 This is another very important session, there are two more important topics which I have I will be discussing, in part one I am going to discuss about how to express breast milk, how to manually express breast milk, how to store that breast milk and how to feed that express breast milk, because many times you know we have this situation where you know mother has to express breast milk, okay. So there is a technique to it and we have created really good tutorials on all three topics, so you will be watching one after another. Understand, I want to discuss one important point over here is that you know I come from, you know my training is in from US actually and I work there in urgent care and we get lot of mothers when they get discharged from the hospital they come to urgent care and what I have experienced that most of these mothers are prescribed breast pumps, okay. Of course many of them they go back to work but even if mothers who are not going back to work within two weeks because in US you know we get maximum of two weeks of maternity leave, we don't get more than two weeks and that's not the case in India you know and especially now during COVID time most of us we do work from home you know we do online thing and I don't see any reason why mothers should be given breast pumps, okay. I am not very, I am not for it, this is because what the experience that I have had in US and not just me like all the doctors we felt that you know mothers were just getting used to pumping the milk and then just feeding the baby through bottle, pumping the milk and feeding the baby through bottle or say nifty cup or any of those right. Now here what was happening that she was not learning the correct method of breastfeeding, she was not learning to latch, she was not learning to position the baby correctly and it kind of became very easy to just put that breast pump and then you know so I feel that we have to be very careful you know in India we don't want to go into that mode where you know every second mother that when I talk to especially in privileged mothers they just get by breast pump left right in center even in fact so many of them are prescribed breast pumps but I don't understand what is the reason I mean you know why why can't we focus on latching and positioning of the baby you know rather than just giving a shortcut I mean breast pump is a shortcut way of removing breast milk and another thing I'm really concerned of and there is a very good scientific study which got published that mothers who breast pump the milk that milk has a different bacteria than the milk which basically baby gets by direct latching okay so you don't want any other bacterias to go into baby's mouth okay so where are those bacteria coming from it's coming from basically pump it's coming from probably bottle it's coming from God knows once you take it out you know all different kind of bacteria as another you know organism kind of start multiplying so just make sure that you know please discourage breast pumps as much as you can there are few conditions where mother may need breast pumps those those are different okay so if suppose baby is admitted in ICU and ICU and mother need to kind of remove although even for those mothers first few weeks excellent study says that manual expression is much better than pump you know so to recommend manual expression very easy there are no complication other complication that I see with breast pumps are you know lot of this mastitis and breast abscess and you know so many other problems that I see sometimes they have nipples sore because the pressure is too high and you know I'm not I'm not for it okay so this is again kind of bringing my experience back from US to India that let's not fall into the trap of getting into breast pump and feeding the baby you know just expressed breast milk through bottle and lipstick cup which is pumped from you know from breast pumps okay so anyway manual expression works as well second tutorial would be on once you remove that milk you know manual express milk how long you can store at room temperature if you have a fridge then how long you can keep it in the fridge different sections so you know if you have a freezer with the same door then there will be different time period that you can keep that breast milk very exactly to keep their breast milk whether on the door or inside a shelf which position so we have gone kind of in detail about how to store their breast milk you know exactly what process to follow and the third tutorial is on basically once you kind of once you're ready to feed that express breast milk how to feed this is another very important experience that I've got from from our NICU where we always kind of used to give you know our babies milk in a cup you know just a regular small medicine cup and we always use to put the rim of the cup on the upper lip okay we never kind of pushed it down on the lower lip and that really improved the intake that improved or that prevented a lot of spillage of milk you know and it also prevented choking episodes okay so make sure that again I have explained very well in that tutorial on how to feed that baby through you know through that Difty cup or whatever that you have you know you we don't have to have any gadgets you know it's just simple spoon is also fine you know simple those medicine cups also fine you know you don't need to spend so much money in buying Difty cup or anything you know so do watch that tutorial also it's you know you will learn a lot so thank you so much welcome to the spoken tutorial on hand expression of breast milk in this tutorial we will learn benefits of expressing breast milk how to express breast milk by hand and how often should a mother express breast milk breast milk expression is useful to relieve breast engorgement to treat nipple soreness and dry skin on the dark area around the nipple to feed a baby if mother's sore nipple is extremely painful while latching to increase or maintain mother's breast milk supply to keep breast milk available for a baby when the mother goes out or to work to help a baby to attach to a full breast by softening the dark area around the nipple to check whether the baby has fed from one breast completely before offering the other breast to make nutritious complementary food for a baby by using breast milk instead of water or cow's milk and to help in feeding milk to premature babies sick babies babies with poor muscle tone babies with cleft lip and or palate and babies who have difficulty in latching deeply to the breast now let's learn how to express breast milk the most recommended way for a mother to express breast milk is by using her hand because this method causes less discomfort to the dark area around the nipple also this method needs no appliance so the mother can do it anywhere and at any time expressing breast milk by hand is a learned skill and will improve with practice it is easy to hand express breast milk when the breasts are soft therefore a mother should learn this skill on the first or second day after delivery before expressing breast milk mother should have a steel or glass container ready to collect the expressed milk she should choose she should choose a cup glass jug or jar with a wide mouth she should wash the chosen container in soap and water 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 then she should either air dry the container completely or wipe it dry with an unused clean cloth the container should never be dried with a used cloth such as a used kitchen cloth after the clean container is dried completely next step is to release breast milk from the breast to help her milk flow the mother should feel relaxed and emotionally connected to her baby mother can try the following she can sit quietly and privately or with a supportive friend some mothers can express easily in a group of other mothers who are also expressing breast milk she can hold her baby on her lap with skin to skin contact or she can look at her baby or hear her baby's voice sometimes even looking at a photograph of her baby or smelling her baby's clothing helps she can take a warm soothing drink but the drink should not be coffee strong tea alcohol or any stimulant she can also warm her breast to help her milk flow to warm her breast she can apply a cloth soaked in hot water to her breast or have a warm water bath she can stimulate her nipples and the dark area around them by gently pulling or rolling them with her fingers she can massage her breast lightly using circular movements mother can ask a helper to rub her back for the back rub the mother should sit down lean forward fold her arms on a table in front of her and rest her head on her arms her breast should be unclothed and hanging loose the helper should rub down both sides of the mother's spine she should use her closed fist with her thumbs pointing forward she should press firmly making small circular movements with her thumbs she should work down both sides of the spine at the same time from the neck to the shoulder blades she should do this for two to three minutes all these steps will help in releasing the breast milk this release of breast milk is called oxytocin reflex or let down reflex after the oxytocin reflex begins the mother must wash and dry her hands thoroughly then the mother should sit comfortably she should lean forward slightly she should hold the container near her breast now she should place her thumb and fingers on the breast in a C shape hold from the side she can use either hand for holding either breast and she can switch to the other hand when the first one tires while holding the breast her thumb should be on the upper part of the breast and her fingers should be placed opposite to the thumb on the lower part of the breast her thumb nipple and fingers should always be in a straight line and the nipple should be in the middle of the thumb and the index finger there should be a distance of two fingers between the nipple and her thumb and the nipple and her fingers if the fingers are too close to the nipple the milk may not flow for long mother will release more milk when she compresses the milk ducts beneath the dark area around the nipple in this picture the mother is holding her right breast correctly with her right hand now she should press the breast slightly inwards towards the chest wall by applying steady pressure then without moving the hand gently compress the breast between the thumb and the fingers and then release the pressure on the breast the mother should repeat these three steps press back compress and release the first step of pressing back towards the chest wall is an important step pressing only towards the nipple will give very little milk but when the breast is pressed back milk from the dense breast tissue is released but avoid pressing too far back because that can block the milk ducts when the mother starts expressing breast milk by hand very few drops of milk may come out at first as the let down reflex starts milk starts to drip out in the first few attempts it is common for the milk to drip out or come slowly later breast milk may flow in streams as with breastfeeding expressing breast milk is a skill that comes with practice colostrum the first milk after birth may only come in drops but is enough for the newborn the thick often yellow milk has enormous protective benefits for the baby the mother should repeat the three steps until the flow of milk slows down to a drip again then she should reposition her fingers to express milk from other parts of the breast she can feel for where the breast seems fuller and compress those areas she should express milk from one breast for at least three to five minutes until the milk flow slows down then she should express milk from the other breast in the same way from all the areas and then again express milk from both breast a second time expressing breast milk from both breast adequately takes 20 to 30 minutes it may take more time especially in the first few days as in those days only a little milk may be produced it is important not to try to express in a shorter time remember expressing breast milk by hand should not hurt if it hurts the technique is wrong breast tissue is delicate avoid rubbing sliding or pulling the fingers along the skin towards the nipple this can cause breast soreness avoid tightening or stretching the skin over the dark area around the nipple also avoid squeezing or pulling the nipple pressing or pulling the nipple cannot express enough milk it is the same as the baby sucking only the nipple after expressing breast milk the mother should cover the container with a clean cloth or plate then she should store her breast milk safely for later use safe storage of breast milk and feeding stored breast milk to the baby are explained in another tutorial let's now discuss how often a mother should express milk if the purpose is to initiate and maintain breast milk production or to feed a low birth weight baby or sick newborn baby then she should express milk as soon as possible after delivery she may only express a few drops of colostrum at first this helps breast milk production to begin it acts similar to a baby suckling soon after delivery the mother should express as much as she can and as often as her baby would breastfeed this should be at least every two to three hours including during the night if there are long intervals between expressions she may not be able to produce enough milk next if the purpose is to build up mother's milk supply and if it seems to be decreasing after a few weeks she should express breast milk every one to two hours immediately after breastfeeding the baby and if the baby is expected to sleep for more than three hours then she can express in between feeds if the purpose is to relieve symptoms such as engorgement or leaking of breast milk at work the mother should express only as much as is necessary if the purpose is to keep nipple skin healthy the mother should express a small drop of breast milk to rub on her nipple she should do this after a bath and after breastfeeding if the purpose is to keep milk for her baby while the mother is out at work the mother should express milk while at work to help keep up the supply and the mother should express breast milk before going to work and leave it for the carer to give to the baby for doing this mother can plan few weeks ahead if she has a fridge she can express extra milk and store it for later use mother can express even after the baby has breast fair mother should leave about 60 to 90 millilitres of milk for each feed more breast milk can be given as per baby's need while mother is away remember the more frequent hand expression is used the easier it becomes to express milk the faster the milk releases and the more milk mother will make this brings us to the end of this tutorial welcome to the spoken tutorial on storage of expressed breast milk in this tutorial we will learn how to store expressed breast milk safely for later use let us begin expressing breast milk has many benefits for the baby and the mother expressing breast milk by hand is explained in another tutorial in the same series expressed breast milk must be handled and stored safely doing so will maintain its high quality for the baby before handling breast milk mother should wash her hands with soap and water and dry them properly to store breast milk mother should use steel or glass wide mouth containers that can be kept covered those steel containers are recommended we will use glass containers in some of the pictures this will help us to clearly see the milk inside the container next the mother should wash the chosen containers in soap and water after that she should keep the containers in boiling water for at least 10 minutes then she should either air dry the containers completely or wipe them dry with an unused clean cloth the containers should never be dried with a used cloth such as a used kitchen cloth after the clean container is dried completely she should pour the expressed milk into the containers mother should store only enough milk for one feeding or about 60 to 90 milliliters of milk in each container if the mother plans to freeze her breast milk she should leave an inch of space at the top of the container because breast milk expands as it freezes she should label each container with the date and time of milk expression then she should store these breast milk filled containers in the coldest possible place if she has a fridge it is best to save the milk there she should store the breast milk in the back of the lowest shelf of the fridge this is the coldest area of a fridge never store the breast milk in the door of a fridge the lower the temperature of storage the longer the storage time breast milk can be stored for up to seven days in a fridge under clean conditions it must be kept cold consistently remember the more often the fridge door is opened the more likely the temperature will rise if the fridge temperature rises during storage time due to a power cut or other reasons then the mother should use the breast milk within six hours if the breast milk is not used within six hours then she should throw it away if the mother doesn't have a fridge then breast milk can be stored up to six hours in a safe cold and dark place in the house if the room is hot she can store the breast milk near an earthen pot filled with cold water or in a vessel filled with cold water fresh breast milk contains infection fighting factors therefore it can stay unspoiled longer than cows milk germs do not start growing in fresh breast milk for at least six hours even in a hot climate and outside the fridge another way to store breast milk outside the fridge is by using a cool bag or box with deep frozen ice packs changed every 24 hours the milk must be protected from the ice packs or it may freeze the cool bag can also be used to carry milk if the breast milk is to be stored for longer than seven days mother should freeze it as soon as possible after expressing milk which is frozen solid in the freezer of a fridge will be good for two weeks milk stored in a separate freezer will be good for three to six months when this previously frozen breast milk is defrosted by keeping it overnight on the lowest shelf of the fridge it should be used within 24 hours and when it is defrosted outside the fridge it should be used within two hours in other tutorials we have explained how to make stored breast milk ready for the baby to drink and how to feed expressed breast milk to the baby this brings us to the end of this tutorial welcome to the spoken tutorial on feeding expressed breast milk to babies in this tutorial we will learn how to make stored breast milk ready for a baby to drink and how to feed expressed breast milk to a baby let us begin expressing breast milk has many benefits for the baby and the mother expressing breast milk and storing it safely are explained in other tutorials now let us learn how to make the stored breast milk ready for the baby to drink before handling breast milk the caregiver must wash their hands with soap and water and dry their hands well remember the oldest stored breast milk should always be used first when using frozen breast milk ideally defrosted by keeping it overnight on the lowest shelf of the fridge and use this defrosted milk within the next 24 hours but if the frozen breast milk is needed quickly defrosted outside the fridge by first keeping it in a container of cold water and then keeping it in a container of lukewarm water while defrosting in lukewarm water shake the breast milk container gently and occasionally do not shake it vigorously and continuously dry the outside of the breast milk container with a clean cloth before use use this defrosted breast milk within two hours and throw away any unused milk defrosted breast milk can smell and taste different than fresh breast milk it is fine as long as the baby accepts it the caregiver must always smell the breast milk before feeding it to the baby if the milk smells sour do not use it please remember when breast milk is stored it will separate with the cream rising to the top this is normal shake gently to mix the cream back in the milk before use to warm the breast milk just before feeding it to the baby keep the breast milk container in a bowl of lukewarm water for 20 to 30 minutes test how warm the milk is by dropping a little onto the wrist it is right when it feels warm do not use hot water to warm the breast milk try to use stored breast milk straight from the fridge this will help to avoid the risk of overheating and burns do not heat breast milk by keeping it directly on a stove or in a microwave direct heat destroys many of the infection fighting factors present in the breast milk when the breast milk is ready offer it to the baby to do so the following utensils can be used a paladai a small cup a spoon or a nifty cup out of these it is preferable to use a spoon or a cup to feed the baby firstly the caregiver must wash the chosen utensil with soap and water and then air dry it completely or wipe it dry with a clean unused cloth then the caregiver must wash and dry their hands properly they should half fill or two thirds fill the chosen utensil with breast milk then they should hold the baby in a nearly upright position on their lap their hand should support the baby's head and neck if they are using a paladai to feed the baby they should position the tip of the paladai inside the corner of the baby's mouth it should be held lightly between the baby's lips the tip of the paladai should lightly touch the baby's upper lip in this position the milk should stay at the rim of the beak of the paladai as the baby slurps milk the caregiver should tilt the paladai slightly to keep the milk at the rim if the caregiver is using a small cup to feed the baby they should hold the cup lightly between the baby's lips the rim of the cup should lightly touch the baby's upper lip they should tilt the cup slightly until the milk reaches the top edge of the cup this should let the baby take the milk from the rim of the cup if the caregiver is using a spoon to feed the baby they should hold the spoon between the baby's lips the edge of the spoon should lightly touch the baby's upper lip then they should tilt the spoon slightly until the milk is at the edge of the spoon feeding with a spoon is good for the first few days after birth because during these days only a small amount of milk is needed if the caregiver is using a nifty cup to feed the baby they should position the small reservoir of the nifty cup just inside the baby's mouth as the baby slurps the milk they should tilt the cup up slightly this will add milk to the reservoir as it empties when feeding expressed breast milk to the baby never pour milk into the baby's mouth this may cause the baby to choke instead keep the milk at the rim and leave it in that position throughout the feed always ensure that the baby is fully awake alert and interested in feeding if needed wrap the baby to prevent her from knocking the cup out of the feeder's hands always let the baby slurp milk at her own pace look for signs which show that the baby has had enough milk signs such as holding her hands up falling asleep or closing her mouth remember do not apply too much pressure on the lower lip of the baby always let the edge of the utensil touch the baby's upper lip lightly do not put the cup paladai or spoon too far inside the baby's mouth never feed a baby in a lying down position do not use a feeding bottle to feed the expressed breast milk to the baby after feeding the baby wash the cup paladai or spoon well with soap and clean water and let it air dry completely some babies are reluctant to take expressed breast milk particularly at first from some people they may be less reluctant when someone else gives it to them if expressed milk is refused by the baby try not to worry on the mother's return from work the baby will make up any missed feeds by breastfeeding more often or for longer remember keep the breast milk safe by washing hands containers and utensils feeding milk as soon as needed or storing it safely this brings us to the end of this tutorial thank you for joining