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  3. Creating an Express-and-Feed Routine
Course Content
Why Breastfeeding Matters (10 minutes)
Health and developmental benefits for infants Maternal benefits (physical and mental) Economic and community-level advantages Common myths and culturally specific misconceptions
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Health & Developmental Benefits for Infants from Breastfeeding
Maternal Benefits of Breastfeeding (Physical and Mental)
Economic and Community-Level Advantages of Breastfeeding
Common Myths and Culturally Specific Misconceptions about Breastfeeding
Newborn Feeding Cues & Anatomy (20 minutes)
Early vs. late hunger cues and what they mean Normal newborn feeding patterns and stomach capacity Brief breast anatomy (lobes, ducts, nipple, areola) in plain language Signs of effective feeding (swallowing, contentment, diaper output)
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Early vs. Late Hunger Cues in Infants
Normal Newborn Feeding Patterns and Stomach Capacity
Breast Anatomy (in Plain Language)
Signs of Effective Feeding in Breastfed Babies
Positions & Achieving a Good Latch (40 minutes)
Position options: cradle, cross-cradle, football/clutch, side-lying Stepwise approach to help baby latch (prepare — attach — assess) Signs of a good vs. poor latch (comfort, nipple shape, audible swallowing) Small-person adaptations (premature, small mouth, tongue-tie considerations) Safe positioning for mothers with C-section recovery
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Position Options for Breastfeeding
Stepwise Approach to Help Baby Latch
Signs of a Good vs. Poor Latch
Small-Person Adaptations in Breastfeeding
Safe Positioning for Mothers with C-Section Recovery
Protecting & Building Milk Supply (25 minutes)
Establishing supply in the first days and weeks (frequency, skin-to-skin) Night feeds and cluster feeding explained Lifestyle and medical factors that reduce supply (e.g., certain medications, stress) Relactation and increasing milk supply safely Nutrition and hydration myths vs. evidence
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Establishing Milk Supply in the First Days and Weeks
Night Feeds and Cluster Feeding
Lifestyle and Medical Factors That Reduce Supply
Relactation and Increasing Milk Supply Safely
Nutrition and Hydration Myths vs. Evidence in Breastfeeding
Expressing & Storing Breastmilk (20 minutes)
Hand-expression steps and common mistakes Choosing and using pumps (manual vs. electric) — practical tips Safe collection, labeling, storage, thawing and warming guidelines (low-resource options included) Cleaning and hygiene for bottles and storage containers Feeding expressed milk to infant (cup, spoon, paladai, bottle considerations)
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Hand-Expression Steps and Common Mistakes
Choosing and Using Breast Pumps (Manual vs. Electric)
Safe Breast Milk Handling
Cleaning and Hygiene for Bottles and Storage Containers
Feeding Expressed Milk to Infants
Common Problems & Practical Solutions (25 minutes)
Causes of sore nipples and immediate relief techniques Managing engorgement and preventing blocked ducts Recognising mastitis vs. normal engorgement and when antibiotics may be needed Low weight gain: assessment steps and feeding plan adjustments Non-judgmental approach to supplementation and safe short-term options
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Causes of Sore Nipples and Immediate Relief
Managing Engorgement and Preventing Blocked Ducts
Recognising Mastitis vs. Normal Engorgement
Low Weight Gain — Assessment and Feeding Plan Adjustments
Non-Judgmental Approach to Supplementation
Returning to Work or School; Feeding Outside the Home (15 minutes)
Creating an express-and-feed routine (timing, containers, transport) Practical storage and transport tips for different commute types Rights and workplace basics (general guidance; encourage local legal verification) Communicating with caregivers and preparing safe feeder notes Emotional coping and practical fallback plans
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Creating an Express-and-Feed Routine
Practical Storage & Transport Tips for Expressed Breast Milk by Commute Type
Rights and Workplace Basics for Breastfeeding Mothers
Communicating with Caregivers and Preparing Safe Feeder Notes
Emotional Coping and Practical Fallback Plans
Special Situations (20 minutes)
Feeding preterm or low-birthweight infants: kangaroo care, cup or tube feeding basics Managing twins/multiples: tandem feeding tips and time-saving routines Mothers on medication or with infectious illness: how to check drug safety and local guidelines (HIV, TB, etc.) Using donor milk or milk banks (where available) — safety basics
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Feeding Preterm or Low-Birthweight Infants
Managing Twins/Multiples — Tandem Feeding Tips and Time-Saving Routines
Mothers on Medication or with Infectious Illness — Drug Safety & Guidelines
Using Donor Milk or Milk Banks — Safety Basics
When to Seek Help & Building a Support Network (15 minutes)
Red flags for baby and mother (e.g., poor weight gain, fever, severe pain) Where to seek help: clinic, CHW, lactation consultant, emergency care Building a support network: partners, family, peer counsellors, community groups Using telephone/text supports, community groups, and referral pathways
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Red Flags for Baby and Mother
Where to Seek Help for Breastfeeding Challenges
Building a Support Network for Breastfeeding Mothers
Using Telephone/Text Supports, Community Groups, and Referral Pathways
Wrap-up, Resources & Final Assessment (15 minutes)
Key takeaways and common pitfalls to avoid Next steps: seeking local support, advanced training options How to use course materials beyond the course (groups, sharing, peer support) Final 20-question multiple-choice quiz (80% pass mark)
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Key Takeaways and Common Pitfalls to Avoid
Next Steps — Seeking Local Support & Advanced Training Options
How to Use Course Materials Beyond the Course
Final 20-question multiple-choice quiz (80% pass mark)
How to Breastfeed — Self-Paced, Evidence-Based Course for African Moms

1. Introduction

Many mothers need to express milk for times when they are away from their baby. A consistent express-and-feed routine ensures that babies continue to get breast milk safely while mothers protect their supply.

2. Timing — When and How Often to Express

  • Establishing supply (first 6 weeks):

    • Express 8–12 times per day (same as baby would feed).

    • Best times: early morning (milk volume often higher).

  • After supply is established:

    • Express every 3–4 hours during work/school separation.

    • Try to match baby’s feeding schedule.

  • If exclusive pumping:

    • Maintain 8 sessions/day early on, then adjust to at least 6.

  • Night sessions:

    • At least 1 expression between midnight–5am supports prolactin surge.

3. Containers — Collection and Storage

  • Preferred containers:

    • Clean, food-grade cups or glass/plastic bottles with tight lids.

    • Special breast milk storage bags (designed for freezing).

  • Labeling:

    • Date, time, and baby’s name if for daycare/hospital use.

    • Use oldest milk first (“first in, first out”).

  • Low-resource options:

    • Clean cup with secure cover.

    • Avoid disposable plastic bags not designed for milk (risk of leaking/contamination).

4. Storage Guidelines (WHO/CDC Aligned)

Location Safe Duration
Room temp (≤25°C) 4–6 hours
Insulated cooler with ice packs ~24 hours
Refrigerator (≤4°C) Up to 4 days
Freezer (-18°C or lower) 6 months (best within 3)

  • Never refreeze thawed milk.

  • Thaw in fridge or in container placed in warm water (not boiling, not microwave).

5. Transporting Expressed Milk

  • Cooler with frozen ice packs if transporting to daycare/workplace.

  • Keep containers upright and sealed.

  • Transfer to fridge/freezer immediately upon arrival.

6. Creating a Routine: Step-by-Step

  1. Plan daily schedule (work hours, feeding times, pumping breaks).

  2. Choose comfortable pumping spot (privacy, clean surface, handwashing available).

  3. Keep supplies ready: pump, storage containers, cooler bag, labels.

  4. Express at consistent times → keeps supply stable.

  5. Store safely → follow labeling and cold-chain rules.

  6. Transport properly → use cooler bag if traveling.

  7. Communicate with caregivers → teach safe thawing and feeding.

7. Feeding Expressed Milk

  • Use cup, spoon, paladai, or bottle depending on age/resources.

  • Practice paced bottle feeding if using bottles — prevents overfeeding.

  • Warm milk gently in warm water, never boil or microwave.

End of Lecture Quiz

Q1. How many times per 24 hours should a mother express in the first weeks postpartum to establish supply?
A. 2–3 times
B. 4–5 times
C. 8–12 times
D. Once daily

Answer: C. 8–12 times
Rationale: Matches newborn feeding frequency and supports robust supply.

Q2. Which of the following is an unsafe practice?
A. Labeling milk with date and time
B. Transporting milk in cooler bag with ice packs
C. Thawing milk in hot water or microwave
D. Feeding milk by cup in low-resource settings

Answer: C. Thawing milk in hot water or microwave
Rationale: Microwaving or boiling destroys nutrients and creates dangerous hot spots.

Q3. True or False: Thawed breast milk can be refrozen if not fully used.
Answer: False
Rationale: Once thawed, milk must be used within 24 hours and never refrozen.

Curated Online Resources

Key Takeaways

  • A consistent pumping routine protects supply and ensures baby gets breast milk even when separated.

  • Use safe containers, clear labeling, and proper storage/transport to prevent spoilage.

  • Express at least 8–12 times/day early on, adjusting as baby grows.

  • Safe feeding methods (cup, spoon, bottle with pacing) ensure baby gets milk without risks.

Call to Action

  • Mothers: Start early to practice hand expression and plan storage routines before returning to work.

  • Health workers: Teach safe milk storage and transport, especially in low-resource settings.

  • Communities: Support mothers with clean storage options, workplace pumping breaks, and caregiver training.

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