EXPRESSED BREAST MILK (EBM): SAFE HANDLING,

STORAGE, ADMINISTRATION AND TRANSPORT

PURPOSE
The purpose of this practice support document and related appendices is to describe the safe handling,
storage, administration and transport of expressed breast milk (EBM).

POLICY STATEMENTS
Staff or family label, store, retrieve, administer EBM in designated bottles, bins, refrigeraters and freezers
on each unit. On occasion families ship milk to or from the hospital.

SITE APPLICABILITY
Safe handling, storage, administration and shipping of expressed breast milk occurs in the Antepartum,
Postpartum, Birthing, Ambulatory areas, and Neonatal Program including the NICU in the Acute Perinatal
Program at BC Women’s Hospital and all inpatient and critical care areas at BC Children’s Hospital.

PROCEDURE
1.1 Preparation: Registered Nurse (RN)
Identify each mother expressing human milk
 Provide information to the mother/family referring to the Teaching Flowsheet - Appendix A.
 Use education materials available – see Teaching Aids.

1.2 Labelling
Request the Unit Clerk prepare and print multiple, computer generated waterproof labels designated for
EBM. In the NICU this will involve both small and large labels.
 Verify the information on the label is correct.
 Ask the mother to verify the labels are correct.
 Give mother the labels and ask her to label her own EBM bottles when possible.
 The pre-printed label includes the:
 Printed mother’s (on postpartum) or infant’s full name (in NICU and BCCH units)
 Identification/unit number
 Blank for date and time of expression
 Blank for date and time when fully thawed

1.3 Safe Handling

The mother expresses the milk into clean, hard plastic collection bottles.
 Use a new bottle for each expression for NICU infants/ BCCH, do not layer. On other BCW units, with
healthy term infants the bottle may be washed and reused. A new bottle is supplied each 24 hours and
the family may take the bottles home for reuse as per manufacturer’s instructions.
 Add the following information to the label:
 Date and time of expression
 Date and time when fully thawed
 For NICU first milk/colostrum (first 3 days) indication – place a green dot on lid
 Discard unlabelled EBM.
 Clean equipment; see Equipment and Cleaning of Equipment Appendix B.
 Isolation: for mothers on isolation, expressed milk needs to be labeled and double bagged unless
refrigeration is available in the patient room.

NN.07.03 Neonatal Program Policy & Procedure Manual Effective Date: 28-JAN-2015
BCCH Child & Youth Health Policy and Procedure Manual Page 1 of 5
Refer to online version – Print copy may not be current – Discard after use
 EXPRESSED BREAST MILK (EBM): SAFE HANDLING,
STORAGE, ADMINISTRATION AND TRANSPORT

1.4 Equipment
Storage of EBM
Refrigerators and Freezers for Milk Storage
 Label appropriately for storage of human milk
 Plug into emergency power circuits so that power outages will not result in loss of milk
 Keep a thermometer in each unit
 Temperature is monitored by a designated person every 24 hours and a written record of the
temperatures is maintained.
 Adjust doors to facilitate automatic closing as per manufacturer’s instructions.
 Clean all fridge and freezers on a regular monthly basis by defrosting and washing as
appropriate.
 Instruct all staff and families to check bottle label with one other person to confirm correct milk is
being removed for the correct baby.
 Spills of milk are cleaned up promptly and the area sanitized.

Refrigeration of EBM
Fresh EBM is safe at room temperature for 6 hours. Refer to the pamphlet “Cleaning Equipment and the
Storage and Transport of Mother’s Milk” – See the table on page 3.
 Refrigerate EBM as soon as possible after expression if not being used.
 Place EBM in the interior of the designated EBM refrigerator.
 Do not store EBM in the door of the refrigerator or freezer. The temperature is more stable in the
interior of the refrigerator or freezer.
 Fresh EBM can be stored in the refrigerator for 72 hours.

Freezing of EBM
In hospital, freeze any EBM that will not be used within 72 hours.
 Freeze EBM in a refrigerator that has a separate door for the freezer, use within six months or
 Freeze in a deep freezer with a temperature of -20º Celsius, use within twelve months.
 Do not freeze EBM with additives.
 Do not refreeze thawed EBM.
 Discard any EBM not used by the expiry date.

Refrigerator/Freezer Mechanical Failure Resulting in Warming and/or Thawing of Milk

Consult with Lactation Services:
 Determine if milk should be discarded or if still cold and/or partially frozen if it can be re-frozen.
 After hours call the administrator on call.

Storage Bins
Store labelled EBM bottles in the designated covered EBM bins.
 Label each bin with infant’s name and ID number. Some infants may have more than one bin.
 Flag a bin with a name alert sticker for same or similar surnames.
 Check the storage area and ensure adequate space and appropriate organization for all stored EBM.
Consider the storage limits on each unit.
 Provide information to family if volume of EBM exceeds unit limits and assist the family to remove the
excess EBM, see 1.7.
NN.07.03 Neonatal Program Policy & Procedure Manual Effective Date: 28-JAN-2015
BCCH Child & Youth Health Policy and Procedure Manual Page 2 of 5
Refer to online version – Print copy may not be current – Discard after use
 EXPRESSED BREAST MILK (EBM): SAFE HANDLING,
STORAGE, ADMINISTRATION AND TRANSPORT

 Wash bins between users.

1.5 Warming and Thawing EBM:

For term infants (or older infants) EBM does not need to be warmed. Warming milk to body temperature is
recommended for preterm infants.

DO NOT MICROWAVE EBM to thaw or warm the milk.

 Label the warming container. Use one container per infant for the duration of stay.
 Rinse after each use.
 Discard the warming container on discharge

Warming refrigerated EBM

Prior to feeding, place the EBM bottle or syringe in a clean plastic bag.
 Immerse the bagged bottle/syringe in a warm water bath for about 15 minutes.
 To prevent water entry or contamination the water level should not touch the bottle cap.

Thawing frozen EBM

Use oldest dated EBM first
 Ideally thaw milk in the fridge for 8 -12 hours
 If needed in a shorter time period, place EBM bottle in a plastic bag and immerse the bottle in a warm
water bath until fully liquefied. To prevent water entry or contamination the water level should not
touch the bottle cap.
 Record the time the EBM is fully thawed on the printed label (i.e. no ice crystals present).
 Store thawed EBM for up to 24 hours in the refrigerator.

1.6 Administration of EBM

Prepare and handle EBM using aseptic technique.
 To pour and divide into parts or prepare syringes of human milk:
 Clean the preparation area with a low level disinfectant cleaning solution (Virox 5 or alcohol).
 Careful hand washing before and after handling milk and preparing feeds is required gloves are not
required for feeding preparation and should not be worn routinely especially when feeding an infant
(Universal precautions do not apply as occupational exposure to human milk has not been implicated
in the transmission of disease).
 Add prescribed additives if required, and label with EBM labels.
 Note: In the NICU check with another RN or mother or family member that the label on the container
that human milk is being taken from matches for infant name and ID number of the new
container/syringe when preparing feeds. Both RNs/parent initials the preparation section on the label.
 Shake the EBM gently to re-disperse the fat content.
 Refrigerate within one hour EBM that has been warmed but not offered for feeding. The EBM can be
offered for feeding one more time and then discarded.
 Discard partially consumed feedings.

DOUBLE check the correct infant is receiving the correct breast milk.
 At the bedside double check the infant name and ID number on the EBM label:
 With the infant ID bracelet AND
NN.07.03 Neonatal Program Policy & Procedure Manual Effective Date: 28-JAN-2015
BCCH Child & Youth Health Policy and Procedure Manual Page 3 of 5
Refer to online version – Print copy may not be current – Discard after use
 EXPRESSED BREAST MILK (EBM): SAFE HANDLING,
STORAGE, ADMINISTRATION AND TRANSPORT

 With the mother or another nurse or family member.

 Note: In the NICU confirm the above double check has been completed by both RN/parent
initialing the administration section on the label.
 Family members also double check with another family member or a healthcare professional at the
bedside.

Error Information
When an infant receives another mother’s milk see:
 Appendix E Incorrect Administration of EBM
 Appendix F When Your Baby has Received Another Mother’s Milk - Error Information for Families

1.7 Discharge Planning and Transportation of EBM

Prior to discharge, assist families to manage EBM storage in hospital. Options include shipping the milk
home, donation or discard. See Appendix H.

EBM Donation to Milk Bank

Donations of extra mother’s milk may be made to the BC Women’s Milk Bank. The donating mother
completes a screening process. Contact Lactation Services at local 2282 prior to the day of discharge if
possible.

Discarding Expired Milk

To discard milk that has expired or has been left by the mother after discharge:
 The milk can be thawed if frozen and poured down the drain.
 If there is a large amount of milk and insufficient staff time to thaw and empty each container, the milk
can be placed in the medical waste container in the birthing area in BCW or biohazard bins in BCCH.
 Contact the mother if at all possible for consent to discard her milk.

DOCUMENTATION
DOCUMENT EBM feeds using the following documentation tools:
 BCCH – Flow sheet
 EBM labels
 Intake and Output Record – Document volume of EBM fed to infant
 Interprofessional Progress Notes (BCW) or Nurses Notes (BCCH)
 NICU Flow Sheet

REFERENCES
Barry, C and Lennox, K. (1998). Management of expressed breast milk. Is the right milk being fed to
infants? Canadian Journal of Infection Control. Spring,16-9.
Cleaning Equipment and the Storage and Transport of Mother’s Milk (2011). CW#501, BC Women’s.
Human Milk Banking Association of North America (HMBANA) www.hmbana.org.
Jocson, M.L., Mason, E.O. Schanler, R. (1997). The effects of nutrient fortification and varying storage
conditions on host defence properties of human milk. Pediatrics, 10(2):240-243.
Jones, F. (2011). Best practices for the expressing, storing, and handling mother’s milk in hospital, in day

NN.07.03 Neonatal Program Policy & Procedure Manual Effective Date: 28-JAN-2015
BCCH Child & Youth Health Policy and Procedure Manual Page 4 of 5
Refer to online version – Print copy may not be current – Discard after use
 EXPRESSED BREAST MILK (EBM): SAFE HANDLING,
STORAGE, ADMINISTRATION AND TRANSPORT

cares and at home. HMBANA.

Maternity - Breastmilk: Safe Management. (2010, March). NSW Health. Department of Health, Health
Policy Directive PD2010_019. Retrieved from www.health.nsw.gov.au/policies/.
Warner, B. and Sapsford, A. (2004). Misappropriated human milk: fantasy, fear and fact regarding
infectious risk. Newborn and Infant Nursing Reviews, 4(1):56-61.

APPENDIX
Appendix A Safe Handling, Storage and Administration of EBM Patient Teaching Checklist
Appendix B Assembling Breast Pump Kits For Expressed Breast Milk and Cleaning
Appendix C Expressed Breast Milk (EBM) Handling, Storage and Administration Process
Appendix D Breast Milk Expression Using Electric Pump
Appendix E Incorrect Administration of Expressed Breast Milk
Appendix F Parent Letter-When Your Baby Has Received Another Mother’s Milk
Appendix G Transport/Shipping of Mother’s Milk
Appendix H Unclaimed EBM in Freezer

NN.07.03 Neonatal Program Policy & Procedure Manual Effective Date: 28-JAN-2015
BCCH Child & Youth Health Policy and Procedure Manual Page 5 of 5
Refer to online version – Print copy may not be current – Discard after use