Middee Mini Expert Series with Lactation consultant Courtney Garland (mamalinc) : Expressing, storage of breast milk & sterilisation — Middee | Pregnancy, Birth & Postpartum Education

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Hello beautiful people and welcome to Mittie the Podcast, a modern day podcast designed to answer all of your weird and wonderful pregnancy and postpartum questions. I'm your host, Monique Maitland, qualified midwife and nurse, founder of the Middle and someone who is about to become your personal in-pocket midwife and virtual best friend. The Middie Society is a community-based platform where we interview leading healthcare professionals, new mamas, and everyday people who share with us their experiences and reveal what they wish they knew before becoming a parent. So buckle up for this crazy and exciting ride. I'll be talking all things tits, bits, spew, and poo. Alright, let's get started. Hey guys, and welcome back to our Middie Mini Expert Series, a 4-part series proudly brought to you by Tushys, Gaya, and Milton. As part of this mini series, I got to sit down with some of the best experts in their field, such as Dr. Golli, a pediatrician, Courtney Garland, a NICU nurse, lactation consultant, and sleep consultant from MamaLinc, Nicole Gleason, a pediatric emergency nurse from Rhythm First Aid, and Penny Douglas, a pediatric nurse and baby massage consultant from South Coast Baby Massage. This 4-part miniseries has been designed to provide new and current parents with essential education regarding topics that all parents should be aware of, such as normal and abnormal baby's output, expressing and sterilizing, infant skin conditions, and of course, baby massage. So before we get into it, let's hear more about today's sponsor, Milton. Protecting your little one from harmful germs is so important whilst their immune system develops. And thanks to Milton sterilizers, it has never been easier. By using either their combi or solo sterilizers, your bottles, teats, dummies, and who knows what else your baby places in their mouth will be sterilized for your little one in no time. And best of all, it's so simple. You just add your antibacterial solution or tablet to water and wait up to 2 minutes in the microwave or 15 minutes in cold water. How easy is that? With a strong focus on protecting babies and families from germs, Milton is committed to developing formulas from plant-based technology to limit the impact on the environment and its users. So get your hands on a Milton steriliser today to make your journey into parenthood that little bit easier. Now it's time to find out more about this week's episode with expert Courtney Garland. Within this episode, both Courtney and I sit down to unpack everything to do with expressing, preparation, and storage of breast milk, as well as how to best sterilize bottles, teats, and expressing equipment. Both Courtney and I have worked within the healthcare industry where supporting mothers is our priority, and we have both seen just how many parents may need to express at some point in their journey for a multitude of reasons. But we all know that this often comes with some confusion regarding how long we can store breast milk for, or how do I sterilize the equipment I'm using. Courtney shares with us all the useful information that parents may need to know about expressing and sterilization. So please welcome Courtney.

Hello everyone, and welcome back to Mitty the Podcast. Today I am joined by the amazing Courtney Garland, who is one of our experts on our mini series, and we are going to be talking all about expressing, sterilization, and safe storage of breast milk. So Courtney, do you want to tell everyone a little bit more about yourself?

Yes. So my name is Courtney, and as you can probably tell, I sound a little bit different than Mon. So I'm actually an expat. So I'm Canadian and I now live here in Australia and I'm a NICU nurse and I have been for over— oh my goodness, this is dating myself now. I'm over 12 years almost now. And I'm also a lactation certified international lactation consultant and a pediatric sleep consultant. So I really enjoy helping families. As you can tell from my page, Mama Link, it's all about helping families no matter what kind of questions they may have about baby feeding or sleep.

Yeah, so as you can tell, Courtney is an absolute wealth of knowledge. So when I had to source out an expert about this topic, there was no doubt in my mind who I was going for. And I'm so grateful for you coming on and chatting with me today because you and I both know know some of the struggles that parents go through when we've helped so many families in that early stage of parenthood. And just the unknown scares a lot of people, and often we do see a lot of questionable things. So yeah, this episode is really to give you all that up-to-date evidence and just help make that transition into parenthood that little bit easier. And we've got a special guest of Hadley here too, Courtney's cute little daughter. So if you hear some giggles in the background, that's her. So Courtney, often mothers will find themselves needing to express breast milk at some point, and it can be due to multiple reasons. So before starting to express, what should we consider first?

So I would definitely be considering, okay, I need to express. Is this going to be like a few one-off kind of situations, or is this going to be a consistent situation, to know what kind of breast pump you need to buy. Do I need to buy, you know, like more of a manual one or do I need to buy like a good electrical double pump to save me more time? So I think when it does come to expressing, really sit down and think about how often you want to be pumping and how frequently you're going to be need to do it as well. Sorry. So I would really consider those things when you're needing to pump.

And yeah, and often, I mean, I see it all the time because working as a midwife in the hospital, Often women who we commence on the electronic breast pump, and we should say that normally we recommend it after that 24-hour period after birth and when your milk starts to transition in, um, but there is a difference between a hospital-grade pump, so those pumps that women are using in the hospital, versus just their average pump that they have at home. Do you mind sharing with us what the difference is between those?

Yeah, definitely. So, and those are great points too, like with pumping, and I teach this too, if you're antenatally expressing, great, a pump you can use then for sure. But when baby is born, you're 100% right. You need to be bringing baby to the breast as frequently as possible to bring that milk in to help you because the pump's not going to do as good a job as the baby. And that's the issue here. So when you look at a pump, there's hospital grade and then there's just, you know, the regular at-home grade. The hospital grades are usually bigger pumps, and they're bigger because they have a bigger motor in them, which helps them have better suction, different programs, where the smaller ones, you know, they usually have just a few functions, and their suction may not be as powerful as the hospital-grade one. So that's the big difference. But the hospital-grade ones can be very, very expensive. So this is where all these great companies have come out making the ones at home, and they've made ones at home so much better too. They're portable, where the hospital-grade ones usually have to be plugged into the wall. You can't be agile walking around or, you know, doing everything you need to do as a mother while you're trying to express. So that's the big difference between the hospital-grade and the at-home ones. But the at-home ones, like, oh my goodness, they're coming up with ones that you just slip into your bra now. Like, there's so many great ones out there to look into as well.

And I know, you know, when I start to commence someone on a breast pump, that often I'll get all the gadgets that go with it, you know, the flange, um, the tubing, and then I sort of hand it to the mum. But those are very different to the ones that parents will go home with, and there are different flange sizes which will go onto the breast and sit around your nipple. How can parents choose the best flange size for them, and what do they have to actually look for in that?

Yeah, great points. So with the The flange size, it's really important that you do measure your nipple properly because when you go to put on the flange and put your nipple into the flange, the flange part on the pump, if people don't know, that's where you put your nipple into it so it can suck it. [LAUGHTER] And, um, it just protects your nipple a little bit but creates a suction around the nipple and the breast and the areola. But you really need to make sure you have the right size. It's kind of like Goldilocks. You want to have too big, you don't want to have too small, you want to have just right. So when you go to measure your nipple, you really need to measure at the base of the nipple. So that's right at the base where your nipple and the areola— I got someone agreeing with me here.

You got the grizzly bears from Goldilocks in here too.

It's not just right for her right now, I guess. So the nipple sits right at the base, the nipple, and attaches right to the areola there at the base. That's where you want to measure. So you want to measure the diameter. So you want to measure how far across and how big your nipple is, pretty much, the width of it, the diameter. So once you know that, then you add on 3— I usually say 2 to 4 millimeters, depending. Some companies, it depends what company you go with too, some say 3 to 4, some say 2 to 4. So say for instance you measure and you're getting a measurement of 18, then you want to bump yourself up to 21. So whenever companies give you flanges with their breast pumps, it's always usually a standard size. Well, that standard size is not the average size. Like, it is a larger size and usually doesn't fit most women. So it's really good to measure properly because if you don't— this is where, like, the Goldilocks I was talking about— if it's too small, you're going to start getting blisters on the nipple and you're going to get cracked, damaged nipples. If it's too big, then you're going to start getting damage to the areola because it's suctioning in your whole nipple and areola and breast with it. So that's where you can run into issues. So nipple size is like the flange. You really need to— that's the main thing I always tell parents. If anything, just have your nipple flange right and then come back and we can recircle on, you know, how often you should be changing pumping parts, which we'll get into soon too. But yeah, nipple flange is a must, mamas. It's a huge thing.

Yeah. And I think it's often something— I mean, if parents don't have that knowledge that there are additional sizes, they will just use that generic one, which you and me both know that every breast and every nipple is so different. And really, one mold isn't going to fit every single person, and that's totally okay.

That's exactly right. And this is where sometimes I recommend measuring your nipple before you even look into a breast pump, because some companies don't do smaller sizes or larger sizes. Some companies cover an array, but some don't do certain sizes. So it can be really good to measure before you go buy it too.

Yeah, and I mean, for me, when I start someone on a breast pump, I often say, you know, start the suction off because basically how a breast pump works, really, we imagine it like milking a cow pretty much. That's what most women say, I feel like I'm being milked like a cow because, you know, the suction goes on, it sort of does that, and your nipple just gets pulled a little bit, little bit, little bit, and gradually the milk's drawn out. But making sure that you are comfortable and that it's not painful is so important because we don't want to do the complete opposite and actually cause more damage to the breast and make this experience really awful for you. And often choosing the right intensity of suction is another thing to consider rather than just sitting through and bearing through all that pain. So how do moms choose what suction to use?

Yeah, so great. So a lot of pumps now have two functions to it. So they have the suction, then they have the letdown button. So when you first put the pump on, what it's going to do is going to go like, it's more like stimulation at first. It's kind of, it's literally, we've built a pump to imitate a baby's, what they would do at the breast. So it's stimulation first, then as soon as you see milk starting to come out, that's when you will change your pump over to the letdown button. So usually that looks like little milk drops. You push that button and then all of a sudden it starts to do deep long sucks. It goes—

we're really, really mimicking it so well.

It sounds like a breast pump right now. But literally that's what you need to do because then all of a sudden when the milk starts to come, you get bigger longer sucks as they're swallowing and stuff like that and deeper suction. So that's the difference between when to push the buttons, but when you first put the the pump on and you're trying to get the right vacuum suction, like how strong it is— sorry, that's the word I'm looking for— how strong the suction is, I always say put it on, turn it up until you get to a spot where it's like, okay, it's a little bit uncomfortable, turn it back down and just see how that feels. Is that comfortable? Okay, great, stick with that. If you're finding— this is one thing to know too— as your breasts and your nipples get used to being pumped, you also will need to probably increase your suction as you get further pumping journey, which is really important to remember that as you get more into your breastfeeding journey, you may need to turn up the suction. And I think one big thing too, I think that we should let moms know is that with pumping, it's really important to know that you are never ever going to get the exact amount that a baby would get from the breast. No pump can literally get everything that a baby can, just to the natural hormones, all those things. But there are things that you can do, like you're talking about with being comfortable. If you're comfortable, you know, put a heat pack around your neck, around your upper chest to help with pumping. That will really help you with getting a lot of milk too because it relaxes you. We want you to be in a relaxed state to help the pump as well. But please never be shocked by how much you're getting in a pump. It's never a true indicator of your supply. I think that sometimes really worries moms, so I just really wanted moms to know that as well.

Yeah, and often, you know, we know that oxytocin plays a role in our letdown and the way that we excrete milk. So being in an environment that is facilitating that oxytocin production, you know, maybe you're looking at photos of your baby, maybe your baby's asleep in the cot and you're looking at them there, like, they are also great things to do whilst you are expressing.

Yes, exactly, exactly.

And there are so many reasons why women might find themselves at one point expressing throughout their motherhood journey. And there really, really is a big range from early postpartum to, you know, months down the track. And that's what we're sort of going to get into now, looking at the reasons why women might need to express. So do you mind touching on early postpartum? So maybe say in that first week of life, why moms might need to find themselves expressing Yeah, definitely.

So also too, I might just throw in there too, is that some moms can actually— some moms do it antenatally as well. Once they get the go-ahead from their medical provider around that 38-week mark, a lot of moms start pumping sometimes just to help bring in their milk and that too, and they can have an extra storage of milk in case something does go wrong, or, you know, they have gestational diabetes, all those types of things. So that's another reason why pumping can be so great. It's not just for postpartum. It can really help in the beginning with helping milk come in. 2. So reasons the first week you may need to be pumping is, you know, you maybe unfortunately had your baby go to NICU, or, you know, you need to start pumping milk because you've been separated from baby for some reason. Another reason would be because you need to help with your supply, you need to help bring it in, um, increase it. Sorry. So you may have given a bottle and now, okay, I need to get my milk supply back up to help decrease the bottle feeds. So that first week is really about trying sometimes with the supply, usually is a big thing. Gestational diabetes is another one because usually, unfortunately not all the time, but sometimes if the baby is separated, they're going to need to have milk for the baby so the baby can be fed while they're in being looked after too. So that would be the biggest reasons the first week of postpartum, I would say.

Yeah, and I mean, for some parents, I look at like, this is my bread and butter, you know, that first week of a baby's life, that is my favorite thing. [LAUGHTER] So things that I see is especially so many moms go, oh, I'm not really getting too much, like I'm day 3 now, I'm still expressing small volumes. But the thing is that breast milk comes in at all different days. Everyone's different, but we know that breastfeeding works with supply and demand, so I'm quickly going to touch on that. The more you stimulate the breast, that's saying that our demand needs to increase. The messages get sent to your brain to go, hey, I actually need to start producing more volumes of milk here because the demand has increased, and then that will then increase your supply. So another reason what I see in hospital and One thing that I normally put into place is feeding plans for a baby's weight loss.

Yes, and see, that's the hard thing because the first week baby is guaranteed to lose weight. And this is where a lot of new research is coming out on this. And this is where I really push for this. I'm such an advocate because if you're telling a fresh mom to be pumping, bottling, breastfeeding, It is so hard to be triple feeding, and it is— it's unattainable, and you exhaust these poor moms, and it just makes it so— makes a newborn stage so unenjoyable. And you're exactly right, like, it does come down to supply and demand. And I think that's the one thing with breastfeeding that we don't understand before we go into breastfeeding, is that, you know, breastfeeding, especially on that second day, once they wake up and they're more lively and find their voice aka they're screaming for milk now. They could be asking for milk every hour, every 2 hours. It doesn't mean you have a low supply, they're just trying to bring that milk in quicker like you said. And with weight, this is the hard part because they're guaranteed— we always say between 7 to 10%. We don't love, love seeing 10%, but you know, we always usually say around 7% of their body weight.

Yeah, and that's normal.

Yes, that's right.

Before I put a baby on the scales, I say to the parents they can lose up to 10% of their body weight because so many parents look and go, oh my goodness, like they're down 300 grams or whatever, and they freak out. And I'm like, okay, this is all normal just due to their changes into the outside world. It's normal for them to lose weight, but we'll put in a plan once we know what the weight is.

That's exactly it. Like, and I think this is where expressing can be so helpful because, you know, there is issues or a mom is really nervous about something and like, oh, I really just want to help this baby gain a little bit of weight. This is where expressing can be such a heaven-sent— like, you know, you can express the milk to give it and it makes— it can be a little bit more reassuring to parents as well sometimes.

Yeah, 100%. Just seeing that there is milk there, even though I'm always like, if you can hear your baby sucking and swallowing, they're getting something and they're settling after the feed. But for a lot of moms to actually see the milk out in a bottle, they're like, okay, yep, there is something there.

Yes. And like, I think that's another thing too, like your breast is like a tap. It needs to be turned on to flow. It needs to be stimulated. So when to turn on the flow of the breast milk. Your baby needs to stimulate it to then have the milk be squeezed out of these little sacs in the breast to then go to the baby. So that's when you have that tingling feeling, and that's called the letdown. So it's really important to remember that, you know, it takes time. Like, breastfeeding takes time. It's not easy, and it takes a while to get into a groove, and especially if you're expressing and breastfeeding too.

People don't realize how difficult expressing can be because, you know, like you said earlier, we want to offer the baby the breast to begin with, and then the expressing will come after that. So if your baby's feeding for half an hour and then you still need to express afterwards, but then you also need to give the baby the expressed breast milk, it can be really, really hard for a lot of parents. And in the early days, your breasts aren't used to being stimulated so frequently. You know, you're not used to having someone suck on your nipple for hours and hours and hours of a day. And if you haven't mastered that attachment, occasionally we can see women get some nipple damage. And you know, I see them at home and they go, my nipples are so sore, like every time I think about putting my baby to the breast, I just, it gives me goosebumps and chills because I just can't, I can't do that, I'm too sore. And I go, okay, well, we just want the stimulation right now. So we still can't miss stimulating the breast because that's gonna affect our supply. 'But have you actually tried to express instead and put the breast pump on just to give your nipples a break?' And they go, 'Can I do that?' And I go, 'Absolutely, you can do that for a feed.' Like, that is not going to be the be-all end-all of your breastfeeding journey. And I think so many parents are so afraid of doing something wrong and being judged by not exclusively just breastfeeding, but it's absolutely okay to do. And 100%. If you're sore, you need to rest those nipples because we don't want to cause more damage.

That's exactly right. And that's another great time that you could be expressing, you know, like you just said, like you're gonna 100% jump on a pump if you've got sore, cracked, damaged nipples. I'd rather you pump and take a break for a day or two if that is going to help you with the exhaustion and all that too, before you get the baby back onto the breast again. But also too There's something else I want to throw in. A really good tip here is when we first have our baby, especially that first week, you're getting engorged. Engorgement is when your breasts fill up with milk and they're like, they're like, you know, triple D's, and they're like floating off your chest, and you're just like, oh my gosh, this is so painful. And like, it's hard to latch the baby on, and it's the hardest latching the baby those first few weeks. We'll be— I'll be really honest. But also too, because you're engorged, you're leaking milk all the and then you have breast pads on, and then if you get sore, cracked, damaged nipples, you're increasing the chances of getting thrush. And this is where a lot of moms don't know what thrush is. And sometimes having pain while you're breastfeeding isn't just down to sore nipples, it could be more certain things like thrush, it could be stuff like that. So it's really important that you consider that as well, that it's not just sore, cracked, damaged nipples, because With breast pads, it's a breeding ground for thrush. So it's just like getting thrush down there for women. It's the same up there, but you may not have any symptoms. Like, the only symptom will be pain with feeding. That's it. There may be no other symptom at all, like maybe a little bit of redness, but it doesn't have discharge like down there. There's no whiteness or anything. So it's really hard to diagnose, but it always goes by how they're feeling. So if it's excruciating and you just have like a little bit of a sore, cracked, damaged nipple, maybe you should reevaluate and see if it's possibly thrush too. So I would really recommend that to moms.

And you mentioned engorgement, and often, you know, that's when that milk's starting to transition in anywhere between like day 3 to day 5, day 6. And women are like, what is going on? Like, they're so rock hard, I'm so uncomfortable. And that's another great way for when to introduce— maybe you need to do a little bit of expressing First of all, offer the baby the breast, and then if you're still feeling really sore and engorged and full, I say, okay, maybe you might need to do either a little bit of hand expressing to soften the breast and massage those areas out, or you might wanna do like 5 minutes more on the pump just to try and soften it. But I say do not do more and more and more because supply and demand, the more you stimulate, the more milk you're gonna produce, and we don't want it to do the complete opposite of increasing your milk supply. [Speaker] That's it. Softening that breast can really help ease that discomfort a little bit.

Yes, 100%.

And so they're probably the— all the early postpartum phase of why expressing can be really, really great.

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But you know, as the motherhood journey keeps going, you know, you start to get back into your social life. Maybe we've just passed Christmas and New Year's, but it's summer here in Australia and everyone likes a glass of wine now and then. And women sometimes are really worried about having the alcohol because they're not actually too sure what to do when they introduce alcohol and they're breastfeeding their baby. Do you have any tips for expressing when consuming alcohol?

Yes. This is— I really do recommend we have, um, oh my goodness, I'm having a mom brain moment, uh, the Safe Feeding app, the breastfeeding Safe Feeding app, and it's fantastic. So I always recommend going to there because breastfeeding and drinking and consuming alcohol really is based on a few things. The biggest thing is time. So time is what's going to take the alcohol to get out of your system. But drinking alcohol, it's just, it goes in. It's just like if you were to drive a car. That's why I always assimilate it to, if you feel comfortable to drive a car, then you're probably comfortable enough to feed your baby because the alcohol goes into the blood system and then it filters through the blood system. So in the breast, it goes in and out. It doesn't stay dormant in the breast. And that's another thing people just think alcohol just stores in the breast. It doesn't. It filters with your blood system and all that just as quickly as your blood would. And you being able to drive. So when it does come time to consuming alcohol, you really need to look at a few things. How old is your baby? Because a really young baby under 3 months has an immature liver, so they can't process alcohol as quickly as an older baby can. So you really need to look at your baby's age, how long in between drinks you're going. Also, too, have you eaten? Have you eaten before you started drinking or while you're drinking? And how hydrated you are. Make sure you're drinking lots of water too in between drinks. But they do say a standard, standard size drink is okay. And they say it takes about 2 to 3 hours for the milk to be cleared in that and safe to feed. So I always recommend, you know, have a drink and then wait. So feed baby, have a drink, because then you usually get like, you know, a nice little sleep, and then feed the baby again after that 2-hour mark or whatever. But I really do want people to know that you can still drink. It doesn't mean you can't drink, but there is a safe limit as well too. Like, I don't want you going out there, you know, willy-nilly and having, you know, 5, 6 drinks and breastfeeding right after because the alcohol level will probably be a lot higher then in your blood system. So this is where I recommend, if you don't feel comfortable enough to feed your baby, then pump, but don't pump and dump. Pump and save that milk, properly label it, and use it for, you know, milk baths or for their skin or things like that. Put it in the freezer. But You don't necessarily have to pump and dump, but you still need to be mindful again of time, your age, your baby's age. Sorry, not yours. It doesn't matter how old you are.

Make sure you're over 80.

Yeah, that's true. Sorry. [LAUGHTER] But not like how old your baby is. And then also too, food, because those really do impact. It's just like, you know, when you used to go out and have like a night out, you know, you always, you would always be hit harder if you didn't eat beforehand. So it's just those things in mind when you're consuming alcohol. It doesn't mean that you can't while breastfeeding because gosh almighty, we deserve to have a nice glass of wine every once in a while. Like we've just birthed a baby, we're breastfeeding a baby. It's, it's high demands. Like, you know, we want to enjoy social time. So it doesn't mean you can't enjoy social times. Just be more aware and conscious of it.

Yeah, 100%. It's just once again, it comes down to having the knowledge and being able to do it safely.

Yeah, and that app is fantastic. Like, you can put in your weight, your height, all that kind of stuff, and it literally will tell you how long it takes to get the— to clear the alcohol from your blood system. So I highly recommend it. It's a great app.

Yeah, and it's really user-friendly. It's super easy.

Yes.

You know, most moms usually could return to work anywhere, you know, hopefully not as soon as 6 weeks, but we know that some parents have to return to work quite quickly, anywhere up to, you know, a year after or 2 years after, and most of the time they're still trying to breastfeed. And that's when expressing can be really great as well. Do you have any tips for moms that might be returning to work or how to manage that expressing time to keep up their supply?

Yes. So I would recommend you would normally pump whenever baby would naturally have feed. So at 6 weeks, they could be feeding every 2 to 3 hours. So I'd be recommending to try to get on your pump every 2 to 3 hours at work if you can. I would also talk to your employer about the fact that you might need a private room to be pumping. So sometimes, you know, say going to the bathroom, nobody wants to go pump in a dirty bathroom. So try to find a room that you feel comfortable in with pumping. And then the next big tip is bringing an insulated lunch bag. So if you don't have access to a fridge at work and you can put the milk in there, but still bring the insulated lunch bag because some people don't like seeing your breast milk in their fridge. [LAUGHTER] communal work fridge. So what you can do is when you put some ice packs in there, once you pump, throw your milk into them and put it in the fridge. So then this will keep your everything nice and cool. So when you have to go from work to home, your milk stays still safely and properly stored.

Yeah, super, super important. And I think it's just about having that conversation with your workplace. To make sure that, you know, they should absolutely allow you to take breaks to pump because it's so important and you wanna make sure that you still are keeping up with that supply and demand because you're gonna be having to give your baby that breast milk even if they are still at daycare or things like that.

[Speaker] And especially because like, and you can put it to your employers too, like, look, by me giving breast milk, I'm actually giving my baby more immunity so they don't get as sick, so I don't need to take more time off work. [LAUGHTER] So like, honestly, like, Rice milk is incredible. So it does, it can help with those things. And it's just, it'll make it, it's, it's smarter for your employer to give you a little break to do it because they can decrease the amount of sick time you have to take, which we may not like. Might need a break sometimes, but yeah, it makes it beneficial.

Yeah. And this links very well into my next question is some women might actually exclusively express, and that might be a decision that works best for them and that's why they're doing it, but still there might be other indications like, you know, say they're out with friends at dinner and they actually still need to express, or they've got a wedding or they're going away somewhere. How can they express in public? Do you have any tips to how to best navigate that?

Yes, so pumping in public, look, it's going to be a bit tricky no matter where you are. To be honest, check to see some places they have like parent rooms. A lot of places now are upping their game. I have to be really honest, like, I'm pretty impressed sometimes when I go to places and see like their baby changing rooms and stuff like that. They have a little area you could sit and you can pump in. But if you're, say, you're somewhere where you can't get the privacy, what I recommend doing is trying to go somewhere where it's a little bit more discreet. Maybe using a swaddle tied around your neck to put the pumping parts on, the flange and that. And set yourself up. Also too, make sure you're wearing breastfeeding-friendly clothing because they can offer a little bit more discretion too, because you can just kind of, you know, cover your chest up. But I would recommend looking into a cover that you can put over yourself because that can give you the privacy to make you feel comfortable, to help relax yourself, to help get that milk flowing as well too. And while you're doing it, try— well, we mentioned this before— looking at pictures of the babies, videos of the babies, so that it can help with that milk flow too.

And I mean, everyone's different with their comfort levels. You know, for some women, they may think that that's absolutely not what they wanna do and it's, you know, not for them, and that's okay. But it's just making sure once again, we're keeping up with that supply because we don't wanna be skipping feeds because it has an impact on our supply.

That's exactly right. You need to drain the breast to make more.

Yes, you know, we were talking about this before we started recording and it was all to do with safe storage of breast milk because you and I both have seen some very questionable things and for some parents knowing how long breast milk can sit at room temperature for, in the fridge for, in the refrigerator for, it's so, so hard to know exactly what the right time frame is. So can you explain to us Courtney how long our breast milk can stay at room temperature or in the fridge fridge or freezer?

Yeah, definitely. So at room temperature, and this is something I really want people to know too, is that in different countries, if you're listening from a different country right now, please check your country's guidelines because each country, even New Zealand who's next door to Australia, has different guidelines than Australia does. And the same with the UK, US, all that. So make sure you check your country's guidelines to be sure. So here in Australia, If you've just pumped breast milk and you've left it on the counter at room temperature, it is good for 6 to 8 hours. Okay, so that's room temperature, 6 to 8 hours. They do recommend trying to get into the fridge closer to the 3 to 4 hour mark as quick as you can because it just helps just preserve that milk and everything that's in all that good juicy stuff in it. So I would recommend making sure that you try to get it in more around that 3 to 4 mark, 3 to 4 hour mark. Sorry. So if you were to take that milk and put it into the fridge, and when you store your milk, you need to store your milk towards the back of the fridge, because if you're storing it in the door of the fridge, how many times a day are you opening up the door? So that changes the temperature. So this is why they always say the back of the fridge, and it's good for up to 3 days. So that's 72 hours. Before that 72-hour mark, if you're not going to use that milk, make sure it's properly labeled. Always, always make sure whenever you put milk in the fridge that it's properly labeled. The date, and the time. So those things are really important because different times, periods of the day, you do get juicier hormones. So at nighttime, you get a thing called tryptophan that can help with sleep overnight. So trying to give nighttime milk at nighttime is really good. But also too, if you're collecting milk throughout the day and you're adding it all together, you need to know when the first pump of the day was. So say at 8 AM you pumped, and then you pumped again at 11 and 2, when you add all that milk together, it will expire in 3 days at 8 AM. So if you pumped on a Monday, it's going to expire Tuesday, Wednesday, Thursday, right? Tuesday, Wednesday, Thursday. I'm counting on my fingers.

That's right, I have to too, don't worry.

Thursday at 8 AM. So it's really good to write those things down so you know, and then when you put it in the freezer So if you have just a freezer that sits next door to the fridge that you just pull open, that freezer is good up to 3 to 6 months depending how far back you store the milk in that in the freezer. So you always want to use your most— your latest milk first so it doesn't expire in the freezer. That's why it's so important to write the dates and times. And then once you do take the milk out of the freezer and say you have a big chest freezer, like I know in Canada growing up because we lived pretty rural, we had that good old school chest freezer in the garage. And so if you're storing breast milk in there, it's good for up to 12 months in there, 6 to 12 months, which is incredible. So if you have a chest freezer in the garage, make sure you're storing milk in there because it can last longer and gives you longer time. But once you do take breast milk out of the freezer and you thaw it— so say you pop it in the fridge and it's thawing, it's 24 hours. So once that milk is thawed and you've popped it in the fridge, I just say pop it in the fridge at nighttime So by the time you wake up in the morning, it's thawed and it's, you know, you can just warm it up and use it. But 24 hours from when it starts to thaw. And when you warm up milk from a frozen state or even from a fridge where it's already just a liquid state, you need to go from cool to warm. It's good for 2 hours afterwards, 2 to 4 hours. So once you've heated that up, 2 hours, I usually say the max, and just make sure you're giving that milk in that time frame. And we talked about this before, warming up milk. Like, I think this is something really important to cover. A microwave is not your friend, okay? A microwave, little bubbles and pockets of heat that can burn the baby. So it doesn't evenly warm the milk. Where if you're just to get a mug, just get a big mug, put in— like, put the kettle on for a quick little bit, or even just grab hot water from the tap and let the bottle sit in the mug to warm up. It will be warm really soon, it won't take long. So when you're warming up as well, it's really important to be safe about how you're warming up that breast milk.

I can't tell you how many times when I've visited families in hospital and no one's, well, I've visited families at home and no one's really shown them how to properly heat up breast milk in the hospital and I see them getting it out of the microwave and I'm like, in the corner of my eyes, I'm like, did you just get that out of the microwave? And they're like, yes. And I'm like, okay, that's all right, but here's actually the correct way to do it. We probably don't wanna give that because we might scold your baby, but here's how to do it properly.

[LAUGHTER] Yes, exactly. But like, they don't get taught this. Like, this is why I'm so passionate about catching parents and giving them breastfeeding classes before they have their baby, because they just need to learn these things. Nobody teaches them, and then they're just expected, okay, here's your baby, go survive here, you know, like, so hard for parents nowadays and there's just no support.

Absolutely. And I guess that's why we do what we do, because we see it all firsthand. Um, and you know, even when we're— we've worked in— I've worked in special care, you've worked in the NICU, um, we know how tricky it can be to look at all the different types of bottles and work out which milk is going to be used first and when it came out of the freezer how long it can be used for. So that's with knowledge behind us. For a parent that hasn't educated themselves, like, it's just a whole different ball game, and it can be really, really challenging.

That's it. And like, even in the hospital too, I think it's important to know we have to get milk checked by another nurse. So two people have to check the milk to make sure that what we're doing is actually correct. And that's really important for you. Like, you don't even know. Like, in here we are getting two trained people to check it.

Yeah, and often a question that I get is, if I expressed 3 hours ago and I've just expressed now, can I mix the two expressions to have more milk? And absolutely you can, definitely.

The only thing I always say to parents is, if you've had— you just expressed milk, that's warm milk. If you have milk in the fridge, that's cold, you can't mix them together. You need to put the freshly expressed into the fridge, let it cool down, then mix it together. And like, this goes back to where I was saying, like, you know, make sure you're labeling, um, morning from night because of the juicy hormones. If you're just getting enough milk to do one bottle a day and you're only doing one bottle a day, combine all that milk together. It's fine. It doesn't matter as long as baby's getting the milk. It does not matter. It is really important that all milk is at the same temperature when being mixed because you don't want to increase the risk for possible bacterial growth.

Yeah, absolutely. And, you know, heating up and storing breast milk is one thing, but then also going into sterilizing bottles and breast pumps, lots of parents aren't actually sure how to do that either. And you and I know how important it is to sterilize equipment correctly because in hospitals we're going through bottles and pumps so frequently because we want to reduce the chance of any bacteria growth. We're going to start to explain how to sterilize equipment and what parents need to know. So Courtney, how often do parents need to sterilize their bottles?

So you need to be sterilizing at least once in a 24-hour period. So a good trick that I always say to parents is at nighttime, you're tired, don't do the sterilizing at nighttime, okay? We're exhausted. So at nighttime instead, put your bottles in the dishwasher. Set the dishwasher, have it go overnight, because that considers as a clean. Because after every single use, you need to be cleaning with hot, warm, soapy water. Then in the morning, mid-morning, after, you know, you've got through the morning craziness, you've had your coffee, you're feeling a little bit more human, then do the sterilization. It's a little bit easier then.

Absolutely. And what about for our breast pump equipment?

So when it comes time to, uh, sterilizing your pumping parts, the tubing, you never have to sterilize that. If you get water in it or milk in it— if you've got milk in it, there's another issue happening— but if there's water in it for some reason, then this is where I just recommend exchanging it. You should be changing your tubing every 6 months. And if you get anything in it, I would just change your tubing. So when you're buying your pumps, get extra pumping parts. I always say grab 1 extra tubing and grab 2 to 3 extra flanges, not the nipple flange but the membrane. So the membrane, that's that little white thing that sits in between the pump, like where the nipple flange is and where the milk goes into the bottle, and those white things need to be changed really frequently, 2 to 4, every 2 to 4 weeks you'll be changing those. So when you take your pumping parts, when you take your pumping parts apart— that's a tongue twister.

I know, I knew exactly what you were saying and I was like in my head trying to say it too.

So take the nipple flange, you clean that, you sterilize that, you're going to sterilize the bottle, and then you're going to sterilize the, um the part where— it depends on the pump that you have too— the part that attaches to the bottle and your flange. You need to sterilize that because that's where the milk is going in through and down, where that membrane sits, that white membrane we're just talking about. So those are the pumping parts you need to be sterilizing and cleaning frequently. So like I just said, you should be cleaning after every pump. Hot, warm, soapy water, clean it up, and then sterilize once in a 24-hour period. Now there's Multiple ways you can sterilize. Cold sterilization. A really great thing about cold sterilization is that you can do it anywhere, like we said before. But with cold sterilization, you really need to be careful that when you do sterilize your bottles and they've gone, you know, you've left them in to sterilize, whenever you put your hand in that water, you have now made it unsterile. Your hands are not sterile, they're dirty, you know. If you would pick up a bottle or a teat out of there to mix the bottle up or grab your pumping parts, that water is now sterile— unsterile now. So once you've sterilized everything, always store everything in a container, a Tupperware container that you can put all your pumping parts into that's been sterilized and nicely cleaned, whether you're boiling, microwaving, um, using cold water technique, whichever way you're sterilizing, always have a separate container to keep everything that's sterile in it. And those little tongs, I know it's corny seeing when you see those little tiny tongs, but they work so well and it helps keep things sterile.

Yeah, and you mentioned the cold water sterilization, and there's lots of different ways that we can sterilize bottles, um, and parts, but But I guess the positive thing about cold water sterilization is if you're out and about and you're traveling around, having access to that just makes it so much easier for parents because they don't have to go looking for that boiling hot water or a microwave. So yeah, Milton do have a really great cold water sterilizer that parents can use.

Yes, definitely, which allows— it makes it easier because when you're out and about, giggling-suit, you barely have time to pump, let alone clean all your pumping parts.

Yeah, you want to just make, make it that little bit easier.

Yes, but a big tip and trick too when you're out pumping, bring two massive big Ziploc bags. I always say Ziploc, but you guys call it something different here. Sorry, I always forget what you guys call it, but a big bag that you can store your clean pumping parts in and your dirty pumping parts in, and maybe even an extra one for when you need to sterilize.

There's just so much to consider, isn't there?

Honestly, there is so much. Honestly, like, I don't know how— why don't we are educating parents more before birth about all this stuff? Because once you've had the baby, you're sleep deprived, you're exhausted. It's so much harder then, and you're already in the trenches where we don't want you to be in the trenches. Like, no, it's so hard.

Yeah. And you think about how long we've just spoken for about one specific topic, and that's been about an hour. We do not have the time to educate families like this in hospital, and that's why it's so important to do your own research and listen to podcasts like this one with experts that actually work in the fields and do this firsthand to know that it really is beneficial to learn.

Exactly, 100%. Like, taking it upon yourself to do education before your baby's here is one of the best things you could do.

Mm, absolutely. And Courtney, that pretty much wraps up this episode. You have been such a wealth of knowledge, and I didn't— I didn't write this question down for you, and I'm really throwing you, um, under the bus here, but it is a motherhood question, and you have managed to settle a baby to sleep, play with the baby, all while recording this episode. I don't know how you've done it. [LAUGHTER] But Hadley is sound asleep now in Courtney's arms. For you being a mom, what do you think has been one of the most challenging parts?

Hmm, that's a good question. See, I have 3 now, so I think that's important to know. So I have 3 children and my children are all less than 2 years apart. So I had 3 under 4 at one point. I think the hardest part of motherhood has been how much you change as a person and how much— I didn't know how incredible motherhood could be, but also how hard it could be. I knew it would be hard, but it's not until you're in it that you understand it. Like, I think the biggest thing was that I didn't know who I was for a bit when I first had my baby, my first son. It's hard because you lose yourself in motherhood sometimes. Finding who you are within motherhood in that journey, where you feel like you're absolutely smashing motherhood. You're like, yeah, I'm on top of this. But I think being like a NICU nurse, and I was doing all these private consults for families, as well as a lactation consultant, sleep consultant, I really lost who I was as a mom— as, as a— not as a mother, as me, as Courtney. And I always say to parents, like, that's really important that you find who you are within motherhood too, because it makes me such a better mom. Like, me doing this, like, right now, like, even though I have Hadley on my lap, I'm doing this because I love doing this, and this is what me, Courtney, is, and not as a mom. And I think that's really important. I think that was one of the biggest challenging things. And then obviously, the more kids you have, you worry about having the time for each child, and I think that's one thing I really worried about. But as mothers, I've learned we are the most incredible human beings. I'm sorry, men, like, I hate to throw your name right now, but mothers really do— they can adapt to anything. Like, we can multitask 6 different lists in our head and we can still deal with, you know, what to feed children. And I really think that motherhood shows you how patient and incredible you actually can be.

You just answered that so beautifully. You did so well, so well considering I just threw you under the bus to answer it. But it is so important, and I guess for so many parents, they can lose sight of who they once were before being a mum. And it's that identity shift and adapting to this new version of themselves. But it's okay to miss part of your old life and what you used to do, and it's making sure you take time to do something that really serves you because without realizing it, you're serving this little person every single day, and that takes a heck of a lot.

And it's not just during the day, it's 24/7. Like, I think that's another thing too. Like, it's literally 365 days a year, 24/7. Like, there is no breaks. There is, but there isn't. Like, you may get a break, but you're still, like I said, itemizing things in your head. Yeah, groceries, or do I have enough nappies? So yeah, 100%, like, I completely agree with you. I think motherhood, it's just a whirlwind, but an incredible whirlwind.

Yeah. And looking after yourself is so important. And I know we touched on it a bit earlier about, you know, maybe needing to express because at that point in time, the breastfeeding just seems way, way, way too hard. And I know you share the same views as me, Courtney. It's the mom comes first in some cases, and it's okay to express rather than put the baby on the breast if that's what you need to do for your mental health to get yourself in a more positive place.

That's it. And like, as a lactation consultant, I'm here to teach you and to keep you safe, you and your baby, the dyad. I'm here to keep the two of you in the best possible position you two can be in. If breastfeeding is getting too hard now, Okay, let's look into other options. Let's look into expressing. Let's look into bottling. But I'm going to teach you how to do all those things the right way so that you can still carry on doing the right things for you and your baby. Because you're right, at the end of the day, the only thing that matters is how that mom is feeling. That is the only thing. And this is where, like, why you and I both know, like, on my page I teach you everything because a breastfeeding journey is not always one path. A breastfeeding journey can be 2, 3 different paths. It can change. And, you know, motherhood journeys can change. So you're exactly right. And I think another one too we didn't cover, but I just thought of this, but, you know, like with parents, our partners are really wanting to give a bottle. They're really wanting to have that connection and connect with the baby. And so this is where we start to pump and use expressing for the partner to give a bottle so you can maybe, you know, have that relaxation, have a little bit of self-time. Or, you know, it's really important that there are so many different ways to breastfeed, and it doesn't have to be an all or nothing. It doesn't have to be just only breastfeeding. You can breastfeed so many different ways. You can mix feed. There's so many different ways to still help your baby and give your baby the best nutrients that they need.

Absolutely. Um, well, Courtney, thank you so much for coming on. You've been such a joy to speak with, and I'm so grateful for you to come on and share your knowledge with not only me but my audience too. Um, you've done amazing things in the motherhood, parenting, pregnancy space on social media. So where can our listeners, my listeners, find you?

Oh, thank you you so much. And thank you so much for having me. It's been awesome. Like, we've connected ages ago on Instagram, and it's so good to finally like see you face to face and do this podcast with you. I'm so excited to be here. I can't wait to come back again.

Yes, please come back.

But with, uh, if you're ever looking for any type of help towards your baby feeding or sleep, my page is @mamalink. So that's M-A-M-A-L-I-N-K. NC. So it's on Instagram, Facebook, TikTok, you name it, you can find it.

But thank you so much, Courtney, and you have a wonderful day.

Thank you, you too, Lauren.

Bye-bye.

Thank you for listening to today's episode of Middie. Your support means the absolute world to me. So if you loved this episode and want to stay up to date with the latest interviews and midwifery education, please hit the subscribe button and leave a 5-star review. For further information about this episode, please check the show notes below. If you wish to share your pregnancy and motherhood experience, you can get in touch with me by emailing hello@themiddiesociety.com.au and find us on Instagram at @themiddiesociety or @monique_maitland. I cannot wait for you to join me next week I'll be talking all things Flapchat. In the meantime, I hope you have an amazing week, and remember, you're doing the best you can.