Health-and-Nutrition/C2/Hand-expression-of-breastmilk/English-timed

Time	Narration
00:00	Welcome to the Spoken Tutorial on Hand expression of breastmilk.
00:06	In this tutorial, we will learn- benefits of expressing breastmilk,
00:12	how to express breastmilk by hand and
00:15	how often should a mother express breastmilk.
00:20	Breastmilk expression is useful- to relieve breast engorgement,
00:25	to treat nipple soreness and dry skin on the dark area around the nipple,
00:31	to feed a baby if mother’s sore nipple is extremely painful while latching,
00:38	to increase or maintain mother’s breastmilk supply,
00:42	to keep breastmilk available for a baby when the mother goes out or to work,
00:49	to help a baby to attach to a full breast by softening the dark area around the nipple;
00:57	to check whether the baby has fed from one breast completely before offering the other breast,
01:05	to make nutritious complementary food for a baby by using breastmilk instead of water or cow’s milk,
01:14	and, to help in feeding milk to - premature babies,
01:18	sick babies,
01:20	babies with poor muscle tone,
01:22	babies with cleft lip and/or palate and
01:27	babies who have difficulty in latching deeply to the breast.
01:32	Now, let’s learn how to express breastmilk.
01:37	The most recommended way for a mother to express breastmilk is by using her hand.
01:44	Because this method causes less discomfort to the dark area around the nipple.
01:51	Also, this method needs no appliance. So the mother can do it anywhere and at any time.
02:00	Expressing breastmilk by hand is a learned skill and will improve with practice.
02:08	It is easy to hand express breast milk when the breasts are soft.
02:13	Therefore, a mother should learn this skill on the first or second day after delivery.
02:21	Before expressing breastmilk, mother should have a steel or glass container ready to collect the expressed milk.
02:29	She should choose a cup, glass, jug or jar with a wide mouth.
02:36	She should wash the chosen container in soap and water.
02:41	After that, she should either keep the container in boiling water or pour boiling water into the container and leave it for a few minutes.
02:52	Then, she should either air dry the container completely or wipe it dry with an unused clean cloth.
03:01	The container should never be dried with a used cloth such as a used kitchen cloth.
03:10	After the clean container is dried completely, next step is to release breastmilk from the breast.
03:17	To help her milk flow, the mother should feel relaxed and emotionally connected to her baby.
03:26	Mother can try the following: She can sit quietly and privately or with a supportive friend.
03:34	Some mothers can express easily in a group of other mothers who are also expressing breastmilk.
03:41	She can hold her baby on her lap with skin-to-skin contact.
03:46	Or she can look at her baby or hear her baby’s voice.
03:53	Sometimes even looking at a photograph of her baby or smelling her baby’s clothing helps.
04:00	She can take a warm soothing drink, but the drink should not be coffee, strong tea, alcohol or any stimulant.
04:12	She can also warm her breasts to help her milk flow.
04:17	To warm her breasts, she can apply a cloth soaked in hot water to her breasts or have a warm water bath.
04:28	She can stimulate her nipples and the dark area around them by- gently pulling or rolling them with her fingers.
04:38	She can massage her breasts lightly using circular movements.
04:44	Mother can ask a helper to rub her back.
04:47	For the back rub, the mother should- sit down, lean forward,
04:53	fold her arms on a table in front of her and rest her head on her arms.
05:01	Her breasts should be unclothed and hanging loose.
05:07	The helper should rub down both sides of the mother's spine.
05:12	She should use her closed fist with her thumbs pointing forward.
05:17	She should press firmly, making small circular movements with her thumbs.
05:24	She should work down both sides of the spine at the same time from the neck to the shoulder blades.
05:34	She should do this for two or three minutes.
05:38	All these steps will help in releasing the breastmilk.
05:43	This release of breastmilk is called Oxytocin reflex or let down reflex.
05:51	After the Oxytocin reflex begins, the mother must wash and dry her hands thoroughly.
05:59	Then, the mother should sit comfortably.
06:04	She should lean forward slightly.
06:07	She should hold the container near her breast.
06:11	Now, she should place her thumb and fingers on the breast in a C shape hold from the side.
06:20	She can use either hand for holding either breast. And, she can switch to the other hand when the first one tires.
06:29	While holding the breast, her thumb should be on the upper part of the breast.
06:35	And her fingers should be placed opposite to the thumb on the lower part of the breast.
06:42	Her thumb, nipple and fingers should always be in a straight line.
06:48	And, the nipple should be in the middle of the thumb and the index finger.
06:54	There should be a distance of 2 fingers between- the nipple and her thumb and the nipple and her fingers.
07:04	If the fingers are too close to the nipple, the milk may not flow for long.
07:10	Mother will release more milk when she compresses the milk ducts beneath the dark area around the nipple.
07:19	In this picture, the mother is holding her right breast correctly with her right hand.
07:27	Now, she should press the breast slightly inwards towards the chest wall by applying steady pressure.
07:36	Then, without moving the hand gently compress the breast between the thumb and the fingers.
07:44	And then release the pressure on the breast.
07:48	The mother should repeat these 3 steps- Press back, Compress, And release.
07:56	The first step of pressing back towards the chest wall is an important step.
08:02	Pressing only towards the nipple will give very little milk.
08:07	But when the breast is pressed back, milk from the dense breast tissue is released.
08:15	But, avoid pressing too far back because that can block the milk-ducts.
08:23	When the mother starts expressing breastmilk by hand, very few drops of milk may come out at first.
08:30	As the let down reflex starts, milk starts to drip out.
08:36	In the first few attempts, it is common for the milk to drip out or come slowly.
08:42	Later, breastmilk may flow in streams. As with breastfeeding, expressing breastmilk is a skill that comes with practice.
08:53	Colostrum, the first milk after birth, may only come in drops but is enough for the newborn.
09:01	The thick, often yellow, milk has enormous protective benefits for the baby.
09:08	The mother should repeat the 3 steps until the flow of milk slows down to a drip again.
09:15	Then she should re-position her fingers to express milk from other parts of the breast.
09:23	She can feel for where the breast seems fuller and compress those areas.
09:30	She should express milk from one breast for at least 3 to 5 minutes until the milk flow slows down.
09:38	Then she should express milk from the other breast in the same way from all the areas.
09:45	And then, again express milk from both breasts a second time.
09:51	Expressing breastmilk from both breasts adequately takes 20 to 30 minutes.
09:57	It may take more time, especially in the first few days. As in those days, only a little milk may be produced.
10:07	It is important not to try to express in a shorter time.
10:12	Remember, expressing breastmilk by hand should not hurt. If it hurts, the technique is wrong.
10:21	Breast tissue is delicate.
10:24	Avoid rubbing, sliding or pulling the fingers along the skin, towards the nipple. This can cause breast soreness.
10:36	Avoid tightening or stretching the skin over the dark area around the nipple.
10:42	Also, avoid squeezing or pulling the nipple.
10:46	Pressing or pulling the nipple cannot express enough milk.
10:51	It is the same as the baby sucking only the nipple.
10:57	After expressing breastmilk, the mother should cover the container with a clean cloth or plate.
11:04	Then, she should store her breast milk safely for later use.
11:09	Safe storage of breastmilk and feeding stored breastmilk to the baby are explained in another tutorial.
11:19	Let’s now discuss how often a mother should express milk.
11:24	If the purpose is to initiate and maintain breast milk production Or to feed a low birth weight baby or sick newborn baby, then-
11:35	she should express milk as soon as possible after delivery.
11:40	She may only express a few drops of Colostrum at first.
11:45	This helps breastmilk production to begin.
11:48	It acts similar to a baby suckling soon after delivery.
11:54	The mother should express as much as she can and as often as her baby would breastfeed.
12:02	This should be at least every 2 to 3 hours, including during the night.
12:08	If there are long intervals between expressions, she may not be able to produce enough milk.
12:16	Next, if the purpose is to build up mother’s milk supply and if it seems to be decreasing after a few weeks:
12:25	she should express breastmilk every 1 to 2 hours immediately after breastfeeding the baby and
12:33	if the baby is expected to sleep for more than 3 hours, then she can express in between feeds.
12:42	If the purpose is to relieve symptoms such as engorgement or leaking of breastmilk at work: the mother should express only as much as is necessary.
12:53	If the purpose is to keep nipple skin healthy: the mother should express a small drop of breastmilk to rub on her nipple.
13:02	She should do this after a bath and after breastfeeding.
13:07	If the purpose is to keep milk for her baby while the mother is out at work:
13:14	the mother should express milk while at work to help keep up the supply.
13:20	And, the mother should express breastmilk before going to work and leave it for the carer to give to the baby.
13:29	For doing this - mother can plan few weeks ahead if she has a fridge.
13:34	She can express extra milk and store it for later use.
13:39	Mother can express even after the baby has breastfed.
13:44	Mother should leave about 60 to 90 milliliters of milk for each feed.
13:51	More breastmilk can be given as per baby’s need while mother is away.
13:57	Remember- the more frequent hand expression is used, the easier it becomes to express milk, the faster the milk releases.
14:07	And, the more milk mother will make.
14:11	This brings us to the end of this tutorial. Thank you for joining.

Contributors and Content Editors

Debosmita, PoojaMoolya, Sandhya.np14