of warm water.
Defrosted milk cannot be re-frozen or re-used if your baby does not take it all at one feed. Do not mix breast milk and formula for one feed. It would be better to give either a full formula or breast milk feed.
Breast milk does tend to separate and look curdled when defrosted or left standing. Shake gently and it will be fine.
Containers:
Glass containers such as baby food jars are preferable, especially if the expressed milk is to be frozen.
Hard plastic for example Addis or Tupperware could also be used. Some companies produce special plastic bags for freezing breast milk.
Hard plastic ice cube trays covered in cling wrap can be used for freezing smaller volumes. Once frozen the milk cubes can be kept in a new plastic bag. Containers and feeding equipment must be sterilised and securely sealed to prevent contamination.
For further information about breastfeeding, email breastfeeding@telkomsa.net or contact the Breastfeeding Association on 021 - 686 8363.
EXPRESSING FOR DONATION
Expressing for donation
If you're considering becoming a milk donor you probably have a few questions to ask about expressing your milk and the donation process:
Will I have enough milk to donate?
By expressing extra milk for another baby, you will not be depriving your baby in any way - in fact, expressing increases milk production. That is because milk production is enhanced by emptying the breasts often, in other words, the more often you empty your breasts either by feeding your baby or expressing and feeding, the more milk you will produce.
What containers can I use?
Sterile glass jars with screw top lids are ideal and are available from Milk Matters. Hard plastic sterilised containers with well fitting lids are also acceptable. Please do not use ice cube trays or plastic bags. We are unable to guarantee that your containers will be returned. Containers need not be full but a new container must be used each time you express. Always leave plenty of headspace to allow room for expansion on freezing.
How do I clean and sterilise the containers?
The containers that you receive from our Milk Matters depots are sterile. Should you need to sterilise your own containers, wash the jars and lids in hot soapy water and rinse well, submerge in water in a saucepan and boil for 10 minutes. Once sufficiently cooled, empty and shake out the excess water, then firmly close each container. Sterilising solutions are not recommended.
How do I express milk using a pump?
Wash your hands well. Ensure the pump and containers are washed and sterile. Follow the manufacturer's instructions on how to sterilise your pump. We prefer steam sterilising or boiling but do recognise that not all pumps can withstand such high temperatures and that you may need to use a cold sterilising solution. Please avoid using bulb-and-funnel pumps, as they are extremely difficult to wash and sterilise.
How do I store breast milk?
Please label the jars with the date and your name or donor number once we supply you with one. Masking tape is ideal for labelling the jars, but any removable sticker is fine. Please avoid writing on the jars or lids as we reuse them. Allow your expressed milk to cool at the back of the fridge before freezing it within 24 hours.
How do I get my donated milk to the milk bank?
Once you have a number of jars in your freezer please contact us for referral to your nearest depot, where you can deliver the frozen milk and collect sterile glass jars. Should it not be possible for you to get to a depot, please discuss the possibility of us collecting your milk and supplying you with sterile jars.
Please note: Milk cannot be allowed to defrost at all and must always be transported in a cooler box with ice blocks.
For further information about donating breastmilk please email info@milkmatters.org or contact Jenny Wright on 083 771 6230
