Antepartum, Maternal and Newborn Postpartum: Breast Pump Use SECTION: 19.23

Antepartum, Maternal And Newborn – Postpartum: Breast Pump Use SECTION: 19.23 Strength of Evidence Level: 3 __RN__LPN/LVN__HHA

PURPOSE: PROCEDURE: To express milk when unable to nurse infant; to relieve 1. Adhere to Standard Precautions. engorgement; and to stimulate milk production. 2. Identify patient and explain procedure to patient. 3. Remove bra flap and nursing pads carefully. If CONSIDERATIONS: nipple is sticking to the bra or pad, use warm water 1. There are a variety of breast pumps, including to gently dislodge. manual, battery-operated and electric. The most 4. Observe nipples for irritation and/or cracks. effective manual pumps are cylindrical. Bulb-type 5. To improve suction, have patient moisten breast pumps should NOT be used because of the before applying flange. possibility of trauma to the nipples and because 6. Put pump to breast over nipple and areola, ensuring sterility cannot be maintained due to milk that gets the nipple is centered in the flange so that it does trapped in the bulb. Follow manufacturer's not rub against the side. Only use as much suction instructions for use and cleaning of pump. as needed to maintain milk flow into collection 2. Do not apply soap to nipples. Soap dries out the container. Time limit of 15 minutes on each breast is nipples and can increase problems with dryness recommended. and cracking. 7. Switch breasts when milk flow decreases and switch 3. Use only prescribed nipple creams or thin layer of again several times during each session to breast milk after pumping to help prevent or heal effectively stimulate the let down reflex. irritated and cracking nipples. 8. Allow breasts and nipples to air dry. Apply thin layer 4. Use of pumps may cause irritation and cracking of of breast milk or prescribed nipple cream. nipples, resulting in risk of infection, so the nipples should be assessed frequently for problems. AFTER CARE: 5. To promote “let down,” the following methods may 1. Store milk in plastic bottles or plastic bottle liners. be utilized: 2. Expressed milk can be stored in the refrigerator (39 a. Massaging breasts. degrees Fahrenheit or -4 degrees Celsius) if used b. Taking a warm shower. within 5 days or frozen for longer storage periods. c. Applying warm compresses just prior to Frozen milk may be stored in the freezer pumping. compartment of a refrigerator (5 degrees Fahrenheit d. Minimizing distractions. or -15 degrees Celsius) for 2 weeks or in the freezer e. Relaxing and focusing on the baby, e.g., compartment of refrigerator with separate doors (0 pictures, tapes. degrees Fahrenheit or -18 degrees Celsius) for 3 6. Pumping should not be uncomfortable or painful. months. Frozen milk may be stored in a deep Patient should discontinue pumping at first sign of freezer (-4 degrees Fahrenheit or -20 degrees discomfort. Celsius) for 6 months. Store it at the back of the 7. Pump should be taken apart and thoroughly cleaned freezer, never in the door section. Instruct patient to after every use. Follow manufacturer's instructions date each bottle or plastic liner. Use the oldest milk for use and cleaning of pump. first. 8. Patient should be advised not to use bra pads with 3. If transporting milk to the hospital, use an ice chest. plastic liners and to let nipples air dry 10 to 15 4. Once thawed, never refreeze milk. To defrost, thaw minutes after pumping to help prevent cracked in refrigerator (up to 12 hours) or under warm nipples. running water. DO NOT boil or warm in microwave. 9. The manual pump is relatively efficient for short- Use thawed milk within 24 hours. term or intermittent use. 5. Document in patient's record: 10. Hand expression and manual pumps require that a. Condition of nipples, amount of milk pumped the patient have ordinary strength and hand and ease of procedure. coordination. b. Instructions given to patient. 6. Report any problems to physician. EQUIPMENT: Pump of choice Bottle for milk storage Towel Gloves