Stimulation of Breast Milk Supply

Why is it beneficial to stimulate breast milk production/express breast milk at an early stage?

Hours after childbirth, the levels of the breastfeeding hormones oxytocin and prolactin are particularly high. By stimulating breast milk production/expressing breast milk as early as possible after delivery, preferably within the first one to two hours, you can take advantage of the high hormone levels, which will result in faster and greater milk production. However, if this is not possible, it is never too late to start.

We refer to it both as breast milk stimulation and expression because it is common for no milk to come at all or only a few drops on the first few occasions. This is perfectly normal and continued breast milk stimulation/expression will gradually, within a few days, initiate milk production and will cause the volume of breast milk to increase.

Every drop is precious and should be given to your baby as soon as possible

Giving a small amount of colostrum/first milk to the baby will activate and strengthen its immune system and can reduce the risk of infection. Most babies can start taking colostrum as soon as possible after birth, preferably within the baby's first few hours of life and then you can continue to give it some a few times a day.

How to go about it?

As soon as drops of colostrum start to be produced, if possible they should be administered directly onto the mucus membranes of the baby's cheek where protective factors that stimulate the immune system can be absorbed via the cheek mucosa. This can be done by the parent with support from the staff.

When and how?

Stimulate the breasts/express breast milk about 8 times a day to initiate and then maintain milk production. We also encourage breast milk stimulation/expression at some point during the night to stimulate continued high levels of the lactogenic hormone prolactin.

In the beginning, only a few drops of colostrum will usually be secreted, but with continued and repeated breast milk stimulation/expression, breast milk production will increase more quickly and a greater quantity of breast milk will be produced. The number of times per day that breast milk expression occurs is more important than the number of minutes per occasion. If possible, sit next to your baby, skin-to-skin, or close to the baby while you are expressing breast milk as it may increase the release of oxytocin, the hormone that affects the ejection reflex and ensures that breast milk starts to flow. If it is not possible to be near your baby, the ejection reflex can be stimulated by smelling something that has the baby's scent on it, such as a comfort blanket.

In order to create optimum conditions, it can be beneficial to try to get some time to rest, drink, eat and have sufficient pain relief.

Which methods can you use – expressing breast milk by hand or using a breast pump?

On the first occasion or first few occasions, it can often be easier to stimulate the breasts/express milk by hand, which can also make it easier to increase the amount of colostrum that is secreted. For example, if you have recently undergone a caesarean section or have pain in the abdomen after childbirth, it can sometimes be difficult to find a comfortable position in which to use a breast pump. Many women choose to use a breast pump at a later stage, as it is often considered to be useful if you need to express milk for a longer period of time.

Hand hygiene

Good hand hygiene is important before and after breast milk stimulation/expression, regardless of the method used. Use soap and water, then clean your hands with hand disinfectant and allow them to dry before expressing breast milk.

Expressing milk by hand

Techniques and tips on how to express by hand

If possible, sit close to your baby, preferably skin to skin.
A few minutes before breast milk stimulation/expression, lightly stroke your breast from the chest out towards the nipple.
Make a C-shape with your fingers and place them near the areola but not on it. Move your fingers, maintaining the C-shaped grip, back towards the chest, then press your fingers together and move them forward towards the nipple.
Continue to repeat point 3 in a rhythmic manner, keeping your hand relaxed. Move your fingers around the areola to stimulate the entire breast. Stimulate each breast for 5 minutes and repeat several times. Switch breasts when the milk stops flowing. It can take several minutes/attempts before the milk starts to appear, which can seem like a long time. Have patience and continue to stimulate the breast.


Photo: Sandra Hegestrand
Photo: Sandra Hegestrand


Expressing breast milk using an electric pump

You can choose to double-pump your breasts or pump one breast at a time. The advantages of double pumping are that you save time, and more hormones are released that can stimulate an increase in the volume of milk. Try it out and see what feels best for you.

Choose a breast pump flange that fits your breast so that your nipple in the middle of the flange can move freely back and forth without rubbing against the inside of the flange.

Correct fit - the nipple is centered and moves freely
Too small
Too big
  1. Moisten the edge of the flange with water, to create an air seal.
  2. Start the pump and increase the vacuum pressure until you feel a powerful suctioning sensation, then lower the vacuum pressure until it feels comfortable. You should not feel any pain when using a breast pump!
  3. The breast pumps available on the ward have two different programmes, one is called Initiera (Initiate) and the other Upprätthålla (Maintain).

Depending on the programme being used, the expression of breast milk is carried out as follows:

Initiera (Initiate)

When using the Initiate programme, double pumping is recommended. You start the breast pump by pressing the start button on the left – then immediately press the button with the drops symbol on it. A drop symbol will be visible on the display when the programme starts, set the vacuum pressure to a moderate level.

The breast pump automatically switches off after 15 minutes. If you have pumped 20ml of milk three times in succession or after the first five days, switch to using the Maintain programme, see below.

Upprätthålla (Maintain)

Start the pump using the start button on the left, the pump will start and there will be three drop symbols visible on the display. Set the vacuum pressure to a moderate level. The "stimulation phase" will run for two minutes and then it will automatically switch to the "extraction phase". You can also switch manually between the phases by pressing the button with the drop symbol on the right if milk starts flowing before the two minutes are up. Before breast milk production has been established, it is usually sufficient to use the pump for about 5-15 minutes on each breast. Once breast milk production is established, you can express milk for as long as it continues to be secreted, about 15-(30) minutes per breast or for as long as it suits you.

Cleaning the breast pump

The pump parts will be replaced once a day while your baby is being cared for at the hospital. The pump must then be disassembled, and the parts rinsed with cold water first, then with warm water and then with cold water again. The parts should be air-dried and stored on a clean surface in the baby's room. At home, the pump parts can be used for a longer period of time and must then be boiled once a day in addition to other cleaning measures.

If you have any questions – do not hesitate to ask a member of staff