The Star Online

Sunday March 7, 2004

How to express successfully
By Tee Shiao Eek

THE World Health Organisation recommends that mothers breastfeed exclusively for four to six months, and continue breastfeeding until children are aged two and beyond. In the modern double-income family, mum would likely have to return to work after the standard maternity leave of two months. For most mothers, bringing the baby to work is not an option, so the best way to continue breastfeeding baby is to express milk at the workplace.

“Mothers should breastfeed baby exclusively for the first six weeks. Then two weeks before she starts work, she should start expressing her milk,” says paediatrician and lactation consultant, Dr Koe Swee Lee.

During these two weeks, mums can express following a fixed schedule (refer to table). According to Dr Koe, who is also Chairman of the Sub-Committee on Breastfeeding, Malaysian Paediatric Association, the idea of this schedule is to replace some of the feeds with the expressed breast milk, so that baby will get used to feeding from the bottle, and mum will get used to expressing her milk. By the time mum returns to work, she will have “trained” her breasts to produce milk at specific times.

The two-week programme also gives mum a chance to build up a temporary supply of milk to be given to her baby in the first week she returns to work. Mum can continue breastfeeding and expressing at the usual times on weekends and holidays.

Although breast pumps are sometimes preferred for expressing, it is not a necessity as some mothers find hand-expressing just as easy and comfortable. When choosing a pump, Dr Koe offers this advice: “(Preferably) you should go for an electric pump, one that won’t hurt the nipple, is portable and is easily cleanable.”

When expressing milk, mum should first pump for seven minutes on each breast. Then comes the MSS technique, which consists of Massaging the breast with the flat of the hand, Stroking gently using the fingernails, then Shaking by leaning forward and jiggling the breast. After that, mum can pump again for another seven minutes on each side.

“MSS stimulates a let-down, which is the act of the breast ejecting milk. When baby suckles at mum’s breast, two hormones are produced by the brain – prolactin (which tells the breast to make milk) and oxytocin (which tells the breast to eject milk),” explains Dr Koe.

Initially, mum may only be able to express about 15ml of milk. Eventually, she will be able to produce about 60-90ml each time. Expressed milk can be stored in sterilised bottles or containers. “Mum can also use clean (food-grade) plastic bags, tie them up and write the date on the front. She can then put the bag in a container and freeze or chill it,” says Dr Koe.

The milk can be stored in a refrigerator, or a cooler box with Ice packs. Breast milk can be kept for two days in the refrigerator, three months in the freezer and six hours at room temperature. Storage can be trickier if mum is travelling or frequently mobile. However, mothers have proven to be very imaginative in desperate situations. There is the story of a mother who was frantic when she could not find a refrigerator in her hotel, and ended up storing her milk in the freezer of an ice-cream restaurant!