Breastfeeding During Emergencies

Rainsville, AL after the April 2011 tornadoes–Copyright Mike Wilks (used with Permission)

Emergencies can happen at anytime, often with little or no warning. Natural disasters can force families to live without power for days at a time. Families may be evacuated to a safer area, displaced due to loss or damage to their homes, or forced to live in less than ideal situations due to storm damage and inaccessibility to shelter.

Even in the USA and Canada, infants are especially vulnerable to malnutrition and disease during emergencies. The cleanest and safest food you can give your baby is your milk. Breastmilk protects babies against diseases like diarrhea, cholera, pneumonia and other respiratory infections, and ear infections. Breastfeeding is also comforting for your baby and you–something that is even more important when safety is a concern.

During an emergency, breastfeeding saves lives!

If you are pregnant, plan to breastfeed after birth.
Ask your nurse or midwife to show you how to hand express shortly after your baby is born. This simple skill is safe, sanitary, and can help you build or maintain your milk production.
If you’re already breastfeeding, keep breastfeeding! The American Academy of Pediatrics recommends that infants be breastfed exclusively for the first six months of life and continue to be breastfed with the addition of complementary foods (solids) for at least the first year. Mothers are strongly discouraged from weaning during a disaster. Preparing infant formula requires clean water and fuel, and formula is difficult to preserve without electricity. By contrast, human milk is always clean and ready to eat. It contains antibodies that fight infection and provides complete nutrition for your baby. Additionally, breastfeeding releases hormones that lower stress and anxiety in both babies and mothers–a very important benefit in any stressful situation.
Exclusively breastfed infants do not need extra water, even in very hot conditions. Water supplies often become contaminated during emergencies. Exclusive breastfeeding protects infants against water-borne pathogens (germs that can make people sick). Continue to breastfeed when your baby shows signs of hunger or thirst, and keep yourself hydrated by drinking when you are thirsty. For more information on breastfeeding in extreme heat conditions, please see: Baby, it’s hot outside!

Stress and milk production

Studies have found that stress does not decrease or stop milk production. Mothers need not wean because of stress and insecurity. If a mother is feeling anxious or stressed, the milk ejection reflex can be temporarily delayed or inhibited. If you feel your milk is taking longer to “letdown,” you might find it helpful to try some of these tips before and during breastfeeding:

Find a safe, comfortable, and private place to breastfeed.
Before beginning to breastfeed, take a few deep, cleansing breaths. Tense, then release your muscles. Visualizing calm, peaceful scenery may help you feel more relaxed.
Hold your baby skin to skin. This contact is comforting and familiar to both of you, and it also triggers the release of oxytocin, the hormone that causes milk ejection.
Gently massage your breast to help stimulate letdown.
Try Reverse Pressure Softening (RPS), a technique used to decrease engorgement and aid in latch on. It also assists with oxytocin release and milk ejection.

Relactation during emergencies

Sometimes mothers find themselves in situations where they want, or need, to start breastfeeding again. Relactation is possible even under less than ideal circumstances. It is easiest when a baby is young, will latch on, and has weaned recently. Mothers who never started breastfeeding can relactate even if it has been weeks or months after birth. Here is some helpful information:

ENN: Relactation in Emergencies

Infant Feeding in Emergencies – Module 2, Version 1.0 for Health and Nutrition Workers in Emergency Situations

Expressing milk without power: Planning ahead

Mothers who are exclusively pumping with an electric pump might find it helpful to be prepared for power outages:

Practice hand expression and hands on pumping–not only does it help increase overall milk production, but it also makes hand expression easier and familiar if you are faced with a situation in which you cannot pump.
Have an alternative power source available for emergencies if your pump allows for it. Some manufacturers offer options like car chargers or battery packs.
Manual pumps (hand pumps, pedal pumps) are inexpensive and widely available. Note that some popular electric pumps can also be used manually, so this may not require a separate purchase. See your manufacturer’s instructions for more information.

Protecting your freezer stash of breastmilk during power outages

Worries over extended power loss can be especially troublesome for families who are dependent on a freezer stash of milk to feed their babies. If you have warning that your area may experience power outages, here are several options to consider:

Purchase, rent, or borrow a generator for your home. They range in price depending on the amount of power they generate. Remember that you’ll also need fuel for the generator as well as a place to safely store the fuel.
Ask for help storing your milk. Some mothers have found that hospitals, clinics, churches, and even grocery stores are willing to temporarily store breastmilk. Another option is to ask your neighbors–someone with a generator and freezer space may be willing to help.
Fill your freezer as full as possible in advance of the storm. You can freeze containers of water (plastic drink bottles, freezer bags, freezer boxes, etc) or gel ice replacements such as “blue ice” several at a time to help fill free space. The fuller the freezer, the longer it takes to defrost. Separate meats from your milk and other foods so they won’t contaminate them if the meats should start to thaw. Ensure the freezer temperature is on the coldest setting. Plan not to open the door until the power is back on unless you’re moving your food to another location. The more often you open the door, the higher the freezer temperature will rise. Consider options for maintaining freezer temperature, such as dry ice or block ice.

If power goes out unexpectedly:

Quickly group frozen foods together as this will help maintain the temperature of the food, at least temporarily. Separate meat from other foods as best you can. Take out foods you will eat immediately (including your milk if it will be used within 24 hours) and store it in a cooler. Close the freezer door and plan not to open it unless it becomes necessary.
Cover the freezer or refrigerator/freezer unit with a blanket to help maintain its temperature (avoid putting the blanket on top of the compressor).
If possible, consider obtaining dry ice or block ice to help maintain freezer temperature.

If you must travel with frozen expressed milk (or temporarily store your milk in a cooler):

Choose a well-insulated cooler
Rather than covering your milk in ice, use a gel ice replacement such as “blue ice.” Because water freezes at a higher temperature than breastmilk, covering your milk in ice can actually speed up defrosting. Gel ice replacements freeze closer to the temperature of breastmilk. * For reference, water freezes at 32 degrees F. Human milk freezes between 26.6 and 28.4 degrees F.
Line the bottom of the cooler with ice replacement.
Add your milk to the cooler, then use crumpled up newspaper to take up air space between the containers of milk and between the milk and the cooler.
Add more ice replacement to the top of the cooler then seal the cooler tightly. Plan not to open it until it is necessary.
For better insulation, some mothers store their milk in a cooler inside another cooler (such as a small foam cooler inside a slightly larger plastic one) or a thermal food bag (like the handled silver bags often found near the frozen foods section of grocery stores) inside a cooler. This is especially helpful when the weather is extremely hot.
Duct tape around the seal of the cooler and a heavy blanket on top can help slow down heat transfer. Remember to keep the cooler away from direct sunlight and sources of heat.
If you do not have gel ice replacements on hand, and your milk is still hard frozen, the same steps can help your milk stay frozen. Remember to pack it together tightly and fill in gaps with newspaper (air space promotes thawing).

* Credit: Kittie Frantz, RN, CPNP-PC

If your frozen expressed milk thaws partially:

USDA food safety guidelines suggest that if a food is still partially frozen (slushy, with visible ice crystals), it can be refrozen. Some experts recommend mothers follow this advice with their frozen breastmilk, ensuring that they use the refrozen portions as soon as possible. Be sure to check with your health care provider before refreezing partially thawed milk for your baby.

Interestingly, a 2006 study by Rechtman et al. looked at the effects of freezing and thawing on unpasteurized donor milk. The results showed that human milk was more robust than previously thought and thawing and refreezing had remarkably few effects on the milk.

Breastmilk that is fully thawed should be used within 24 hours or discarded.

For more information about breastmilk storage, please see:
Breastmilk Storage and Handling Guidelines

More information:

Emergency preparedness
Ready America

Information for parents, professionals, and anyone who works with breastfeeding mothers

American Academy of Pediatrics: Infant Nutrition During a Disaster, Breastfeeding and Other Options

International Lactation Consultant Association: Position on Infant Feeding in Emergencies

Emergency Nutrition Network

Wellstart: Infant feeding in emergencies

UNICEF: Breastfeeding in Emergencies

World Health Organization: The Importance of Breastfeeding During Emergencies

Webcast: Dr. Karleen Gribble speaks on the importance of breastfeeding during emergencies

World Alliance for Breastfeeding Action: Breastfeeding in emergencies