1. Expressing and Feeding Breast Milk Birth & Beyond California: Breastfeeding Training & QI Project With funding from the federal Title V Block Grant 1

2. Objectives Identify three reasons for hand expression List two indications for milk expression in the hospital List at least two alternative feeding methods which can be used to support breastfeeding 2

3. Hand Expression DVD: Breastfeeding Management, Teaching Tools for Physicians and Other Professionals Jane Morton, MD 3

4. Why Teach Hand Expression? To provide supplementation with own mother’s milk Softens areola for easier latch Assists with milk transfer –instruct mother to hand express directly into the baby’s mouth The skin to skin contact of hand expression provides stimulation for milk production and letdown Reinforces to mother that every drop is valuable. Mannel, Core Curriculum for Lactation Consultant Practice, 2007 4

5. Indications for Breast Milk Expression in the Hospital Baby is premature or sick Maternal illness Baby unable to latch or breastfeed well Mother at risk of inadequate milk production 5

6. Milk Expression to Initiate and Maintain Lactat ion Combine hand expression and breast pumping for the first few days Use hospital grade pump with dual collection kit If baby is separated from mother, begin milk expression within 6 hours after birth If baby needs to be supplemented, mother should express milk Express at least 8 times per day 6

7. Cleanliness Concerns Hand washing Breast cleansing unnecessary Personal collection kit – wash with hot soapy water after each use Gloves unnecessary 7

8. Storage Guidelines MethodOMM- Term Infant (fresh expressed) OMM- Preterm Infant (fresh expressed) PDHM Room temperature 26ºC/ 79°F < 4 hrs ☼ < 24 hrs at 15ºC ( a cooler with frozen gel packs) < 4 hours ☼ Only for completion of feeding, then discard Refrigerator<48 hours (hospital use) Less than 8 days (home use) <48 hours Completely thawed in refrigerator but not warmed < 24 hours (hospital use) < 48 hours (home use) <24 hours< 48 hours ** Freezer compartment (1-door refrigerator) 2 weeksNot recommended Freezer compartment* (2 door refrig. 12ºC, 5-15ºF ) *not in door 3-4 months< 3 months Deep Freeze (-20ºC, -4ºF) < 12 months Less than 3 mo is optimal6 months Do not refreeze 8 OMM- Own Mother’s Milk ☼ with preterm or sick infants, it is safest to refrigerate milk immediately PDHM- Pasteurized Donor Human Milk In general: use the first two (2) weeks of milk in chronological order, then proceed to fresh breastmilk whenever available. HMBANA Guidelines 2006 CPQCC Nutrition Tool Kit 2005 ** Rhodes, JHL, 2006

9. Alternative Feeding Methods –Syringe or dropper feeding –Cup feeding –Spoon feeding –Supply line/ tube feeding –Finger feeding –Bottles 9

10. 10 Baby-led Bottle Feeding Baby upright; bottle held horizontally Stroke lips to elicit wide gape Follow baby’s sucking rhythm When baby needs a break, tip bottle down

11. Summary Breast pumping and hand expression are important techniques for initiating and maintaining mother’s milk supply when the baby is unable to breastfeed or cannot breastfeed well Hand expression is a valuable, empowering technique that every mother can learn When feeding expressed breast milk to babies, various feeding methods should be considered 11