Combination feeding: mixing breastfeeding and bottle feeding
Many families find that a combination of breastfeeding and bottle feeding works well for them. One practical way to do this is by expressing breast milk so your baby can receive the benefits of your milk even when you are not there to feed directly, or so that another caregiver can share feeds. This article explains why parents express, how to do it safely, and how to store and use expressed milk, drawing on NHS guidance.
Why parents choose to express
Expressing breast milk is the process of squeezing milk from your breast so it can be stored and given to your baby by bottle later. There are several reasons you might choose to do this alongside direct breastfeeding:
- Time apart from your baby. If your baby is in special care, or you are returning to work, expressing means your baby can continue to receive breast milk while you are separated.
- Uncomfortable fullness. If your breasts feel overfull or engorged, expressing can provide relief.
- Latch or sucking difficulties. If your baby is finding it hard to latch or suck at the breast, expressing allows you to still offer them your milk by bottle.
- Sharing the feeding. Expressing gives your partner or another caregiver the opportunity to feed your baby, which can be a meaningful way to involve them in caring for your newborn.
- Supporting your milk supply. Regular expressing can help to maintain or increase the amount of milk your body produces.
How to express by hand
Hand expression requires no special equipment beyond clean hands and a sterilised container, which makes it particularly useful in the early days and weeks. Some parents find it the easiest approach at this stage.
- Wash your hands thoroughly with soap and warm water before you begin.
- Prepare a sterilised container to catch the milk. Hold it just below your breast as you express.
- Gently massage your breast before starting if you find that helps your milk begin to flow.
- Cup your breast with one hand. With your other hand, form a C-shape with your forefinger and thumb, keeping them a few centimetres back from your nipple and just outside the darker area of skin around it (the areola). Do not place your fingers on the nipple itself.
- Squeeze gently and release, building a steady rhythm. Avoid sliding your fingers across the skin. Drops should appear first, followed by a more steady flow.
- Move your fingers to a different area of your breast when the flow slows, then swap to the other breast. Continue alternating until the milk slows to a drip or stops.
Hand expression should not be painful. If it is, adjust your finger position and make sure you are not squeezing the nipple itself. Your midwife or health visitor can show you the technique in person if you would like guidance.
Using a breast pump
If you prefer to use a pump, there are two main types: manual and electric. Manual pumps are generally less expensive, while electric pumps tend to be faster. Electric pumps can often be hired rather than bought, and your midwife, health visitor or a local breastfeeding supporter can point you toward hire services in your area.
A few important things to keep in mind when using a pump:
- Start with low suction and increase gradually. Going straight to a high setting can cause pain or damage to the nipple.
- Check the funnel size. Most pumps come with different funnel sizes to fit different nipple sizes. The pump should not cause bruising or catch the nipple uncomfortably as it draws into the funnel.
- Sterilise everything before each use. Both the pump parts and any container you use to collect milk should be clean and sterilised.
It can take a little time for your milk to flow when you first start expressing, whether by hand or pump. Trying when you feel relaxed, keeping your baby close (or looking at a photo of them), and placing a warm towel over your breasts beforehand can all help.
Storing expressed breast milk safely
Expressed breast milk can be stored in a sterilised container or in breast milk storage bags. How long it stays safe depends on how it is stored:
- In the fridge (4°C or lower): up to 8 days. If you are not sure your fridge reaches 4°C, or if it runs a little warmer, use the milk within 3 days to be safe. A fridge thermometer can help you check.
- In the ice compartment of a fridge-freezer: up to 2 weeks.
- In a freezer (-18°C or lower): up to 6 months.
- In a cool bag with ice packs: up to 24 hours, if the milk has already been chilled in the fridge.
Store milk in small amounts. This reduces waste because once a feed has been started any leftover milk needs to be thrown away. If you are freezing milk, label and date each container so you can use older stock first.
Defrosting and warming expressed milk
The safest way to defrost frozen breast milk is to move it into the fridge and allow it to thaw slowly overnight. If you need it quickly, you can place the sealed container in a jug of warm water or hold it under warm running water until it has thawed.
Once defrosted, give the milk a gentle shake if it has separated into layers. Use it straight away. Do not refreeze milk that has already been defrosted.
To warm refrigerated milk, you can place the bottle in a jug of warm water or hold it under warm running water until it reaches a comfortable temperature. Some babies are happy to take milk straight from the fridge; either approach is fine.
Never use a microwave to heat or defrost breast milk. Microwaves heat unevenly and can create hot spots in the liquid that are not visible but can burn your baby's mouth.
Once your baby has started drinking from a bottle of expressed breast milk, use the remainder within 1 hour and discard anything left after that.
If expressing is not going well
Some parents find expressing straightforward; others need time and support before it becomes comfortable. If you are struggling, you do not need to work it out alone. Your midwife, health visitor or a local breastfeeding supporter can help with technique, equipment choice and any physical difficulties. The National Breastfeeding Helpline is available 24 hours a day on 0300 100 0212 and can offer guidance at any time.
If your baby is premature or unwell and in hospital, the ward staff will be able to give you specific advice about expressing and storing milk for your baby's particular needs.
Frequently asked questions
Why would I want to express breast milk?
There are several reasons parents choose to express: being apart from their baby (such as returning to work or a baby in special care), dealing with breast engorgement, a baby who struggles to latch, wanting a partner to help with feeding, or wanting to maintain or boost milk supply.
How long can expressed breast milk be stored in the fridge?
Expressed breast milk can be kept in the fridge for up to 8 days at 4°C or lower. If you are unsure whether your fridge reaches that temperature, or if it runs slightly warmer, use the milk within 3 days.
Can I freeze expressed breast milk?
Yes. Expressed breast milk can be stored in a freezer at -18°C or lower for up to 6 months. In the ice compartment of a fridge-freezer it keeps for up to 2 weeks. Always label and date it before freezing, and store in small amounts to reduce waste.
How should I warm expressed breast milk?
You can offer it cold straight from the fridge if your baby is willing. To warm it, place the bottle in a jug of warm water or hold it under warm running water. Do not use a microwave, as microwaves create hot spots that may burn your baby's mouth.
What should I do if I find expressing difficult?
Speak to your midwife, health visitor or a breastfeeding supporter. You can also call the National Breastfeeding Helpline 24 hours a day on 0300 100 0212. Support is available and most difficulties can be resolved with the right guidance.
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