CLC Hand Expression Competency Questions and Answers

CLC Hand Expression Competency Questions and Answers When should be the first time you express milk? Why? 1 hour following birth; gives you the highest milk volume What is a difference between hand expressed and pumped milk? Hand expression gives more calories and fat than pumped milk. Why is early hand expression beneficial? It increases in energy and fat Why is hand expression the best way to extract milk? It is the cleanest How to hand express is... 1. Wash hands and gather supplies 2. Knead/rub the nipple to stimulate and get horomones flowing. 3. Create 'C' shape with outside hand 4. Squeeze areola on top and bottom 5. Pull back toward chest wall and compress your thumb and finger together gently and rhythmically, mimicking suckling or rolling on the breast. 6. Position container on table if standing and in lap if sitting, aiming spray into container. 7. Repeat in spot until milk slows and then move to another spot. Repeat. 8. Switch breasts and repeat. *Include wait time to allow milk to flow. Is milk a raw food? Yes, it should be handled with care. Should breastmilk be heated? Why? No, if you heat breast milk it should be minimally to preserve immune properties and nutrients. How to prepare formula... 1. Use clean and disinfected bottles/nipples 2. Use filtered/clean water 3. Heat water to "not quite boiling" (158 degrees) to kill bacteria 4. Mix powder with heated water 5. Cool to room temp before feeding into baby 6. If not using right away, refrigerate immediately until feeding. *measure water and formula outside of bottle, bottles aren't always accurate or measurable What kind of container should be used when expressing breastmilk? Larger container should be used for the first few expressions. Can you express milk from both breasts at once? Yes! Use both containers. When expressing breast milk should mom be sliding the fingers along skin? No, just suckling pattern and rolling. What can you do to help with engorgement? Expressing breast milk can help. Putting breasts into warm water will also help release some of the milk before putting baby on. Pumping is not recommended due to too much stimulation causing the possibility of blood in the milk. How can we help a mother rheumatoid arthritis to hand express? This can be very difficult. Medication might be needed to help with pain. Refer to PT or OT to help with motor skills. Neurological deficits might be present as well. How does hand expression impact oxytocin? Baby massage and nipple stretching increase oxytocin. Faster letdown is present if nipple stretching is done. How would you suggest a mother do the return demonstration for hand expression if she is scheduled for a C-section, without risking inducing labor? You can use the knuckle of a finger for mom to demonstrate back to you. Is it a good idea to pump during pregnancy to increase confidence? Increased oxytocin multiple times/day could put mom into early labor. If mom is breastfeeding/pumping throughout pregnancy, the increase in oxytocin is not related to early labor. However, it is not recommended because bradycardia was known to be found in babies. It may reinforce the scarcity of milk, which is not true. Is it normal for a mother's hands to get tired from hand expression? It is not uncommon, but should be discussed. Expressing breastmilk shouldn't be too hard, especially if there is not a motor impairment. When hand expressing milk. does the container need to be sterilized? Does it matter if it is going to be used immediately? If a fragile baby, container should even be single use container. If a baby is completely healthy, using it from the dishwasher is okay too. Why does hand-expressed milk have a higher fat content than pumped milk? Unknown. Maybe coming out faster. Compression pumps have higher fat (more milk); however, we don't have many of those anymore. Why is it best to hand express in the first few days versus using a breast pump? Hand expressed milk (colostrum) was higher in fat, nutrients, and energy than pumped milk. This increases confidence when using smaller containers. All you need is drops in the first few hours. Better messaging to brain with hands than "vacuum cleaner". Cleaner milk compared to pumping. What is the best containers to use to store brest milk? Reusable glass or plastic, hard-sided containers are best. Cap should fit securely as well. Companies with pumps typically have storage items for sale as well. Plastic bags can also be used that are manufactured specifically for storing breastmilk. However, bags can leak and are easily contaminated. How should breastmilk be labeled after expression? At least the date needs to be labeled on breastmilk containers. If baby is in the hospital, breastmilk should have date, patient ID number, unit, and so on. If the baby goes to daycare, name and date should be written. What to do if mom is storing a lot of milk? Storing bags of frozen milk inside a freezer-grade plastic bag to limit contamination. It is also recommended to try multiple methods to find the most affective storing technique. What is advised to storing milk in the hospital setting? Each hospital is different. Some may need the milk frozen; others may request milk not be adjusted at all to preserve all of the components of human milk. Instructions will be given to parents in the hospital. Storage might be recommended to be stored in the small quantities that the baby is being fed. How long can milk be kept refrigerated/frozen? Up to 3 months in a refrigerator freezer Up to 6 months in a deep freezer (-20 degrees F or less) Always place milk away from door or near the fan for it to be frost free and cold. Can you mix refrigerated milk with frozen milk? Yes, small expressions of chilled milk can be added to milk stored in the refrigerator. How should frozen breastmilk be thawed? Thawed in container which it was frozen, ideally in the fridge. You can also run it under lukewarm water or warming a pan of lukewarm water and putting the breastmilk in. Why should a microwave not be used to warm up milk? It has been known to burn babies because of "hot spots". Components of breastmilk can also be damaged. What do you do with thawed breastmilk? Keep it cold before feeding it to baby. Should be used within 24 hours of being defrosted. Do not refreeze the milk. Where can I find good hand expression videos? Global Health Media