Expressing and storing breast milk when you go back to work

Freshly expressed breast milk keeps for up to 4 hours at a room temperature of 25 degrees C or cooler, up to 4 days in the fridge, and about 6 months in the freezer.¹ In a hot Kolkata room, play safe and chill it sooner. With a little planning, most mothers can keep giving breast milk long after they return to work.

How long can breast milk stay at room temperature in Indian heat?

Up to 4 hours, but only if the room is 25 degrees C or cooler.¹ In a hotter room, put the milk in the fridge or a cool bag with ice packs as soon as you finish expressing.

Most Kolkata homes and offices are warmer than 25 degrees C for much of the year, especially from April to October. The safety times in guidelines were set for cooler rooms. Germs multiply faster in heat, so the safe window shrinks. My rule for families here: if there is no air conditioning, do not leave expressed milk out at all. Chill it straight away.

How long does breast milk last in the fridge and freezer?

In the fridge, use expressed milk within 4 days. In the freezer, about 6 months is best and up to 12 months is acceptable.¹

• Keep milk at the back of the fridge, not in the door, where the temperature swings each time it opens.¹
• If you will not use it within 4 days, freeze it right away.¹
• A small freezer compartment on top of an old single-door fridge is less cold than a deep freezer. Use milk from there sooner.

Power cuts are common. If the power goes, keep the fridge and freezer doors shut. An insulated cool bag with frozen ice packs is a useful backup. The CDC allows up to 24 hours for milk carried this way when travelling, so treat that as the outer limit.¹

What container should I store breast milk in?

Use clean, food-grade glass or hard plastic containers with tight lids, or bags made for breast milk.¹

Do not use ordinary polythene bags. Freeze milk in small amounts, about 60 to 120 ml, or one feed's worth, so nothing goes to waste.¹ Leave some space at the top, because milk expands when it freezes. Label every container with the date. If the milk goes to a creche, add your baby's name.¹

How do I thaw and warm frozen breast milk?

Thaw it overnight in the fridge, or stand the closed container in a bowl of warm water. Never thaw or heat breast milk in a microwave.¹

Always use the oldest milk first. Once thawed in the fridge, use it within 24 hours, counting from when it is fully thawed.¹ Once milk has been warmed or brought to room temperature, use it within 2 hours.¹ Never refreeze thawed milk.

Breast milk does not have to be warmed. Many babies take it cool. If you warm it, swirl gently to mix the fat back in and test a few drops on your wrist. Leftover milk from a feed should be thrown away after 2 hours.¹

Why does my stored breast milk look or smell different?

Stored milk often separates into a creamy top layer and a thin bottom layer. This is normal. Swirl it gently to mix.

The colour also varies, from bluish to yellowish, depending on the time of day and what you eat. Some mothers find their thawed milk smells a little soapy or metallic. Most babies still drink it happily. If the milk smells truly sour, like spoiled curd, throw it away.

Is hand expression or a breast pump better?

Both work. Hand expression is free and many mothers find it easy once they learn, while a pump can be quicker for frequent sessions at work.

A Cochrane review (a careful summary of all the trials) found that no single pump consistently gave more milk. Simple measures such as relaxing, warming the breasts and massaging them before or during expression did increase the amount collected.² The review also found that low-cost methods, including hand expression, can work as well as large electric pumps for some outcomes.²

My suggestion: learn hand expression in the first weeks, even if you plan to buy a pump. It rescues you during power cuts, travel or a broken pump.

How do I express breast milk by hand?

Place your thumb and fingers in a C shape at the edge of the darker skin around the nipple, press back towards your chest, then gently squeeze together and release.

1. Wash your hands and use a clean wide bowl or cup.¹
2. Sit comfortably. Look at a photo of your baby or smell her clothes; this helps the milk flow.
3. Massage the breast gently for a minute.
4. Press, squeeze and release in a steady rhythm. Do not slide your fingers along the skin.
5. When the flow slows, move your fingers around the breast, then switch sides.

It may take a few days of practice before you get more than drops. That is normal.

When should I start expressing before going back to work?

Start building a small freezer store a few weeks before you return, once breastfeeding is going well.

Express once a day, often in the morning when many mothers have more milk, after or between feeds. Even a small amount each day adds up. Also, let another family member give your baby expressed milk by cup or paladai a few times before you start work, so the change is not sudden.

How often should I pump at work?

Express regularly through the working day. Your supply depends on removing milk often and draining the breast well.³

Milk supply depends on how often and how well milk is removed from the breast.³ Long gaps make the breasts overfull and, over days, tell your body to make less. In Dr Dutta's practice, most mothers manage two or three short sessions in a full working day. Breastfeed just before you leave and as soon as you get home. Feed often at night and on weekends to keep your supply up.

What are my maternity leave and workplace rights in India?

Under the Maternity Benefit Act as amended in 2017, eligible women get 26 weeks of paid maternity leave for their first two children.⁴

• Workplaces with 50 or more employees must provide a creche, and allow you four visits a day to it.⁴
• Your employer may allow work from home after leave, if the nature of the job permits.⁴
• A woman who already has two or more children gets 12 weeks.⁴
• The Act applies to establishments employing 10 or more people.⁵

These provisions have since been folded into the Code on Social Security, so check the current rules with your HR team. Ask early for a clean, private place to express (not a toilet), a fridge to store milk, and breaks. A short, polite written request usually works better than a last-minute one.

How do I carry expressed breast milk home from work?

Keep milk in the office fridge, then carry it home in an insulated cool bag with frozen ice packs.¹

If there is no fridge, use a good cool bag with frozen ice packs all day. The CDC gives up to 24 hours for milk kept this way while travelling.¹ On a crowded bus or metro in May, the bag matters. Put milk in the home fridge as soon as you arrive.

Should I use a cup, paladai or bottle for expressed breast milk?

A small cup or a paladai (the traditional Indian spouted feeding cup) works well and avoids teat confusion for many babies. A bottle is also fine if it suits your family.

A Delhi study compared bottle, cup and paladai in newborns. With the paladai, babies took the most milk in the least time and stayed settled longest; the cup caused the most spilling.⁶ A Cochrane review found that cup feeding may help breastfeeding continue in late preterm babies, but there was not enough evidence for term babies.⁷

Whichever you use, the carer should hold your baby upright, let her take milk at her own pace, and never pour milk into her mouth. Wash and sterilise the paladai like a bottle.

How much expressed milk will my baby need while I am at work?

Plan for one portion for each feed your baby would normally have while you are away. Store milk in portions of about 60 to 120 ml, or one feed's worth, so little is wasted.¹

Breastfed babies do not usually need ever-larger feeds as they grow, because breast milk changes to match their needs. Some babies drink less while you are away and make up for it with extra feeds at night. This is called reverse cycling, and it is normal if your baby is gaining weight well.

When should I see a doctor about expressing or feeding?

See your doctor if your baby is not gaining weight, or if you have breast pain with fever.

• Fewer than 6 wet nappies a day in a baby older than one week.⁸
• Your baby refuses all feeds while you are away for more than a day or two.
• A painful, red, hot area on the breast, or fever with body aches.
• A sharp drop in the amount you express that lasts more than a few days.
• Cracked or bleeding nipples from pumping (often a wrong flange size).
• Any fever of 38 degrees C or more in a baby under 3 months.

Go to hospital at once if your baby is very drowsy, floppy, breathing with difficulty, or will not feed at all.