Expressing

Having twins or more can be a particularly demanding time when it comes to feeding. Exclusive breastfeeding can be achieved, and your body will be able to produce enough milk to feed your babies. However, it is important to get things right early on and you may need help and support with latching on and positioning.

Early days

Occasionally your babies may need some additional help and support if they are born early or small and may need to stay in a neonatal unit or special care. If your babies are unable to feed from the breast the nursing team will help you to start expressing as soon after birth as possible, ideally within 6 hrs of birth. You will be advised to double pump (from both breasts) 8-12 times per 24-hour period for the first 14 days. It is important to express little and often as this more closely mimics a breastfed baby’s feeding pattern. Later, you could adapt to 6-8 times a day depending on how much milk is collected.

You will be advised to also express during the night, when your hormone levels for producing milk are at their highest. It is important to leave no more than 5 hours between expressing sessions.

Skin to skin time with your babies is especially important. This will allow you to get to know each other, stabilise the babies’ temperature, stimulate your milk supply and allow babies easy access to your breasts. Recent evidence - https://www.unicef.org.uk/babyfriendly/baby-friendly-resources/implementing-standards-resources/skin-to-skin-contact/ - supports that when a mum expresses during or following skin to skin time, she will produce more milk than if expressing took place in a separate room and the milk expressed will also contain the most up to date antibodies.

Top tips to help

Make sure you are comfortable and have everything you need to hand
Wear a top that provides you with some coverage - a shirt with a vest top is one option
To achieve ‘hands free’ pumping, purchase a hands free expressing bra or modify a well fitted maternity bra by cutting a hole in each cup so that the breast shield is next to the breast and held in place
Use a pump that allows you to express from both breasts at the same time
Keep a picture, clothing or a video of your babies close to hand if you are unable to express next to your babies as this helps with milk production
Breast massage is useful to relax and warm the breasts
Expressing during or just after skin to skin cuddles with your babies is especially helpful
Don’t worry about volumes – in the early days it is normal to only produce small amounts of milk by expressing. The technique for expressing requires practice and you will find that the amount of milk you produce will usually increase over time and with regular practice.
- Make sure that you have the correct breast shield size - too big or too small will not be so comfortable and milk volume will be affected.
- Have the vacuum set at a comfortable setting – there shouldn’t be any pain or tenderness.

Expressing at home

You might like to consider expressing milk so your partner can get involved with feeding, but it is a good idea to try and get breastfeeding well established before doing this.

When expressing at home it is important to choose the right breast pump for you. Ideally a double electric breast pump is the most appropriate if you need to support breastfeeding with expressing. If you don’t want to buy a double pump you can hire one and they are usually delivered the next day.

Research proves that when a mum uses a double pump compared to a single pump she achieves 18% more milk volume that is higher in energy. Not only is it more comfortable but it is more time efficient, cutting pumping time by half.

Find a time that you could add a pumping session in – maybe keep a feed diary to see if you have a couple of hours between feeds to express. To make things easy follow the same ‘Tips to help’ as for the early days.

Storing your breast milk

Label your milk with the Date, Time and amount to help you keep a track. Use in sequence if the milk is frozen but if you have fresh milk available use this first.

Room temperature - you can store freshly expressed milk in a cool room for up to 4 hours after expressing.

Refrigerator - you can store fresh expressed milk in the refrigerator for 3-5 days.

Freezer – you can store your milk in the freezer for up to 6 months depending on your domestic freezer (don’t store it in a fridge top freezer for any longer than 2 weeks).

Thawing your milk

Use all previously frozen breast milk within 24hrs of taking it out of the freezer

Ideally thaw the milk in the refrigerator or use cooled boiled water that is tepid to warm the milk in a jug or alternatively use a breast milk warmer.

Feeding your baby expressed breast milk

You will need to feed your babies your expressed milk by using a bottle with a teat or by using a cup. Occasionally babies don’t take to a bottle and this is fine, it just means that they much prefer mum or are not ready to take to the teat. Some babies transition straight to a cup.

Warm your breast milk so that it is around body temperature, although some babies will happily drink it at room temperature. Test the temperature by dropping some milk onto your wrist (don’t let the teat touch your skin), if you can’t feel the milk on your skin it is at the right temperature, i.e. it isn’t too hot or too cold.

When introducing a bottle wait until breastfeeding is well established. Decant only a small amount of expressed breast milk into a bottle or a cup to minimise wastage. Get your partner or another person to offer the feed as if babies are too close to mum they may just want to be breast fed rather than taking a bottle / cup.

Remember that not cleaning and sterilising bottles properly can increase the chance of a baby becoming ill. You need to clean and sterilise the breast pump and bottles in the same way that you would if you were making up formula milk – see the NHS leaflet about this here: https://www.unicef.org.uk/babyfriendly/wp-content/uploads/sites/2/2008/02/start4life_guide_to_bottle_-feeding.pdf