Breast/Chest Care and Expressing Milk

There are times when you will need to remove (express) milk to save for later. When you need to be away for a few hours or if your baby cannot be fed directly while they are in the hospital, you will need to express your milk. This prevents swollen breasts (engorgement) and lets you keep making milk. This will also help keep you comfortable.

How Our Bodies Make Milk

The breasts/chest are made up of milk-producing glands, tubes (ducts), and fatty tissue. The glands produce the milk. When a baby sucks, the milk flows from the glands, through ducts, to the nipple openings (Picture 1).

How to Care for Your Breasts/Chest

• Wash your chest with clear, warm water every day when you shower.
• Wear a well-fitting nursing bra for support. Make sure it is not too tight or too loose. A nursing bra lets you feed your baby or express your milk without taking it off.
• You may want to keep nursing pads (washable or disposable) or clean, folded cloths inside your bra. These will soak up drops of milk that may leak between feedings or expressions. Change the pads when they get wet.
• You do not need to wash your breasts/chest before or after feeding or expressing milk. You can let your milk dry on your nipples after feedings.

When and How to Express Milk

• Express your milk as often as your baby would feed (at least 8 times a day or every 2 to 3 hours). This includes any feedings that would happen during the night. Milk can be expressed with:
  • Your hands (hand expression)
  • A breast pump (electric pump, battery-powered pump, or a hand-pump)
• Pumping usually takes 15 to 20 minutes per side. Many electric pumps can pump both sides at once. Use a hospital-grade electric breast pump if your baby is in the hospital. You can get this through the hospital or talk to your insurance company about how to get one.
• If you have trouble at first, try not to worry. Expressing milk takes practice no matter which method you use. It is easier to express milk when you are relaxed.

Hand (Manual) Expression

1. Wash your hands thoroughly with soap and water for 15 seconds.
2. Start with a gentle breast/chest massage (Picture 2). You should not press any harder than if you were petting a cat.
   
3. Place your thumb on top and your forefinger under the nipple (Picture 3).
4. Gently push your finger and thumb back toward your chest (Picture 4).
5. Squeeze gently in a “milking” motion to remove the milk (Picture 5).
   
6. Express the milk into a container:
   • For babies at home, express the milk into a clean container. Some parents use a cup or bowl.
   • If your baby is in the hospital, you will get sterile containers to store the expressed milk. You can mix expressed milk with pumped milk if expressed during the same pumping session.
7. Repeat steps 3 through 6, changing the position of your grasp so all areas of the breast are drained well. Repeat on the other side.

Safe Storage and Use of Expressed Milk

• Use a clean, empty container each time that you express milk. Do not add newly expressed milk to a container that already has stored milk.
• Write important information on the label of the bottle or storage container:
  • For well-babies at home, label the milk container with the date and time of the collection.
  • For hospitalized babies, be sure to write your baby’s name, medical record number, and the date and time of the milk collection. Also note any medicines you have taken in the past 24 hours.
• Refrigerate or freeze the expressed milk based on your baby’s feeding plan and if your baby is in the hospital. Follow these guidelines (page 4) to know how long your milk can be stored and when it needs to be thrown away.

Storage Guidelines for Breast Milk

• If you need to bring breast milk to the hospital, pack the milk with freezer packs in a cooler. Do not pack your milk with ice. When you arrive, give your breast milk to a staff member and ask them to immediately store in the freezer unless needed immediately. If your baby is in the hospital, bring only frozen or freshly expressed refrigerated milk to the hospital. Do not thaw frozen milk before coming.
• Thawing milk at home:  frozen milk can be thawed in three different ways. Thawing time will vary based one of the methods below:
  • Use a commercial bottle warmer. Follow the manufacturer’s instructions.
  • Place frozen bottle in a plastic bag and place in warm tap water. Do not use boiling water.
  • Place frozen bottle in cold water in a refrigerator to thaw overnight.
• Milk should not be refrozen once thawed. Thawed milk should be thrown away after 24 hours.
• Milk in stored containers can be combined right before feeding the baby if it is all at the same temperature.
• Throw away any leftover milk in the bottle after feeding.
• Do not microwave breast milk! This can destroy the parts of the milk that protect your baby from illness and it could burn your baby’s mouth!

Engorgement

Engorgement is when milk and fluid buildup in the chest. This can cause pain and a possible infection. It usually lasts only a day or two. Here are some things you can do to help prevent these complications:

• Gently massage the breast/chest to help the milk flow.
• Express milk by hand or with a pump between feedings if you’re uncomfortable.
• Stand in a warm shower or place warm, moist compresses on the breasts/chest for relief.
• Put ice packs on the sides of your breasts/chest for no more than 20 minutes after pumping or nursing.
• Loosen your bra if it is too tight.

When to Call the Doctor

Call your doctor or health care provider if:

• Your breasts/chest stay swollen or painfully engorged after expressing milk many times.
• Your breasts/chest feel hot when you touch them.
• Your breast/chest is red.
• Your nipples are sore, cracked, or bleeding.
• You have a fever over 101° Fahrenheit (F) or 38.3° Celsius (C).

If you have any questions, please call the Nationwide Children's Hospital lactation consultant at (614) 722-5228.

Breast/Chest Care and Expressing Milk (PDF), Somali (PDF), Spanish (PDF)

HH-IV-61 • ©1982, revised 2023 • Nationwide Children's Hospital