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There are times when you may want to express breast milk. If your breast may be too full and hence hurt then it would be a good idea to express the milk and store it for later use. You may want to go out and would like the person minding your baby to feed the baby breast milk. You can express milk with your hand or with a breast pump.
Hand Expression

To express breast milk with your hands you need:
Sterile wide rimmed container to collect milk.
Clean, washed hands.
Privacy
Massage your breast gently to increase milk flow or use flannel to warm your breasts.
Hold your breast with one hand and with the fingertips of the other, move all around the breast stroking it gently. You can use the back of your knuckles, massaging from the outer edge of the breast to the nipple.
Once you have completely relaxed, place your hand behind the areola and start squeezing gently. You should be applying pressure on the milk sacs that are under the skin, at the edge of the areola. These sacs, will feel like peas under you fingertips.
As you squeeze in, milk will first drip out and then spurt. Move your hand all over the breast to remove milk from all the ducts.
Breast Pumps

There are a variety of breast pumps available today. You will have to very carefully select the pump that is best for you. If you choose the wrong one you may harm your breast tissue. It is best to consult your doctor before buying a pump. There are two types of pumps:
Battery-operated Pumps: These are easy to use. But may not be very durable. These make less noise than electric pumps. Use a pump that has been designed to release suction at regular intervals to prevent excessive pressure.
Electric Pumps: There are different kinds available in the market. Some come with a double pumping system, which is convenient for expressing milk from both breasts at the same time. Small and light pumps are available, which can be easily carried to work and when you travel. These pumps have adapters that can be fixed into, the cigarette lighter plug in your car to recharge it.
Storing Expressed Breast Milk

There are bags that are specially made to store expressed breast milk. You can use small disposable bottle bags or small glass or plastic bottles also. Depending on how soon you want to use the expressed milk either refrigerate it or freeze it. Here are a few tips you can follow:
At room temperature fresh expressed milk can be stored for ten hours. Milk brought to room temperature after refrigerating or freezing, must be used within half an hour.
Fresh expressed milk can be refrigerated for anything between five to seven days. Taste the milk to find out whether it is fresh before giving it to your baby.
You can store freshly expressed milk for up to six months in an average freezer depending on the efficiency of the freezer. If ice cream is frozen solid, then your freezer can be used to freeze milk for six months. If ice cream stays soft, then you can store milk for three months. In the deep freeze milk can be stored for 12 months. Make sure you store in the coldest part of the freezer and away from the door.
Pumped milk that has been refrigerated for less than 48 hours can be frozen. Milk that has been refrigerated for more that 48 hours should not be frozen.
Freezing cause breast milk to expand. While filling bottles or bags leave about one inch from the top so that there is place for this expansion. If you are using a disposable bag fasten fold the top and fasten it with a rubber band.
Milk containers should be labeled with the time and date on which it was expressed.
If you can express large quantities of milk, do not store it in a big bottle or bag. Use small bags or bottles. The baby will need only small quantities at a time and you can defreeze one small bag or bottle each time. Thus wastage will be minimized.
If you want to transport stored breast milk to use away from home, keep it cold till you use it. Use a cooler with ice or frozen packs to keep the milk cold while transporting it.
The oldest milk should be used first.
Defrosting Expressed Breast Milk: Here are few ways to defrost:
To thaw breast milk, use a hot bowl of tap water or do it at room temperature. Defrost using minimum amount of heat.
Do not microwave to defrost, as it destroys the essential vitamins and enzymes in the milk.
Feed the baby defrosted milk only when it has thawed completely.
If the milk smells or tastes sour do not use it.
Milk that has been thawed should be kept in the refrigerator and used within 24 hours.
Follow these measures to ensure express and store breast milk safely and efficiently till required.

Everything that is used to feed that baby must be washed and sterilized thoroughly before and after use. Use a diluted solution of detergent to wash the bottles. Use a brush with a long handle to clean the bottles this will ensure that the bottom is also cleaned. Rinse well with water so that all the detergent is washed, clean and then sterilize. Modern methods of such as electric and microwave sterilizing are becoming very popular in the recent years. One should be aware of the traditional methods, which include boiling and cold water sterilizing too, as one may not have access to electricity and a microwave all the time.

Steam sterilizing: Electric steam sterilizing is similar to what is used in hospitals. This takes about eight to twelve minutes, excluding cooling time. This process is efficient and doesn’t take long. You must use only those parts that are safe to boil. Bottles and nipples should be placed upside down to ensure proper sterilization. If you are using a microwave, you will have to buy a steamer for it. Do not place any metal parts inside the microwave. Sterilization in a microwave will take five to eight minutes plus cooling time. Remove the lid of the steamer very carefully as the interior becomes extremely hot. The greatest advantage of using this method of sterilization is that there is no smell or taste. If kept closed the items remain sterile for three hours.
Boiling: Is another method of sterilizing. All the bottle-feeding items need to be boiled for a minimum of 10 minutes. You must have a separate pan, only for the purpose of boiling these items. Some items like nipples or teats will have to be replaced more often if you use this method, as they get sticky.
Microwavable bottles: These bottles can be sterilized on their own in the microwave. A single bottle takes 90 seconds to get sterilized. While microwaving the bottles must be kept open.
Cold water sterilization: Tablets used for this method are available in the market. Dissolve them in the prescribed amount in the prescribed amount of water. This will form a solution that is effective against bacterial. These tablets are safe and will not have any side effects even if swallowed. You can buy a sterilizing unit for this or buy a bucket with a lid, which is used for this purpose alone. You must ensure that the bottles are completely submerged in the solution. For complete sterilization make sure that there are no air bubbles in the bottles. Sterilization should be complete in half an hour, but it is safe to leave items in the solution for 24 hours. Fresh solution must be made every day. Make sure your hands and washed before removing the sterilized equipment. Fill the bottles with milk and store them in the fridge for up to 24 hours. Keep bottles in the main part of fridge, as it is colder than the door. Keep away from raw food.
Do not leave sterilized bottles in the open for too long, as they lose their sterility rapidly. Having a sterilizer with a built-in storage facility is best, as items can be removed as and required. Once the bottles are sterilized you can make the baby’s feed and store it. Here are a few tips for making the baby’s feed:
You can either make a bottle each time you need one, or make a number of bottles at one time.
Bottle-milk can be kept in the fridge for 24 hours.
If you want to warm the milk once you remove it from the fridge, just place in it a jug of hot water for sometime. Ensure that your baby is not near the jugs, as there have been a number of unfortunate instances where, babies have been scalded by tipping jugs.
Before making formula milk ensure that you read the instructions on the package carefully. Follow them exactly, as the proportion of water and formula powder has been calculated to provide the required amount of food and water for the baby. If you use too much water the baby will not get the required amount of calories and if too much formula is used, it may lead to dehydration. Follow the steps given below:
Fill the bottle exactly to the level required, with water that has been boiled and cooled.
Use the scoop provided to remove the formula from the package. Level the scoop each time with a knife that is clean. Do not press the powder into the scoop.
Put the formula into the bottle carefully, without dropping any of it.
Fit the cap of the bottle securely and shake well till all the formula dissolves.
Drip one or two drops of this milk on the back of your palm, to make sure that it is not too hot, before feeding the baby.

Both mother and baby will have to learn to master the art of breast-feeding. This will take time and what works for one pair need not necessarily work for another pair. If you face problems ask your nurse or doctor to help you out. Given below are the causes and solution to some of the common breast-feeding problems:

Baby wants to keep feeding all the time: This is normally caused because the baby is not positioned properly and there is insufficient supply of milk. In the initial days the baby may insist on feeding continuously simply because he enjoy it and it is very comforting. It could happen if the baby is trying to increase the supply of milk. If this activity is a change from his normal feeding pattern then it may return to normal in a day or two. Make sure that you position them properly and let them feed on demand.
Bleeding/sore /cracked/nipples: This happens because the baby is sucking your nipple and not the breast as a result of bad positioning. Dislodge the baby, by inserting your finger gently into his mouth to break his grip. The reposition your breast so that the breast not just the nipple is inside his mouth. Try different positions. Express milk and rub it on the nipples this will help it heal. Use the less sore side to feed.
White marks on sore nipples that don’t seem to heal: This is known as thrush, it can appear when either you or the baby have taken a course of antibiotics or may appear without any particular reason. Both of you may have to take oral medication or use anti-fungal cream.
Flat nipples or lumpy, hard and full breasts: Primary engorgement takes place when milk first ‘fills in’ on the third or fourth day. Secondary engorgement takes place when the baby reduces the number of feeds he takes maybe, because he has started sleeping for longer hours at night. If this is case, your body will reduce the amount of milk it is producing. Feed the baby more often to reduce engorgement. If baby is unable to latch on properly, the express some milk to help it do so. Wear warm flannel clothing to ensure milk flow or have a warm shower before feeding to ensure the same. Using chilled cabbage leaves inside your bra can reduce the swelling.
Tender, small lump in the breast: Free movement of milk is stopped because of a block in some duct of the breast. This can happen because you have slept in funny position, sat for a few hours with the seat belt across your breast or a tight bra. Massaging the area or using warm compress on the area will help the lump to dissolve. If possible, position the baby in such a way that, his jaw is near the lump so he can feed and help dissolving the lump. Feed from the sore side, if it doesn’t work express milk from the breast.
Inflamed, red areas on the breast; along with flu symptoms like temperature, aches, sore breast that is full: This is known as Mastitis, which is an inflammation of the breast when milk leaks into the breast tissue. Rest as much as possible, but continue to feed the baby, starting with the sore side. Use of warm and cold compress will reduce the swelling. If there is no improvement go to your doctor who will probably prescribe painkillers or a course of antibiotics.
Baby refuses to feed from the breast: There could be a number of reasons for this:
A change in the taste of milk because of a change in diet or medication.
You are using nipple cream.
You have stopped using nipple shields.
You are undergoing dental treatment or your periods are starting.
Whatever the case maybe, continue feeding your baby. Try feeding when he is almost asleep he may not notice the change in taste. When you decide to stop using nipple shields do it gradually, by trimming more and more of the shield each day so that the baby gets used to it. If nothing works you will have to express milk in order to maintain milk supply.

Breast - Feeding Twins: When you have twins the task of breast-feeding becomes a little more difficult and there is the often-asked question of about whether to feed them together or one at a time. Feeding one baby at a time improves bonding between mother and child. But this can be time consuming. Letting the feed together will improve your milk supply and it will be easy to remember who has had how much. If you decide to feed them together then placing one baby under each arm is the best position to use. You can also criss-cross them on your lap and feed them together. Swapping the babies between the breasts ensures equal production of milk. But using one breast exclusively to feed one baby will customize the supply for that baby and ensure that he gets sufficient hind milk.

When you are new mother, there are a number of things that you have to learn and teach your baby. One of them is to breast-feed. Sit down comfortably. The baby should be on his side facing you. Tuck the baby close to you, with his head on your forearm. His nose should be opposite your nipple and in level with it. If you find it easier use a pillow at first. When his mouth is wide open, bring him towards your breast, allow him to take as much of your breast as possible. His tongue should be under your breast. If your breast hurts a lot or he manages to dislodge himself, start again. Repeat this till you get it right and feel him lodged firmly. Things you should be able to see:

Baby tucked close to your body.
The chin should be against your breast and stretched upward and not tucked in.
Mouth should be open wide and their bottom lip should curl outwards.
There should be movement of the face and jaw.
Lower lip should take in more of the areola that the upper lip.
Things that you shouldn’t see:
Cheeks that are sucked in.
Lip action as if they are sucking a straw.
Sounds you should hear:
Slow and quick sounds of milk being swallowed.
Sounds you should not hear:
Clicking noises
Smacking lips
You should feel:
Being firmly gripped.
Feel the letdown reflex, a tingling feeling in the breasts, usually when feeding begins as the milk flows to the baby.
Slight pain when the baby begins to feed, in the initial weeks.
You should not feel:
Pain lasting longer than the initial momentary pain.
If you feel, hear and see things that you shouldn’t, then put your finger gently inside the baby’s mouth, between the corner of his mouth and your breast. This will stop his suckling and prevent you from becoming sore. Re-position the baby.

Before you begin breast-feeding, make sure that you are comfortable, relaxed and have enough support. Make whatever arrangements are required to keep you comfortable while feeding. Remember the following:
Tuck the baby close to you
His ear, shoulder and hip should be in the same line and not twisted.
Always ensure the baby is facing your breast, if he is turning away feeding becomes more difficult for them.
Memorize ‘tummy to mummy/chest to chest/nose to nipple/chin to breast’.

There are a number of positions to breast-feed a baby. Here are a few of them:

Traditional position: Keep a few pillows on your lap; place the baby on it so that he is on the same level as your breasts. Support his head with your forearm in such a way that the rest of his body in across your stomach. You can help by cupping his head in your hand (use your right hand for left breast and vice versa).

Underarm position: Arrange a few cushions at your side and place the baby on it in such a way that his legs are pointing behind you. Hold your baby in such a way with your right hand that you cradle his head while he feeds from your right breast. Women with Caesarean section use this position use this position to avoid pressure on the scar. Twins can be breast-fed together using this position.

Lying down: Lie on the bed with your head resting on a pillow and place the baby close to you. The bed will give them the support they need. With your free hand bring them to your breast and support them. Keep pillows behind your back to prevent a backache.

Find a position that is comfortable for both you and your baby so that breast-feeding is easy.

Deciding to bottle-feed your breast-feeding baby is a conscious step taken by mothers when they want to return to their original routines. Either they want some time off from their babies or want to go back to working. It is better to think carefully about bottle-feeding as many children learn to use a cup for drinking without going through the bottle phase. Bottles need to be sterilized very well, otherwise they will breed germs and your baby will easily fall ill. Not all babies need to be taught to bottle-feed, a number of them take to it without much fuss. Timing plays an important role. If bottle-feeding is introduced too soon, then the baby may give up breast-feeding. If introduced too late the baby may not want to give up breast-feeding.
Once you have decided to bottle-feed, you either use expressed breast milk or artificial milk also called formula. Expressing milk can be a tedious task. You can use your hand or a breast pump. Once expressed the milk will have to store it in a previously sterilized container. You will have to express a number to times to collect enough milk for your baby. Formula milk is dried cow’ milk which has been modified to suit the baby’s digestive abilities. Most doctors recommend a soya-based formulation. It is important to prepare formula milk exactly according to the instructions provided. It this milk is diluted the baby will not receive the required number of calories. If it is too thick it can lead to dehydration.

The bottles and nipples or teats will have to be well sterilized as milk breeds bacteria easily. It must be remembered that formula milk increases the risk of infection and illness. It is best to exclusively breast-feed the baby for the first few months. The baby does not need water or fruit juices till he starts having solids. Giving him these could reduce the efficiency with which breast milk works in protecting the baby against infection. We still have not found a method to artificially produce breast milk. Breast milk produces hormones and antibodies in such a way that it fights germs specific to the baby’s environment. Research on these is still in its initial stages.

Even after you start bottle-feeding it is best to continue breast-feeding as well. This is known as mixed feeding. Introduce the bottle after breast-feeding is well established. Once you start bottle-feeding, your milk supply will decrease; as the number of breast-feeds the baby will have decreases. You can increase the supply by breast-feeding often. Whenever you have the time let the baby feed on demand, this will help supply increase. Many working women like to continue breast-feeding their babies once the go back to work, as it helps to bond again after their brief absence.

Since we have established that breast-feeding is best for your baby for the first six months of his life. It is a good idea to understand how the breast produces milk. Each breast is divided into lobes and this is where milk is produced. Individual lobes have as many as 15 to 25 tubes that convey milk to the nipples. These tubes widen on the way to the areola (the dark area around your nipples) where milk collects before being expressed. Studies with the help of infrared photographs show that the breasts grow hot when a baby cries. As a result blood rushes to the breasts bringing with it sugars to the milk glands.

As the baby suckles, oxytocin is released into the bloodstream, causing the muscle cells around the milk gland to contract and squeeze out milk that tastes sweet. The squeezing is also known as “the let-down reflex’. Before this reflex takes place, the baby gets some milk. This milk is called ‘fore milk’, which satisfies the baby’s immediate need and is rich in protein. The milk that follow is known as ‘hind milk’ is more satisfying as it, has more fat and hence more calories. The ‘let-down reflex’ has to be stimulated for milk supply to build up. Let your baby decide how much milk needs to be produced. Feed him on demand do not regulate his feeding. If you do this the baby and your breasts will work in coordination and your breasts will produce milk according to your baby’s requirement.