Health-and-Nutrition/C2/Hand-expression-of-breastmilk/English
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Slide Number 1
Title Slide |
Welcome to the Spoken Tutorial on hand expression of breastmilk. |
Image: Woman feeding breastmilk to a baby from a cup
GIF: Mother expressing breastmilk with her hand. Image: Multiple pictures of mother expressing breastmilk |
In this tutorial we will learn,
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Image: Mother is expressing her breastmilk by hand.
GIF: Mother expressing breastmilk Image: Mother with engorged breasts. |
Breastmilk expression is useful to:
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Image: Dry, sore and cracked nipples.
Image: Sore and cracked nipple |
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Image: Mother in pain
Image: sore nipple |
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GIF: Mother’s breastmilk supply increasing |
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Image: Working mother |
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Image: Full breast Image: Baby trying to attach to a full breast |
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Image: Foremilk. Image: Hindmilk. Image: Mother breastfeeding from right breast Image: Mother offering left breast to the baby. Image: Empty breast and breast full of milk. |
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Image: Bowl of complementary food with water added to it.
Image: Bowl of complementary food with breastmilk added to it. Image: More than sign. (>) |
To make nutritious complementary food for a baby by -
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Image: Premature baby
Image: Sick baby Image: Baby with poor muscle tone Image: Baby with cleft lip Image: Baby with cleft palate Image: Baby is unable to latch deeply to the breast |
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GIF: Mother expressing breastmilk | Now, let’s learn how to express breastmilk. |
Image: Mother expressing breastmilk by hand | The most recommended way for a mother to express breastmilk is by using her hand. |
Image: Red nipple and areola after expressing breastmilk | Because this method causes less discomfort to the dark area around the nipple. |
Image: breast pump |
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Image: Mother is practising expression of breastmilk. | Expressing breastmilk by hand is a learned skill and will improve with practice. |
Image: Soft breasts. | It is easy to hand express breast milk when the breasts are soft. |
Image: 1st and 2nd day after delivery.
Image: Calendar |
Therefore, a mother should learn this skill on the first or second day after delivery. |
Image: Wide mouth steel container Image: Wide mouth glass container |
Before expressing breastmilk,
Mother should have a steel or glass container ready to collect the expressed milk. |
Image: Wide mouth cup
Image: Wide mouth glass Image: Wide mouth jug Image: Wide mouth jar |
She should choose a cup, glass, jug or jar with a wide mouth. |
Image: Mother is washing a wide mouth cup with soap and water | She should wash the chosen container with soap and water. |
Image: Cup is kept in boiling water
Image: Mother is pouring boiling water in the container Image: Clock showing 10 minutes |
After that, she should either -
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Image: Cup is air-dried completely | Then, she should either
The container should never be dried with a used cloth such as a used kitchen cloth. |
Image: Inside of the breast showing breastmilk release from the tissues in the ducts | After the clean container is dried completely, next step is to -
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Image: Mother is relaxing with the baby | To help her milk flow, the mother should feel relaxed and emotionally connected to her baby. |
Image: Mother is sitting quietly and privately
Image: Mother is sitting with a supportive friend |
Mother can try the following:
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Image: Mother is sitting with other mothers. |
Some mothers can -
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Image: Skin-to-skin contact between mother and child |
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Image: Mother is looking at the baby
Image: Mother is listening to the baby’s voice. Image: Mother is listening to her baby’s voice on phone. |
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Image: Mother is looking at baby’s photograph
Image: Mother is smelling baby’s blanket and clothing |
Sometimes-
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Image: Mother is drinking a hot drink from a cup
Image: Tea Image: coffee Image: alcohol |
She can take a warm soothing drink, but -
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Image: Mother is applying warm compress on breasts
Image: Mother is taking a warm water bath |
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Image: Mother is gently pulling or rolling her nipple and areola | She can stimulate her nipples and the dark area around them by-
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Image: Mother is massaging her breasts using circular movements | She can massage her breasts lightly using circular movements. |
Image: Helper is rubbing mother’s back | Mother can ask a helper to rub her back. |
Image: Mother is sitting. Helper is standing close to her.
Image: Mother is leaning forward. Helper is standing close to her. Image: Mother has folded her arms on a table in front of her. Her head is on her arms. |
For the back rub, the mother should-
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Image: Mother’s breasts are unclothed and hanging loose | Her breasts should be unclothed and hanging loose. |
Image: Helper is rubbing down both sides of mother’s spine. | The helper should rub down both sides of the mother's spine. |
Image: Helper’s fist is closed with thumbs pointing forward. | She should use her closed fist with her thumbs pointing forward. |
GIF: Helper massaging mother’s back | She should press firmly making small circular movements with her thumbs. |
GIF: Helper is massaging mother’s back.
Image: 2-3 minutes clock |
She should -
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Image: Oxytocin reflex | All these steps will help in releasing the breastmilk.
This release of breastmilk is called Oxytocin reflex or let down reflex. |
Image: Mother washing her hands.
Image: Mother showing her dry and clean hands. |
After the Oxytocin reflex begins, the mother must wash and dry her hands thoroughly. |
Image: Mother is sitting comfortably | Then, the mother should sit comfortably. |
Image: Mother is leaning forward slightly | She should lean forward slightly. |
Image: Mother is holding the container with her left hand near her right breast | She should hold the container near her breast. |
Image: Mother has placed her right thumb and fingers on her right breast in a C shape hold from the side.
Image: C shape hold |
Now, she should place her thumb and fingers on the breast in a C shape hold from the side. |
Image: Mother is using left hand to hold her right breast in C shape hold.
Image: Mother is using her right hand to hold her left breast in C shape hold Image: Mother switches from her right to her left for holding her right breast in C shape hold. |
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Image: Highlight mother’s right thumb on the upper part of the right breast | While holding the breast, her thumb should be on the upper part of the breast. |
Image: Highlight mother’s fingers on the lower part of the breast | And her fingers should be placed opposite to the thumb on the lower part of the breast. |
Image: Mother’s right thumb, nipple and fingers are in a straight line. Nipple is in the centre. | Her thumb, nipple and fingers should always be in a straight line. |
Image: Nipple is in the middle of the thumb and the index finger | And the nipple should be in the middle of the thumb and the index finger. |
Image: Distance of 2 fingers between the nipple and her thumb
Image: Distance of 2 fingers between nipple and mother’s fingers |
There should be a distance of 2 fingers between-
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Image: Mother’s thumb and fingers very close to the nipple and pinching it. Very less milk is coming out. | If the fingers are too close to the nipple, the milk may not flow for long. |
Image: Mother’s thumb and fingers are at a distance of 2 fingers from the nipple.
Image: More milk is coming out from the milk ducts beneath the areola. Image: Milk flowing inside the breast. |
Mother will release more milk when-
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Image: Mother is holding her right breast in a C shape hold with her right hand | In this picture, the mother is holding her right breast correctly with her right hand. |
Image: Mother is pressing the breast slightly inwards towards her chest wall by applying steady pressure. | Now, she should -
Press the breast slightly inwards towards the chest wall by applying steady pressure. |
Image: In that pressed position, without moving the hand, mother is gently compressing the breast between the thumb and fingers. | Then, without moving the hand -
gently compress the breast between the thumb and the fingers. |
Image: Mother releases the pressure on the breast and comes to the starting position. | And then, release the pressure on the breast. |
Image: All 3 steps together
GIF: Mother is expressing breastmilk in these 3 steps |
The mother should repeat these 3 steps-
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GIF: Mother is pressing the breast slightly inwards towards the chest wall | The first step of pressing back towards the chest wall is an important step. |
GIF: Mother is pressing towards the nipple and very little milk is released. | Pressing only towards the nipple will give very little milk. |
GIF: Correct expression technique and more milk is released. | But when the breast is pressed back, milk from the dense breast tissue is released. |
GIF: Mother is pressing too far back and too hard
Image: Blocked milk ducts |
But, avoid pressing too far back, because that can block the milk ducts. |
GIF: Mother is expressing milk the right way but only a few drops come out. | When the mother starts expressing breastmilk by hand -
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Image: Let down reflex
Image: Mother is still expressing breast milk and milk is dripping out. |
As the let down reflex starts, milk starts to drip out. |
GIF: Mother is expressing breastmilk and milk is dripping out slowly
GIF: Mother is expressing milk and milk flows in streams Image: Mother’s confidence increases when she breastfeeds for a long time. Image: Mother’s confident increases when she expresses breastmilk for a few days. |
In the first few attempts, it is common for the milk to drip out or come slowly.
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Image: Few drops of colostrum coming out of mother’s breast when she is expressing breastmilk
Image: Colostrum protects the baby from diseases |
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Image: Step 1 of hand expression. Mother is pushing her breast back towards the chest.
Image: Step 2 of hand expression. Mother is pressing the breast. Image: Step 3 of hand expression. Mother has released the pressure. Image: Breastmilk flows in a drip |
The mother should repeat the 3 steps until the flow of milk slows down to a drip again. |
Image: Mother is holding the breast in U shape hold
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Then, she should reposition her fingers to express milk from other parts of the breast. |
Image: Mother checking the breast for fullness and compressing. | She can feel for where the breast seems fuller, and compress those areas. |
Image: Clock 3-5 minutes
Image: Milk flow slows down |
She should express milk from one breast for -
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Image: Mother is expressing milk from the other breast | Then, she should express milk from the other breast in the same way from all the areas. |
Image: Mother is expressing milk from both breasts again | And then again express milk from both breasts a second time. |
Image: clock showing 20-30 minutes
Image: clock showing 45 mins Image: Expression in first few days Image: 5-10 minutes clock |
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Image: Mother is feeling the pain while expressing milk
Image: Cross mark |
Remember,
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Image: Breast tissue
Image: Mother is rubbing fingers towards nipple. Image: Sliding Image: Pulling Image: Breast soreness |
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Image: Tightening or stretching the skin over areola | Avoid tightening or stretching the skin over the dark area around the nipple. |
Image: Pulling the nipple
Image: Less milk comes out when mother presses the nipple Image: Baby is nipple-feeding |
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Image: Container covered with cloth
Image: Container covered with plate |
After expressing breastmilk -
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Image: Container is stored safely in fridge | Then, she should store her breastmilk safely for later use. |
Image: Container is stored safely in the room |
are explained in another tutorial. |
Image: Mother expressing breastmilk multiple times in a day | Let’s now discuss how often a mother should express milk. |
Image: Initiating and maintaining breastmilk production
Image: Milk supply in a container Image: Low birth weight baby Image: Sick newborn baby Image: Mother is expressing breastmilk within 6 hours after delivery |
She should express milk as soon as possible after delivery. |
Image: Mother is expressing few drops of colostrum
Image: Breastmilk production begins Image: Baby breastfeeding in the delivery room in laid back hold. |
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Image: Mother is expressing breastmilk as often as baby breastfeeds
Image: Mother is expressing breastmilk every 3 hours for 24 hours Image: Mother is expressing breastmilk after 3 hours. Breastmilk output is low. |
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Image: Mother’s milk supply is increasing from 350ml to 850ml. Mother is happy.
Image: Mother’s milk supply is low 350ml. She is sad. Image: Mother is breastfeeding the baby every 1-2 hours. Image: Immediately after breastfeeding, mother is expressing breastmilk. Image: Baby is sleeping for more than 3 hours. Image: Mother is expressing milk between 2 breastfeeding sessions. |
Next, if the purpose is to build up mother’s milk supply -
And if it seems to be decreasing after a few weeks:
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Image: Breast engorgement
Image: Leaking of breastmilk at work Image: Mother expressing breastmilk Image: Mother gets relief from breast engorgement Image: Leaking of breastmilk at work stops |
If the purpose is to relieve symptoms such as engorgement, or leaking of breastmilk at work:
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Image: Mother is expressing a small drop of breastmilk.
Image: Mother is rubbing the small drop of breastmilk on her nipple. Image: Mother is bathing. Image: Mother is breastfeeding. |
If the purpose is to keep nipple skin healthy:
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Image: Mother is working
Image: Father is feeding milk to the baby from a small cup Image: Mother is expressing milk at work Image: Mother is expressing milk at home Image: Mother gives the expressed milk to father who is holding the baby |
If the purpose is to keep milk for her baby while the mother is out at work:
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Image: Refrigerator
Image: Expressed breastmilk stored in fridge Image: Mother is expressing breastmilk after feeding the baby Image: 60-90 ml expressed breastmilk Image: Father is adding more milk than 90 ml to the container for feeding the baby Image: Mother is at work |
For doing this -
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Image: Mother is expressing breastmilk more often
Image: Mother is comfortable while expressing Image: Milk is flowing from the tissues to the milk ducts beneath areola Image: Mother is producing more milk 750 ml |
Remember,
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Slide Number 2
Acknowledgement |
This brings us to the end of this tutorial.
Thank you for joining. |