Hospital Universitario La Zarzuela Madrid


Breastfeeding Unit


Maternal milk is the best food for the majority of babies. Its composition provides the child with the necessary amount of nutrients at each stage.

  • Place yourself in the most comfortable and relaxed position possible, with your back straight and supported.
  • Wash the breast before feeding.
  • Massage the breast before each feeding with circular motions, pressuring towards the ribs.
  • Place your baby in front of the nipple belly-to.belly, hold the breast forming a "C" with your index finger and thumb (see Cradled Position on the following page). The nipple should be facing the baby's nose. The baby's mouth must be open wide, covering the nipple and areola such that the lips are spread outwards and the nose and chin are stuck to the breast. Thus, the baby can breathe perfectly.
  • Remember that breastfeeding must be "on demand". It is normal for the baby to frequent feedings in the first days. The baby's suction is the best stimulus for producing the milk let-down.
  • Allow the baby to suck one breast calmly. The breast must be emptied before moving to the other one, so that the baby receives milk rich in fat.



Try changing positions when breastfeeding. This will help prevent cracks and will help the baby to empty the breast completely.

  • Cradled. The mother will be seated on the bed or chair; the baby's head will be supported by the mother's forearm.
  • Cross Cradle. The baby's head will be supported in the hand of the mother.
  • Lying down. The mother and baby will be lying on their side, facing one another. This posture is very useful in the first days after labour or at night time at home.
  • Rugby ball or football. The mother will be seated on the bed or chair with one pillow behind her back and another under her arm. The baby will be leaning backwards, alleviating pain in the nipple and emptying the external area of the breast.



They are caused when the baby does not latch on correctly. To prevent them and alleviate pain:

  • Ensure that your position is correct. The baby's mouth must be wide open, covering the nipple and the areola.
  • To remove the baby from the breast: introduce your little finger into the baby's mouth to break the suction and remove them with no problems.
  • You can apply a few s of your milk after each feeding and leave to dry. Afterwards, apply a lanolin or calendula ointment.
  • Avoid moisture on the nipple. Avoid using nursing pads and if you use them, change them often.
  • Try to change posture when breastfeeding.

It is produced with the milk let-down. In the first week after labour it is frequent for mothers to experience engorged, burning or painful breasts. To alleviate the symptoms we recommend:

  • Applying moist heat before each feeding.
  • Massaging the breasts as indicated in Figure 1.
  • At the end of the feeding you can apply cold cloths.
  • It is caused by a breast infection.
  • Fever and malaise appear.
  • Keep an eye out if you experience burning, hardness or redness of the breasts.
  • Consult with your doctor. This infection is treated with antibiotics.
  • During the first days, colostrum is produced.
  • The baby's suction makes the milk production increase.
  • Breastfeeding should be established in the first week of life.
  • If this does not happen, consult your paediatrician.
  • After the first 4-6 weeks, the baby can increase the milk demand for a phase of growth.
  • The frequency of feedings increases and thus the production of milk will increase.
If at any time you think you are producing less milk, try to increase the frequency of feedings and thus your milk production will increase.


The expression of breast milk is a technique that s learning and practice. Breast milk can be obtained by manual expression, with manual or electrical pumps.

  • Before expressing milk you must wash your hands with soap and hot water and follow the manufacturer's instructions to wash the pump and its parts.
  • Before use, you must wash it meticulously with soap and hot water, sterilise all the parts of the pump and the containers that will collect and store the milk and leave them to dry naturally.
  • Find a quiet and private place you feel comfortable for expression and you have the collection equipment clean and ready to use.
  • You can even lie down for 10 minutes, listen to soft music or perform abdominal breathing exercises.
  • Apply heat to the breasts, taking a hot shower or bath or applying hot moist compresses, particularly if they are very engorged or hard.
  • The stimulation of the nipple with soft circular movements before expression promotes the secretion of oxytocin, thus stimulating the milk let-down reflex.
  • To stimulate the breasts, a massage can be performed as follows:
    • Squeeze the breast firmly with the fingertips towards the rib cage (ribs), performing circular movements without sliding the fingers on the skin.
    • After a few seconds, change to a different part of the breast.
    • Rub the breast gently from the upper part towards the nipple, producing a tingling sensation.
    • Continue this movement from the outside of the breast towards the nipple. Finally, shake both breasts gently, leaning forwards.

Marmet technique or manual.

  • The first few times, we will use a sterile container as small as possible, even a syringe with the piston removed, thus to collect the first lets of colostrum.
  • Squeeze the breast firmly, starting from the outer edges and moving towards the nipple, placing the thumb and index and middle fingers at a distance of 3 or 4 cm from the nipple, such that they form a “C”.
  • This distance must be taken as a reference and not the edge of the areola as these vary in size in each woman.
  • Press the fingers towards the ribs and squeeze the thumb, index and middle fingers towards the nipple (if the breast is very big you must lift it a little before pressuring towards the ribs), using an open hand or using the thumbs and index fingers of both hands in a circular shape around the breast. This will help the milk to flow towards the breast. Support the breast from below with a hand.
  • Place the thumb of the other hand on top of the breast close to the outer edge of the areola and your index finger in a similar form on the lower part.
  • Squeeze the thumb and index finger firmly towards the ribs and then continue with firm pressure, squeezing the finger and thumb towards each other to express the milk from the ducts. The finger and thumb must not slide on the skin or squeeze the nipple.
  • To be able to express milk from all the ducts, the position of the thumb and index finger must be rotated around the areola. Some areas will be more productive than others. Establishing a rhythm helps to express milk. When the amount of milk being ed reduces, start to massage and express the other breast.
  • The first breast can also be massaged and expressed again. Learning to express with both hands helps to reduce fatigue. The hand-expression process takes approximately 20 minutes. You do not have to stretch, press down on or rub the breast. The hand must rotate around the breast to massage and squeeze all the areas. Each mother develops her own natural style, and so rigidly following a method can be er-productive. The efficiency is measured by the comfort with which the milk is ed. At the start it is common to obtain just a small amount of milk, and so you should not be disheartened and continue trying.
  • Massage the breasts as indicated.
  • The breast pump must be washed according to the manufacturer's instructions.
  • Wash your hands before setting up the equipment and do not touch the parts that will be in contact with the milk.
  • Moisten the edges of the pump cups with warm water to obtain a tighter adaptation, apply it to the chest focusing on the nipple and use the unit.
  • In electrical pumps, start with the lowest suction intensity and increase gradually as much as possible without feeling discomfort.
  • If it hurts a lot with the electric pump, perform manual expression at the ning. Try to clear the breasts a little and an amount of milk similar to that which the baby would consume in a feeding, or a little more. Do not persist until emptying the breast; the more you express the more you produce later.
  • The milk may take a minute or two to start to come out.
  • You should check the correct adjustment of the cup regularly, observing the rhythmic movements that the nipple must make. Going faster does not make more milk come out.
  • Throw away the first lets.
  • Start with short and fast suctions of a few minutes and move on to longer, slower suctions the rest of the time, ensuring that the nipple protrudes well.
  • Start with one breast for 7 minutes or so, change breast and stimulate for another 7 minutes.
  • Return to the first breast and stimulate for 5 minutes; change to the other for 5 minutes.
  • Return to the first for 3 minutes; change to the other for 3 minutes.
  • The times are for guidance; the idea is to alternate from one to the other in order not to irritate the breast too much, and in decreasing periods in order not to stop the stimulation drastically and simulate the suction of the baby, which gets tired as it sucks.
  • It may be that with the let-down of milk, the breast gets hard and no milk can be expressed. This is normal; you should relax and not get disheartened; it is something physiological and will improve if you apply moist heat a while before.
  • Applying cold cloths after the expression will alleviate the engorgement.
  • Once breastfeeding is established, we will empty a breast fully in each expression to obtain milk as complete as possible and the appropriate amount to cover the baby's feedings. At times it will be necessary to express from both, emptying one and finishing with the other and starting with the second breast in the next expression.
The more refrigerated it is and the fewer changes in temperature to which it is subject, the better, and so it will be necessary to have a mobile fridge or an isothermal bag and blocks of ice, cold packs or a small bottle of frozen water. If the milk is expressed outside of the home; for example, in the workplace, it can be useful to have a small mobile fridge. There are specific fridges on the market which a compartment for the pump but any beach fridge will perform the same and probably be more economical. The mother can introduce a bag or block of ice into the fridge every morning and take it to work. After expressing the milk and depositing it in the containers to transport it, all the utensils are kept inside the fridge to travel back home.

Once there, they can be stored in the fridge to be consumed in the following days (it lasts 48 to 72 hours inside the fridge) and it can also be frozen if it is not going to be used in this time frame. (It lasts up to 6 months in a combi freezer).

You can be calm and breastfeed without pumping, devices or alternative methods of feeding, once your baby consistently displays the nutritive suction associated with effective breastfeeding. Your baby will be fine and will receive sufficient food exclusively from breastfeeding when:

  • They awake and that they wish to be fed at least 8 and up to 12 times in 24 hours.
  • They soak six or more nappies in 24 hours.
  • They have at least two or three bowel movements per day up to several weeks after the age they would have been had they been born at full term, with a possible reduction in the frequency thereafter.
  • They increase at least 120 to 240 grams in weight every week during the first three or four months, according to the baby's age.

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