Wednesday, October 5, 2011

Expressing and Storing Breastmilk

Assalamualaikum semua mummies :) serta yang belum jadi mummies lagi :P

Hari ni, saya nak share a very informative articles I found through Nurturing Newsletter. I love reading this article as it is very full of information about how,when and where to express your breastmilk plus ways to store them. The article was written by Rita Rahayu Omar, the CEO of Nurturing Concept Sdn Bhd. She is the Lactation Consultant for SusuIbu.com. Let's check out the info from the article=)

Choosing How to Express
How you express milk will depend on your situation and needs. If you are regularly separated or 
away from your baby, or if there is a delay in breastfeeding after birth, then a pump may be your 
preferred option. 
As with most products, there is a myriad of types, ranging from hand operated, to small, 
motorized/electric single pumps, to automatic double electric breast pumps. Your choice will 
depend on your needs, as well as availability and budget. Breast pump rental may be an option 
for you, too. In any case, It is best to contact your local Breastfeeding Support Group/Lactation 
Counsellor or a Lactation Consultant for their recommendations. Some places even have a 
special pumping station which allow mothers to try the demo breastpumps before purchasing it. 
These places usually provide expert advice on the features and correct usage of the 
breastpumps.
If, however, milk expression is a temporary requirement, eg. to provide some milk while you are 
away from the baby for a brief period of time, you may find hand expression a natural, 
convenient, and more economical way to express milk. Hand expression is a learned skill. If you 
would like more information on hand expression, consider learning the Marmet Technique by 
going to this website

The Basics of Milk Expression
Whether you are hand expressing or using a pump, many mothers find it challenging at first. 
Some are discouraged that they are unable to express more than a few drops  -- this is very 
normal. With practice and time, expressing can be easy and fruitful.
The amount of milk a woman is able to express depends on many factors, including the time of 
day and how relaxed or stressed she is. The following suggestions may help you have a letdown when you're expressing milk  – which is an  important factor in this process, both psychological and physical.
• Express in a comfortable setting; avoid distractions or interruptions. You may ask those around you not to disturb you while expressing. If you're at home with older children, distract them with 
an activity that does not require your full attention.
• Focus your mind on what you have to do. Having a "pre-expression" ritual (which is for 
relaxation purposes, such as drinking a cup of warm drink (not coffee!) or taking a few deep 
breaths. If you're expressing at home, try taking a warm shower or applying warm compresses 
to your breasts just  before you express/pump.
• Many mothers find that trying to connect with their babies while pumping is especially helpful. 
Looking at a photo, video clip, listening to your baby's cooing or keeping a piece of your baby's 
clothing or blanket can help to stimulate the let-down reflex, too.
• Listen to music, read a magazine or chat with another pumping mom  -- anything that helps 
clear your mind and lets your mind and body work

When to Express and How Often
When to express and how often depends on the age of baby and a mother's individual 
circumstances. If your baby is under six months and you are away from her for a long time, 
expressing about every three hours may be necessary to maintain your milk supply, and also to 
provide your baby with enough milk to feed her while you are away. 
Some mothers stockpile their milk at home, expressing milk in the morning before they leave for 
work. Mornings often yield the most milk. If your baby does not require a lot of milk while you 
are separated (perhaps because she is now eating other foods, for example) then you may only 
need to express once a day, and then only enough to relieve any feelings of fullness in your 
breasts.
How Much?
Point to note: Please do not compare yourself to a bottle of artificial baby milk or another 
pumping mom. Every mother produces enough milk to meet their baby's needs. Generally, 
breastfed babies take between two and four ounces at each feeding, and it is probably not a 
good idea to store your milk in greater quantities than four ounces.
Storage
Your milk is a living substance so pr ecious that some even call it "white blood" or “ liquid gold” . It 
is essential to store your expressed (pumped) milk properly to maximize its nutritional and antiinfective qualities. The beauty and uniqueness of Human milk is that it actually has anti-bacterial 
properties that help it to stay fresh. Giving your baby the freshest milk you have pumped 
ensures its high quality. Do not worry about how the expressed breast milk looks! It will normally 
separate into two parts: watery substance and part tiny fat particles. Once mixed together, run 
the container under warm water to bring the milk to room temperature, whether frozen or 
refrigerated. Do not re-heat directly on the stove top or in the microwave, as this may destroy some of the immune substances in human milk.
You can stor e your milk in either plastic or glass container s with fitted tops, or dedicated fr eezer 
milk bags. Remember to mark the date on the container, and to wash them with hot, soapy 
water, and rinse well; this applies to the pump, too. There is no need to sterilize it every single 
time as this is not a necessity. The most important part is to make sure your hands are clean 
before you express.
This information is based on current research and applies to mothers who: 

• have healthy, full-term babies; 
• are storing their milk for home use (as opposed to hospital use); 
• wash their hands before expressing; 
• use containers that have been washed in hot, soapy water and rinsed. 

Storage Guidelines
All milk should be dated before storing. Storing milk in 2-4 ounce amounts may reduce wastage. 
Refrigerated milk has more anti-infective properties than frozen milk. Cool fresh milk in the 
refrigerator before adding it to previously frozen milk.
Preferably, human milk should be refrigerated or chilled right after it is expressed. Acceptable 
guidelines for storing human milk are as follows.
• Freshly expressed human milk may be stored safely at room temperature (10–29ºC, 50–
85ºF). Different studies suggest different optimal times for room temperature storage 
because the studies vary greatly in the cleanliness of milk expression technique and the 
room temperature during the study. Warmer ambient temperatures are associated with 
faster growing bacterial counts in stored milk. For room temperatures ranging from 27ºC 
to 32ºC (29ºC = 85ºF), 3–4 hours may be a reasonable limit. For very clean expressed 
milk with very little bacteria, 6–8 hours at lower room temperatures may be reasonable.
• Very few studies have evaluated milk storage safety at 15ºC (59ºF), which would be 
equivalent to a blue-ice pack in a small cooler. Hamosh et al. suggested that human milk 
is safe at 15ºC for 24 hours, based on minimal bacterial growth noted in the samples 
from their study.
• Several studies have demonstrated the safety of refrigerating human milk (4ºC, 40ºF), 
either by evaluating the bactericidal capacity of stored milk as a marker for milk quality or 
by measuring bacterial growth in the stored milk samples. Bactericidal capacity of stored 
refrigerated human milk declines significantly by 48–72 hours. However, studies of 
expressed human milk with little contamination at the time of expression demonstrate 
safe, low levels of bacteria growth in milk at 72 hours and even after 4–8 days of 
refrigeration.
• Freezing expressed human milk ( -4ºC to  -20ºC) has been demonstrated to be safe for 
at least 3 months. Vitamins A, E, and B, total protein, fat, enzymes, lactose, zinc, 
immunoglobulins, lysozyme, and lactoferrin are generally preserved when freezing 
human milk. A few studies have found a significant decrease in vitamin C levels in frozen 
milk after 3 months. Bacterial growth was not found to be a problem in frozen milk for at 
least 6 weeks. Antibacterial activity of frozen human milk is preserved for at least 3 
weeks. The basic principles of freezing dictate that frozen foods at  18ºC (0ºF) are 
indefinitely safe from bacterial contamination, although enzymatic processes inherent in 
food could persist, with possible changes in milk quality. Frozen human milk should be 
stored in the back of the freezer to prevent intermittent rewarming due to freezer door 
opening. All containers with human milk should be well sealed to prevent contamination.
• After a container is filled with human milk, space should be left at the top of the container 
to allow for expansion with freezing. All stored containers of human milk should be 
labeled with the date of milk expression and the name of the child if the milk will be used 
in a child-care setting. It is typical for infants in daycare to take 60–120mL (2–4 ounces) 
of human milk at one feeding. Therefore, storing human milk in 60–120 mL increments is 
a convenient way to prevent waste of defrosted/thawed human milk.
• Try to avoid adding warm milk to already cooled or frozen milk, in order to prevent 
rewarming of the already stored milk. It is best to cool down the newly expressed milk 
first before adding it to older stored milk.
• Stored human milk may have an altered smell and taste because of the activity of lipase, 
an enzyme that breaks down fat into fatty acids. This breakdown of fat aids the infant in 
the digestion of human milk, particularly for preterm infants, and is not harmful although 
some infants may refuse to drink it. Heating milk to above 40ºC is not advised because 
this will result in loss of enzyme activity.

Storage and cleaning guidelines apply to healthy full-term babies and milk that is being stored 
for home use rather than hospital use. Follow hospital guidelines if your baby is in hospital.
Remember that the fresher your milk, the better it is. Milk that is refrigerated will have more 
benefits than frozen milk. However, human milk is always the superior infant food
There are many different breast milk storage containers on the market for storing breastmilk. 
This can make the decision a lot more complicated than you anticipated when the time comes to 
begin storing your breastmilk. Your options generally vary from glass, plastic containers, or 
plastic bags. Containers for human milk storage do not need to be sterilized. They can be 
washed in hot soapy water and rinsed or washed in a dishwasher. If soap is not available, then 
boiling water is preferable. If you are using a milk storage bag, make sure the bags say they are 
pre-sterilized. 
Remember to always write the date (and sometimes time) on any breastmilk that you store and 
use the oldest breastmilk first. If you are sending your child to a day care centre, please write 
your child's name as well.

Several studies have been done to evaluate storage containers. 
• Glass and polypropylene containers appear similar in their effects on adherence of lipidsoluble nutrients to the container surface the concentration of immunoglobulin A, and the numbers of viable white blood cells in the stored milk
• Use of polyethylene containers was associated with a marked drop (60%) of 
immunoglobulin A
• Steel containers were associated with a marked decline in cell count and cell viability 
when compared to polyethylene and to glass
• There has been concern about possible contamination of milk stored in polypropylene 
Therefore, plastic bags used for human milk storage should be sturdy, sealed well, and stored in an area 
where damage to the bag would be minimized. Freezer grade quality is recommended.
• Concern has also been raised about the risk of breaking glass containers. Containers 
made with bisphenol A, which is found in several plastic containers including baby 
bottles, should be avoided based on strong evidence of its adverse effects as an 
endocrine disruptor
• Containers for human milk storage do not need to be sterilized. They can be washed in 
hot soapy water and rinsed or washed in a dishwasher. If soap is not available, then 
boiling water is preferable. 
• There is no need to discard the first few drops of milk when initiating milk expression. 
This milk is not more likely to be contaminated than milk that is subsequently expressed. 
Breasts/nipples do not need to be washed prior to expression
• Disposable bottle liners or plastic bags are usually not recommended. With these, 
the risk of contamination is greater. Bags are less durable and tend to leak, and some 
types of plastic may destroy nutrients in milk. Mark the date on the storage container. 
Include your baby's name on the label if your baby is in a day care setting. If you do use 
bags, it is a good idea to double bag the thinner ones and store any bag in a hard plastic 
storage container with a lid, in the freezer. This will help reduce the risk of small tears in 
the bag. Ask your day-care provider that when they warm bagged milk, not to allow the 
water over the top of the bag, since this will likely cause water to enter the bag as it is 
opened. If the water used for warming becomes cloudy, that indicates a leak and the bag 
of milk must be discarded (Mohrbacher, & Stock 1997)


For full article, reference and table of milk storage guidelines, please visit the link.

** Disclaimer: All information in this articles is publish in this blog with permission from the author, Rita Rahayu Omar for educational purposes.Please feel free to contact the author for further clarification on breastfeeding topics. **

Thank You Puan Rita Rahayu for sharing your knowledge on this topic.


4 comments:

  1. Good info dear..mula2 memang nampak macam susah and leceh. Tapi kalau dah buat hari2..sonang je...:)

    ReplyDelete
  2. Thanks MyRule :)
    betul2..mmg mula2 rasa susah nak kena rutin pump hari2.
    tp lama-lama dah jadi kebiasaan.bila xpump rasa xlengkap hari tu.

    ReplyDelete
  3. good ones!

    beruntung ur baby ... =)

    ReplyDelete
  4. Thanks kemn:) Alhamdulillah rezeki Ilyaas.
    takpe, nnt ur second baby can try utk full bf.

    ReplyDelete

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