Secction 6: Breastmilk collection and storage Flashcards
1
Q
BREAST MILK STORAGE GUIDELINES
Freshly Expressed or Pumped
A
- Countertop: up to 4 hrs
- Fridge: up to 4 days
- Freezer: within 6mo is best, up to 12mo acceptable
2
Q
BREAST MILK STORAGE GUIDELINES
Thawed, previously frozen
A
- Countertop: 1-2 hrs
- Fridge: up to 1 day
- Freezer: NEVER refreeze
3
Q
BREAST MILK STORAGE GUIDELINES
Left over from a feeding
A
Use within 2 hours after the baby is finished feeding
4
Q
Before expressing or handling breast milk:
A
- Wash your hands well with soap and water.
- ABHR if soap and water not available (at least 60% alcohol).
5
Q
To store breast milk, use
A
- breast milk storage bags or clean food-grade containers with tight fitting lids made of glass or plastic
6
Q
When storing breast milk, avoid what type of bottles?
A
- bottles with the recycle symbol number 7
- ndicates that the container may be made of a BPA-containing plastic.
7
Q
Never store breast milk in
A
disposable bottle liners or plastic bags that are not intended for storing breast milk.
8
Q
Freshly expressed or pumped milk can be stored in the fridge for
A
- up to 4 days
9
Q
Freshly expressed or pumped milk can be stored at room temperature for
A
- up to 4 hours.
10
Q
Labelling breast milk
A
Clearly label the breast milk with the date it was expressed.
11
Q
Do not store breast milk where?
A
- Do not store breast milk in the door of the refrigerator or freezer.
- This will help protect the breast milk from temperature changes from the door opening and closing.
12
Q
Freezing breast milk
A
- If you don’t think you will use freshly expressed breast milk within 4 days, freeze it right away. This will help to protect the quality of the breast milk.
- Freeze breast milk in small amounts of 2 to 4 ounces (or the amount that will be offered at one feeding) to avoid wasting breast milk that might not be finished.
- When freezing breast milk, leave about an inch of space at the top of the container because breast milk expands as it freezes.
13
Q
If you will be delivering breast milk to a childcare provider,
A
clearly label the container with the child’s name and talk to your childcare provider about other requirements they might have for labeling and storing breast milk.
14
Q
Storing breastmilk while traveling
A
- Breast milk can be stored in an insulated cooler bag with frozen ice packs for up to 24 hours when you are traveling
- Once you arrive at your destination, milk should be used right away, stored in the refrigerator, or frozen.
15
Q
Safe thawing of breast milk
A
- Always thaw the oldest breast milk first.
- Remember first in, first out.
- Over time, the quality of breast milk can decrease
16
Q
Ways to thaw breast milk
A
- In the refrigerator overnight.
- Set in a container of warm or lukewarm water.
- Under lukewarm running water.
17
Q
Never thaw or heat breastmilk in
A
- a microwave.
- Microwaving can destroy nutrients in breast milk and create hot spots, which can burn a baby’s mouth.
18
Q
Use breastmilk how soon after thawing?
A
- within 24 hours of thawing in the refrigerator
- (this means from the time it is no longer frozen or completely thawed, not from the time when you took it out of the freezer).
19
Q
Once breast milk is brought to room temperature or warmed after storing in the refrigerator or freezer, it should be used within
A
2 hours.
20
Q
Does breast milk need to be warmed?
A
- No
- It can be served room temperature or cold.
21
Q
Indications for expressing human milk include the following purposes:
A
- to collect milk for an infant who cannot suckle at the breast
- to relieve engorgement, enhancing the baby’s ability to latch on
- to stimulate an increase in milk volume
- to empty the breast following a breastfeeding if the baby is not able tosuckle effectively
22
Q
Two methods of collecting breast milk
A
- Hand expression
- Breast pumps
23
Q
Types of breast pumps
A
- Manual
- Electric
- Battery operated
- Small semi-automatic
- Large automatic
24
Q
Hand expression
The amount of milk a mother expresses at a sitting will vary, depending on many factors, including the following:
A
- ability to stimulate letdown reflex
- time since last breastfeeding or expression
- milk supply
- time of day
- how experienced the mother is at hand expressing
25
Hand expression instructions
* Tumb and forefingers 1-1.5 in behind nipple and press into breast
* press inward toward chest wall, squeezing gently with slight rolling action toward nipple
* Release pressure as needed to obtain milk
26
A breast pump should meet the following criteria:
* be **easy** **to use**
* be **efficient** in draining milk from the breast
* be **comfortable** to use
* be **easy to clean**
* provide **automatic, intermittent vacuum** rather than continuous vacuum
* have **spare parts** available
* be **portable**
27
**manual breast pump**
* mother uses different muscle groups in the hand, wrist, lower arm, and upper arm
* cycles dependent on the user’s motions
* Most manual pumps do not have vacuum regulators
* High vacuum pressures can be generated if mothers are not properly instructed in the use of manual pumps
* **Tissue damage may result from high vacuum pressures**
* efficiency varies, depending on the mechanics of operation.
28
What is one important quality of a battery operated pump?
**The number of cycles per minute produced**
29
Battery operated pumps are intended for
* occasional use
* not recommended for sustaining a milk supply when the infant is not suckling at the breast.
30
Battery operated pumps work well for
mothers who have an abundant milk supply and a quick milk ejection reflex.
31
Why is it important to be able to regulate the vaccum interruption on a pump?
Uninterreupted vaccum can cause breast tissue damage
32
Why is a higher number of pump cycles per minute better?
maintains milk supply because it mimics the suckling of the infant.
33
What is one important quality of a battery operated pump?
**The number of cycles per minute produced**
34
Battery operated pumps
* small motor that uses two batteries (AA 1.5-volt)
* **fewer cycles per minute** are generated as the batteries lose power
* when the pump is plugged in, it will cycle at a maximum number per minute.
* The Medela battery pump automatically produces 32 cycles per minute with alkaline batteries, 30 cycles per minute with rechargeable batteries, and 42 cycles per minute with the AC adapter
* **The number of cycles per minute produced is one important quality of a pump.**
* A higher number of cycles per minute maintain milk supply because it mimics the suckling of the infant.
* Another important quality is the ability to regulate the vacuum interruption because prolonged high vacuum levels can damage breast tissue.
* These pumps work well for mothers who have an abundant milk supply and a quick milk-ejection reflex.
* They are intended for occasional use and would not be recommended for sustaining a milk supply when the infant is not suckling at the breast.
35
Battery operated pumps
* small motor that uses two batteries (AA 1.5-volt)
* **fewer cycles per minute** are generated as the batteries lose power
* when the pump is plugged in, it will cycle at a maximum number per minute.
* The Medela battery pump automatically produces 32 cycles per minute with alkaline batteries, 30 cycles per minute with rechargeable batteries, and 42 cycles per minute with the AC adapter
* **The number of cycles per minute produced is one important quality of a pump.**
* A higher number of cycles per minute maintain milk supply because it mimics the suckling of the infant.
* Another important quality is the ability to regulate the vacuum interruption because prolonged high vacuum levels can damage breast tissue.
* These pumps work well for mothers who have an abundant milk supply and a quick milk-ejection reflex.
* They are intended for occasional use and would not be recommended for sustaining a milk supply when the infant is not suckling at the breast.
36
Small semi-automatic electric pumps
* available in drug stores and department stores
* The motors generate suction, and the mother determines the cycle by putting her finger on and off a hole in the flange base
* These pumps maintain negative pressure constantly, and many of them do not have a mechanism to regulate the amount of suction
* The amount of vacuum exerted on the nipple and areola depends upon the degree of closure of the hole in the flange
* A level of vacuum that is too high for a prolonged period increases the risk of tissue damage, especially in the nipple
* For this reason, these pumps are not recommended.
37
Large automatic breast pump
hould be recommended whenever possible by the health care professional.
These types of breast pumps are often rented by health care providers such as hospitals, pharmacies, or lactation consultant services.
38
Automatic electric pumps are designed to
* cycle pressure instead of maintaining it
* The pressure settings are intended to mimic the infant suckling at the breast.
39
The health care professional must be aware that recommendations on pumping are
* very specific for each mother.
* A mother who will be pumping long term with a premature infant will need different information than a mother who is returning to work and wishing to maintain her milk supply.
40
Several large electric breast pumps have the capability of
double pumping
41
It was found that double pumping resulted
higher milk fat content, faster pump times, and higher maximum yields
42
What may affect type of pump setup used?
Mothers’ preferences for one type of pumping over another, as well as availability and cost,
43
What would be recommended for long term pumping?
An electric pump with double pumping capability
44
Pumping frequency
* the mother should start pumping as soon as possible following delivery
* pump every 3 to 4 hours around the clock for about 15 to 20 minutes.
45
What type of pump would work well for a mother returning to work?
* an electric pump with double pumping.
* This would be an efficient use of her time and would drain her breasts well.
* These women should be instructed to pump about every 4 hours for about 15 to 20 minutes.
46
Women who are breastfeeding and are in need of expressing their milk should be directed to
the appropriate educated health care professionals in a hospital, clinic, or private practice. These health care professionals have the skills and current information to support the breastfeeding mother with information about the collection and storage of breastmilk.
47
Before expressing milk with any product
read the instructions governing the use and cleaning of a pump.
48
Hands should be washed before
each pumping session.
49
For occasional pumping
pump during, after, or between feedings, whichever gives the best results.
50
Most mothers tend to express more milk in the
morning
51
For mothers employed outside the home, pumping should occur
on a regular basis for the number of feedings that are missed.
52
or premature or ill babies who are not at breast, a mother should pump her breasts a total of
eight or more times in 24 hours.
53
Initiation of pumping should be delayed no longer than
* 6 hours following birth, unless medically indicated.
* This assures appropriate development and sensitivity of prolactin receptors.
* More frequent pumping will avoid the buildup of excessive back pressure of milk during engorgement.
54
With single-sided pumping, optimal duration is
* 10 to 15 minutes with an electric pump
* 10 to 20 minutes with a manual pump.
55
If double pumping with an electric or two battery-operated pumps, optimal duration is
7 to 15 minutes
56
before using a pump
Elicit the milk-ejection reflex
57
When pumping, Use only as much suction as is needed to
maintain milk flow.
58
During pumping, massage the breasts
in quadrants before or during pumping to increase intramammary pressure.
59
Allow enough time for pumping to avoid
anxiety.
60
to obtain the best fit between pump and breast
Use inserts or different flanges, if needed
61
When pumping, avoid long periods of
uninterrupted vaccuum
62
Stop pumping when
when the milk flow is minimal or has ceased.
63
Storage of Human Milk - current guidelines
* Wash hands thoroughly.
* Use a sterilized container; polyethylene bags are acceptable for home use.
* Refrigerate or freeze milk after expressing.
* Freeze milk that will not be used within 48–72 hours.
* Use milk stored in a self-defrosting freezer within 3–6 months (separate
* door from refrigerator, top or bottom freezer)).
* Use milk stored in a deep freeze for up to 12 months
* Use the oldest milk first. Date container at time of collection.
64
Recommendations for thawing human milk
* For immediate use, thaw the frozen milk under cool running water.
* For use several hours later, thaw the milk in the refrigerator.
* Breastmilk should not be thawed at room temperature because bacteria can multiply in the milk.
* Frozen breastmilk can separate when thawed, so shake the container gently to mix the milk.
* Thawed breastmilk must be used within 24 hours.
* Previously frozen breastmilk should not be refrozen.
* Any milk not taken by the baby at a feeding must be discarded.
* Never use a microwave to thaw or warm human milk. Microwaving heats unevenly and destroys important nutrients in breastmilk.
65
Freezing breast milk
Leave an inch of space at the top of the container why?
because breast milk expands as it freezes.
66
Freezing breast milk
Freeze in what amounts?
* small amounts of 2 to 4 ounces (or the amount that will be offered at one feeding)
* this avoids wasting breast milk that might not be finished.
67
Freezing breast milk
Freeze right away if
* you don’t think you will use freshly expressed breast milk within 4 days
* This will help to protect the quality of the breast milk.
68
What type of vaccum should the ideal breast pump provide?
automatic, intermittent vacuum
69
Freeze milk that will not be used within
48–72 hours.
70
Use milk stored in a self-defrosting freezer within
3–6 months (separate door from refrigerator, top or bottom freezer)).
71
Use oldest milk
first
72
For immediate use, thaw frozen breast milk
under cool running water.
73
For use later in the day, thaw frozen breastmilk
in the refrigerator.
74
Can breastmilk be thawed at room temperature?
* No
* because bacteria can multiply in the milk.
75
If frozen breastmilk separates when thawed
shake the container gently to mix the milk.
76
Thawed breastmilk must be used within
24 hours.
77
Can you re-freeze previously frozen breastmilk?
No
78
What should you do with any thawed milk not taken by the baby at a feeding?
Discard it
79
Mothers can express breast milk how
* by hand
* with a manual or electric pump.
80
Make sure pump and tubing are
**clean.**
81
If the pump tubing is molty
Discard and replace immediately.
82
If using a shared pump kit
clean pump dials, power switch, and countertop with disinfectant wipe.
83
Freshly expressed breast milk can be stored in the freezer for
6 months (recommended)
up to 12 months possible
