I was going through my archives of pedcasts the other day and I came across a gem–an interview pedcast with one of my excellent pediatric nurse practitioners, Anne Gessner. Anne is not only a great nurse practitioner but also a certified lactation expert with a lot of experience. She and I talked about various issues surrounding breast milk and I would like to summarize the excellent information that she gave my listeners and I. If you are looking for practical advice about production, storage, and use of breast milk, you’ve come to the right place.
Breast Pumps 101
First, let’s talk about breast pumps. The fact is, many mothers don’t need one. Most babies are excellent at nursing and getting the nutrition they need unless they are born prematurely, are sick just after birth, or have other special health conditions like a neurologic condition, motor difficulties with sucking, or a structural problem like cleft lip, which can be treated with cleft lip surgery. Certainly for these families, a breast pump is essential equipment. There are also other situations where a breast pump is great to have. For instance, if Mom expects short periods of separation from her baby on a very intermittent basis, an inexpensive hand pump may be adequate. This type of pump is slow and tiring to use, but can get the job done for very occasional use. The nice thing about a hand breast pump is that they are very inexpensive. If Mom is going to be away from her baby for longer periods of time however, perhaps working outside the home, Anne and I recommend that you invest in an electric, double pump, manufactured by a quality company that has been in the business for a long time. These pumps will cost $200-$300 dollars, but they are well built, durable, and will hold up for the long haul. Remember, this little pump is going to get a lot of use. For those families that find themselves with a baby who is not a very good feeder like a premature baby, a hospital grade double electric pump may be needed. These pumps are very expensive, costing around $2000 but fortunately they can be rented. These pumps are excellent and worth the rental fee. And remember, under the Obamacare law, insurance companies are required to cover the cost of a breast pump. Take advantage of that opportunity if you think it will help you be successful breastfeeding.
Handling Breast Milk
Ok, now that you have mastered the pumping process, you need to learn how to handle and store breast milk so that your baby gets the maximum benefits of this wonderful food.
Remember, breast milk is a powerful substance that has living cells that actually is capable of cleaning itself and maintaining its power and cleanliness. If some bacteria starts to grow in expressed milk, the milk actually protects itself from spoiling. Amazing. Storing it properly is not only a safety issue but is an attempt to preserve the good stuff that is in milk, the antibodies and living part of breast milk. While the data can sometimes be confusing, here is the consensus among experts at the American Academy of Pediatrics and the La Leche League with regards to the shelf life of expressed breast milk. Pumped breast milk that is kept at room temperature should be consumed in 3-7 hours. If the milk has been stored in the refrigerator, it should be used within 3-7 days, and if it has been frozen since production, it should be given to your baby within 6-12 months. An easy way to remember these times is the rule of 5s. Fresh breast milk, kept at room temperature, should be consumed within 5 hours, milk that has been cooled in the frig should be consumed within 5 days, and frozen breast milk should be used within 5 months. Thawed frozen or warmed refrigerated breast milk should be consumed within an hour of warming.
Storage of Breast Milk
You may be wondering what is the best kind of container to store expressed milk in. Your choices are bottles or plastic disposable liners made of plastic. I think there is not doubt, a glass container is the best since it is inert and will not change the milk in anyway– but they break if you drop them. You may have heard about the chemical BPA (bisphenol-A). Many people feel that this chemical that can come out of some plastics can be harmful so in 2012, the FDA banned their use in baby bottles and sippy cups. Avoid all plastic food containers that bear the number 7 inside a triangle on the outside of the container. These contain BPA. Most plastic liners are BPA free now but not all, make sure you check before using them. When you make up your containers to store them, leave a little air at the top so that the milk can expand if frozen, store in 4 ounce quantities, and and label each with a date and time so you know which milk to use first. As you pull them out of the freezer or the frig, use the oldest first for obvious reasons. Babies can drink milk either cold or warm but most people prefer to warm it. Putting the milk in low temperature warm water and swirling occasionally will do the trick. Never, microwave milk however. Not only does this have the potential of damaging the milk, but there are many cases of serious scalding of babies because the microwave can heat the milk of unevenly.
Finally, there are a few more things you need to know about handling breast milk. Cleanliness, is important. Your hands need to be very clean when handling everything about breast milk. The pump parts can be washed in the dishwasher. the tubing can be cleaned in warm soapy water but should be dried so that mold will not develop inside the tubing. This can be done by blowing air through the tubing. Some moms are surprised that freshly expressed breast milk can be different colors at different times depending on mom’s intake of foods or vitamins. Pink or bluish are not uncommon. Don’t worry about this–it’s OK. And that cream layer, it can separate easily. Just shake it put the fat back into the milk.
So, to summarize, breast milk is a powerful wonderful substance that is far superior to infant formula. It needs to be collected and handled carefully but it is actually pretty hardy, rarely going bad. Remember the rule of 5’s, 5 hours good at room temp, 5 days good in the refrigerator, and 5 months storage life in the freezer. And finally, if you plan to be away from your baby for long periods of time, get a good electric breast pump and keep the milk coming.
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