During my work which involves caring for mothers postpartum, hand expressing breast milk appears to be a skill which is not used much in the present time. However, there are situations where it can be of benefit to both mom and baby. Electric and manual pumps can be great when mothers are expressing larger quantities of breast milk for their babies where their milk is well established. However, for some mothers hand expression can really work better particularly in the first few days where pumping would not be suitable.
How Do I Hand Express Breast Milk
- Wash your hands and have your collection equipment near to hand.
- Massage breasts to stimulate the milk ejection reflex (MER).
- Start by holding your breast with your thumb and fingers so they are cupped around your breast in a C shape.
- Press your fingers and thumb back towards the chest wall.
- Compress the breast between your finger and thumb.
- Move your fingers and thumb in a rolling action without moving your fingers in the direction of the nipple.
- Release the pressure without taking your hand away.
- Repeat these actions until the milk flow slows and then start on the other breast.
- The entire procedure usually lasts 20 – 30 minutes but as you become more skilled the faster you will become.
- Store your milk in the refridgerator or freezer.
Above is a quick guideline how to hand express. In the next part of this article I will give a more indepth description of hand expressing. I will also discuss the other questions you may have around hand expression such as its other benefits, precautions to take and other tips and information to keep you fully informed.
What Is Expressing Breast Milk By Hand?
Expressing milk by hand is where a mother extracts milk from the breast herself using her hands. Nowadays, most moms either use electric or manual pumps to obtain and store milk for their baby. However, hand expression is a skill that has been carried out by women for millennia when they couldn’t be with their babies.
At first, it takes some practice and each mother will have their own individual way and technique. Each mother needs to get to know her own breasts and she will learn where exactly she needs to apply pressure to get the milk flowing.
Hand expression can have many benefits which I have described below. In certain circumstances, It can become an essential skill to learn. For example, a mom who has given birth to a preterm baby. Expressing in the first hour after birth will increase the amount of milk a mother is able to express during the whole first week postpartum. For the first few days, hand expression makes sense. Using a pump is less suitable as colostrum is being produced which only comes in small quantities. It is also a reliable way to relieve fullness or really any situation where she needs to express milk for her baby.
How To Express Breast Milk By Hand
Techniques on how to hand express can differ amongst cultures and even from mother to mother. Each breastfeeding mom will find her own way that is comfortable and works best for her. However, according to Wombach & Rioran in Breastfeeding and Lactation (2016) hand expression becomes most effective when the breasts are compressed well behind the nipple.
This process may seem tedious at the start, but once you get it right, it will come naturally. You may also find you may be able to express more milk than from a pump in a faster space of time. Below are some tips on how to express milk by hand.
- Firstly, wash your hands and have your collection equipment near to hand.
- Sit comfortably and place the collection cup or bowl under your breast with a towel beside you.
- Stroke both breasts with light movements starting from the top of your breasts towards the nipples. This will also help stimulate the milk ejection reflex.
- Shake each breast gently while leaning forward so gravity will assist milk flow towards the nipple.
Massage To Stimulate The Milk Ejection Reflex
To start the flow of milk from the breasts, we need to encourage a process called the milk ejection reflex. This is usually activated when your baby suckles on the breast where a signal is sent to the brain to release oxytocin. This hormone causes the muscles around the alveoli to squeeze, building milk pressure inside the breast. This results in a release of milk known as the milk ejection reflex. Some moms experience a tingling or heavy sensation while others may not feel anything at all. Below are some tips to help.
- If circumstances mean you cannot be beside your baby there are some ways to help stimulate the milk ejection reflex. Physical reminders of your baby such as a photo, blanket or piece of clothing can be helpful. Imagine being close to your baby snuggled in or imagining feed time.
- Place a moist, warm cloth over your breasts.
- In a circular motion gently but firmly massage your breasts. Gradually move around the areola to massage the whole area.
- Stroke the breasts lightly starting at the top of the breast towards the nipple to also help stimulate the milk ejection reflex.
- Shake the breasts gently to help gravity bring the milk towards the nipples.
- When expressing milk don’t forget to keep a bottle or cup underneath your nipples so that you are ready to collect milk.
- Start by holding your breast with your fingers and thumb cupped around your breast in a C shape. Keep a distance of around an inch to an inch and a half back from the nipple.
- Press both your fingers and thumb back towards the chest wall.
- Compress the breast between your fingers and thumb. With a slight rolling action move your fingers and thumb towards the nipple (like you are taking a thumbprint). Try not to glide over your the skin.
- Release this pressure without taking your hand away from your breast. Repeat as needed to obtain milk.
- Change position of the fingers around the areola to express milk from as many ducts as possible. Within 3 to 5 minutes the flow of milk may slow down. This is a signal to express milk from the other breast.
- Both breasts may be expressed as often as is required. The entire procedure usually lasts approximately 20 – 30 minutes. As you become more familiar with the technique you will get quicker each time you express.
- Don’t forget to store the milk away in the appropriate containers in order to freeze for use later. Most moms choose either bottles or disposable bags.
- Label each container with the month, date and year. This will allow the milk to be used in the order in which it was expressed.
- If your baby is in hospital check with the hospital staff regarding the hospitals guideline on their storage guidelines.
Precautions To Take When Expressing Milk Using Hands
Hand expressing milk should not feel painful or result in any bruising or abrasions to the skin. Here are a few tips to avoid discomfort.
Massage your breasts firmly but gently to avoid stretching your skin. Apply a small drop of oil on your hands before you begin your massage.
Never Compress Or Pull Your Areola And Nipple
When expressing by hand focus on applying pressure on your breast about an inch to an inch and a half away from the areola. Also, avoid pinching and squeezing your nipples as this could lead to tissue damage.
Avoid Squeezing Your Breasts
When expressing try to compress the breasts and avoid squeezing. Squeezing your breast will not increase the supply or flow of milk. It could also cause unnecessary bruising.
Benefits Of Hand Expression
Expressing milk by hand has many benefits that make the entire process worth learning. These benefits include the following:
Cleaning And Preparation Is Easier
With hand expressing little preparation is required beforehand. Simply wash your hands, sit comfortably and have your collection cup near to hand. Now you are ready to go.
Helps Stimulate The Milk Ejection Reflex
Expressing your milk by hand will help stimulate the milk ejection reflex more quickly. Many moms find that skin to skin contact is more effective than a plastic shield. Hand expression can also be helpful in situations for example where a woman has adopted a baby and may find the tactile stimulation to induce lactation beneficial.
Helps In Preventing Soreness In Nipples
Some electric or manual pumps can cause discomfort and can be ineffective in removing milk. When you become skilled at hand expression you will find the technique that is right for you. This will let you continue at your own comfort level
Need No Electricity
Obviously, when using an electric pump an electrical outlet is required. If you are traveling or if there is an outage there is no need to worry with hand expression. All you need is your hands!.
Using your hands to express costs nothing. Renting or buying, in particular, a high-grade electric pump can be expensive. This is especially of benefit if you only need to express occasionally or on a very rare occasion such as attending a doctor or dental appointment.
Once you become skilled at expressing by hand you may find that more milk can be obtained quicker than some of the electric and manual pumps.
Along with pumps comes a lot of equipment such as breast milk storage bags and the pump itself. This will be discarded once finished.
Adopting a Baby
Some mothers adopting a baby would love the chance to be able to breastfeed their newly adopted baby to create a special bond with their child. In preparation, you can begin by hand expressing or pumping 6 weeks before baby arrives. This article describes in-depth how you can breastfeed an adopted baby.
Tips To Help You Express Breast Milk By Hand
Expressing breast milk by hand can be a difficult skill to master particularly at the beginning when you are still learning. Here are a few ideas to help the expressing journey a little easier
Assistance From Your Significant Other
If you are having some difficulties expressing milk by hand it’s important to make sure you are receiving help from your partner or anyone else who is in a position to help. Household tasks such as cleaning and cooking can be given over to give you the necessary time you need to learn this skill.
Triggering The Milk Ejection Reflex
As mentioned above the secret to successfully hand expressing is to ensure you have effectively stimulated the milk ejection reflex. If this reflex is not triggered, mom may have plenty of milk but will be unable to express much of it. Follow the guidelines I have described above.
Consult A Lactation Expert
Many mothers find that once they arrive home with their baby there is less support available when they are having difficulties. If might find the process of hand expressing milk overwhelming or if you might have other symptoms such as discomfort or pain in your breasts. It’s best you reach out for help. Consult a lactation consultant for help and guidance.
Does Hand Expressing Increase The Supply Of Breast Milk?
There is no evidence to say that hand expression will actually increase the supply of milk compared with an electric or manual pump. However, in the first week postpartum it will help increase the milk supply for a mother with a premmie baby where pumping would not be suitable. It can also be a preference for some mothers who prefer skin to skin contact compared with a plastic or glass pump flange to help stimulate the milk ejection reflex.
A mother can learn to hand express her milk while the baby is nursing on the other breast with the right positioning. It is also possible to learn to hand express from both breasts simultaneously, with the right hand expressing the right breast and the left hand expressing the left breast.
How Much Milk Can You Express With Your Hands?
It’s understandable that some mothers can start to worry and wonder if the milk they are expressing is enough for their baby. However, there are many factors that will affect the amount of milk you are able to express.
- Time since your baby last had a feed or since you last expressed
- Whether your baby is exclusively breastfeeding or supplementing with formula or has commenced on solids
- Your baby’s age
- Breast storage capacity
- Time of day
- Your emotional state (this can impact the triggering of the milk ejection reflex)
The important thing to be aware of is that your baby is gaining weight and feeding well according to their age. Contact your health care provider if you feel your baby may not be receiving sufficient milk.
Other Methods Of Expressing Breast Milk
Expressing breast milk is a method of obtaining milk without having a baby suckle at your breast. This can be done by two methods. Either by hand expression as mentioned above or by using an electric or manual pump.
There are several types of pumps which include manual, single, double and hospital grade pumps.
What Type Of Pump Should You Choose?
Before purchasing the pump make sure that you check the company that creates the pump; try to look for a pump that is made by a company that solely focuses in manufacturing breast pumps and other equipment for breastfeeding.
These pumps are the least expensive option. They work best for moms who only need to express occasionally.
These pumps come in a wide price range of designs for mothers who are looking for a fast but inexpensive option. The cheaper electric pumps work best for mothers who just need to express their milk occasionally.
The most expensive electric pumps tend to work perfectly for women who have an established supply of milk and are likely to be away from their babies for a longer period of time for example if they have returned back to work full time.
Hospital Grade Electric Pumps
Hospital grade electric pumps are available on rent. These breast pumps are recommended for mothers who need to build up their milk supply. Also, when you want to focus on maintaining your milk supply when your baby cannot breastfeed directly over a long period.
To use this pump, you will have to purchase a kit. This kit is made up of milk collection parts that will connect to the hospital grade electric pump.
Breast milk is no doubt ideal for your baby. It contains the required minerals, vitamins and other components that a growing baby needs. It also helps in protecting your baby from diseases and provides them with a stronger immune system. Any way to help assist giving your baby breastmilk is alway worth a try.
This article does not replace the advice of your health care provider. Please consult with your doctor or lactation consultant for an individual assessment.
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- How to Combine Breastfeeding and Pumping
Wombach,K., Riordan, J. (2016). Breastfeeding and Lactation (enhanced fifth edition). Burlington, MA 01803
La Leche League International (2015). The Womanly Art Of Breastfeeding (8th Edition).