How would you react to finding bottles of breastmilk in your office fridge? Or to the sight of a woman using a breast pump in a public place?
It is now generally accepted that breastfeeding, where and when possible, is the best option for mother and baby. For babies, it lowers the risk of cot death, and reduces the incidence of a wide range of major and minor ailments, from asthma and eczema to diabetes and glue ear. It aids the development of the brain, the nervous system and eyesight. For mothers, simply the act of continuing to produce breastmilk for the months after the birth reduces the risk to her of breast cancer, ovarian cancer and osteoporosis.
The popularity of breastfeeding waned in the middle of the 20th Century: at a time of increasing attempts to standardise childbirth, bottle-feeding was promoted by health professionals, as it was possible to measure how much and of what quality the milk the baby received was. Now breastfeeding is being promoted again, in part at least for the reasons listed above. Public services such as shopping malls and cafés are encouraged to accept breastfeeding mothers and to provide facilities where possible. Generally, people are becoming more tolerant of a woman breastfeeding a child in public.
But there is one aspect of breastfeeding which is still shunned, misunderstood or even treated with revulsion - expressing.
Expressing is when the milk is removed from the breast by another process, to be fed to the baby then, or at a later time. The milk in such situations is often referred to as EBM - expressed breast milk.
There are a number of reasons why a mother may choose to - or be obliged to - express breastmilk. These are some of the most common:
A premature baby may not immediately develop the sucking reflex or have the stamina required for breastfeeding. In these situations the EBM may be given to the baby by gastrointestinal tube, or orally by bottle, syringe or cup (bottles are avoided because it is often hoped that the baby will start natural breastfeeding at a later stage - as the change from teat to nipple may confuse the child).
A baby who has been forced onto the breast in the early days may refuse to breastfeed for some time.
The baby may have a birth condition such as a cleft palate.
The baby has any condition which requires him to be hospitalised away from his mother.
The baby might have a receding chin which can cause a 'docking' problem.
The mother may be spending feed times away from the baby, whether just for an evening out, or because she's returned to work.
The mother may simply be taking a much-needed rest. This can have the added benefit of giving the father a chance to feed the baby, which is a lovely bonding opportunity.
The mother may be producing more milk than the baby needs, leading to painful swollen breasts - a condition known as engorgement, which can in turn lead to infection. Expressing is the only guaranteed way to remedy this without drying up the milk entirely1.
The mother may have flat or inverted nipples, making it difficult for the baby to 'latch on'. Some babies will be able to cope with this, and after a little perseverance and determined feeding, the nipple can be drawn out. However, for babies without the stamina to do this, the act of expressing may cause these nipples to reshape themselves, allowing natural breastfeeding to begin at a later stage.
The mother may be on a course of medication, which could be passed to the baby through the milk.
The mother may be weaning the baby, and is using breastmilk as an ingredient in preparing first foods.
How it's Done
Breastmilk is expressed manually or by using a pump. There are many tips and techniques relating to expressing, but basically, manual expression begins by massaging the breast to stimulate milk production. Then the aureola surrounding the nipple is squeezed with the fingers, which stimulates further production and milk is produced. Manual expression can be convenient, in that it requires no equipment other than a clean container to catch the EBM. However, many women find it to be slow and messy. The nipple contains not one, but many duct outlets, which means that milk can spray in all directions, so that as much milk drips up the woman’s wrist or squirts in her eye as goes in the bowl!
Breast pumps come in all shapes and sizes. They work by applying a vacuum to a funnel placed over the breast to squeeze the aureola and surrounding flesh. Hand-held, electronic and battery-operated pumps are not expensive and can easily be purchased in large branches of stores such as Mothercare or pharmacists and even supermarkets.
Electric and battery-operated pumps may seem like the easy option, but they can be very noisy and it can be hard to regulate the pressure. Hand-held pumps are quiet and surprisingly efficient, but excessive use can lead to repetitive strain injury. Larger breast pumps, including the robust models used in hospitals, allow both breasts to be expressed at the same time. These are expensive, but can be hired for home use.
EBM can be fed immediately to the child, while still at body temperature. It can also be cooled down and stored in the coldest part of the fridge (usually the back of the bottom shelf) for up to 72 hours. EBM can also be frozen, and kept in the freezer for around three months2. It should always be gently warmed to body temperature before being given to the baby3, and warmed milk cannot be refrozen.
Some women find it very easy to express milk; others find it difficult or even impossible. No woman expresses milk for fun, and in most cases a woman does not wish to feed her baby EBM, but is doing so because it is the only practical route open to her if she wishes her baby - and herself - to receive the benefits of breastfeeding. For a woman in this situation, it is impossible to exaggerate how much difference can be made by the support and understanding of those around her.
Attitudes to Expressing and EBM
People who are supportive of a breastfeeding woman can react negatively to expressing. Even other breastfeeding mothers may recoil. Why? What is it that makes breastfeeding in public acceptable, but almost no-one would express while sitting at a café table? These are some of the reactions received to expressing:
Breastfeeding is a natural process, but expressing is unnatural.
Feeding a baby EBM is far more natural than feeding baby formula through a bottle, but bottle-feeding is thoroughly socially acceptable. Expressing is a natural answer to the situations encountered by a breastfeeding mother, and has been used by women throughout history4 - how is that unnatural?
Why can't you wait till you're in your own home?
As the body produces breastmilk on a demand and supply basis, milk will be produced automatically for the next feed. If the mother isn't there to feed the baby directly and the milk is not removed, the mother risks inflammation and possibly infection, and if the milk is not removed regularly, the body can take this as a sign that the milk is no longer needed, drying up the woman's breastmilk entirely.
If you're back at work, shouldn't you be giving up breastfeeding anyway?
The UK Department of Health recommends that babies are exclusively breastfed for the first four months of life. The World Health Organisation extends this to six months; yet the UK statutory paid maternity leave is only 18 weeks, between one and 11 weeks of which must be taken before the birth of the child. This means that if a mother is to follow recommendations on what is best for her baby, and keep her job and income, expressing is probably the only option.
All that breast massage and gadgetry must be kinky.
Breasts may be secondary sexual organs, but their primary and original purpose is feeding babies. If you find this hard to cope with, that’s your problem, not the mother’s. Expressing breastmilk, whether it involves massaging the breast by hand, or hooking up to a gadget, is not sexually stimulating. Any pleasure or satisfaction derived from it is the fundamental satisfaction of being able to do the best for your baby.
Breast milk is gross - I don’t want to even see it, and you’re not putting bodily fluids in my fridge
Breastmilk just looks like full cream milk - there’s nothing weird about it. As for storing bodily fluids: forget Howard Hughes5: breastmilk may be a bodily fluid, but so is cows' milk, found in most fridges. Expressing mothers are scrupulous about hygiene - you can be assured that the breast milk is probably far more hygienically-produced than other products in the fridge!
Please take a supportive attitude to expressing as the constructive attitudes of a few enlightened people could begin to change the attitudes of others, and make a world of difference to mothers everywhere.