Hand Expression: The How and Why
Knowing how to hand express milk is a very important skill that I think all expecting mamas should become familiar with. Although a very beautiful and natural biological process, breastfeeding can be challenging for many dyads (mother/lactating partner and baby) so the more you know ahead of time the greater success you will have at learning this new skill together. I recommend reviewing and practicing hand expressing a few times before your baby arrives so that it is not quite so new when you go to use this technique. You won’t be able to express much before your baby arrives, but you will be able to get a feel for the technique so that you understand the concept when you are ready to feed your baby for the first time.
Although hand expression is fairly simple, like any new skill it may be challenging the first time you try to do it, so becoming familiar ahead of time will help you feel more prepared and knowledgable about feeding your baby. Depending on your breastfeeding journey you may never end up needing to hand express, but again I hope having this information will be empowering for you should you need to use it.
As a first time mama you may be thinking your baby will just latch on their own or that you can use an electric breast pump if needed, but there are some specific instances where hand expression is the better or only option to feed your baby.
Below are a few examples of when you may need to hand express.
To start the flow of colostrum as you help your baby with their first latch or if they are having trouble latching and are frustrated at the breast.
If you need to cup or spoon feed your baby because of difficulty latching or the inability to latch for various reasons.
In the unlikely event that you need to be separated from your baby after birth because one of you needs further medical attention, you can hand express so that someone else can feed your baby.
It can also be very helpful when breasts are full and engorged, and you just need to “take a little off the top” for comfort until your baby is ready to feed.
If you have a plugged duct or mastitis and you need to remove milk, but an electric pump will stimulate more milk production and exacerbate the problem.
Hand expression and massage before and after pumping can help stimulate a let down for a more productive pumping session and drain the breast.
In case of an emergency and you need to express milk for your baby or someone else's baby.
If you need to express milk and you aren’t near your baby.
It may be more convenient in a specific situation because it can be done any place any time with no equipment necessary.
There are some wonderful tools on the market now for saving expressed milk or extra milk that has leaked from the opposite breast during nursing. One device is called a Haakaa and I personally recommend the generation 1 silicon breast pump for this purpose. But you can always express into any clean container that you need to. See the link below to Haakaa products.
Doing a breast massage can also help stimulate milk let down before you are ready to hand express, nurse or pump.
You can massage around the entire breast with gentle circular strokes. You’ll want to use the same level of pressure you would use to touch your baby. If you are engorged you can gently massage around the nipple and areola and even hand express a little to soften the area for baby to be able to latch.
How to Hand Express:
Clean your hands, relax, and get comfortable
Position your thumb above and your fingers below the nipple just outside the edge of the areola
Press your hand back toward the chest wall
Gently compress your fingers and thumb toward each other
Slowly slide them forward toward the nipple to express the milk out
Fully release to allow the milk ducts to refill
Repeat in a rhythmic pattern: press, compress, release.
Tips for success:
The best hand placement on the breast is unique to each woman so explore different hand placements to see what works best for you.
This should be comfortable, if you are not comfortable then you should adjust what you are doing.
Rotate your hands around in a clockwise fashion to see which direction you are able to express the most milk from.
Move your hand to a different place around your breast after every few compressions or whenever milk stops flowing so that you compress all of your milk ducts.
You may also want to incorporate a third finger from the opposite hand to help remove more milk.
This is not a fast process, so depending on your goal with hand expression expect a full session to take 20-30 minutes.
If you want more information on hand expression I suggest watching IBCLC Maya Bolman’s videos linked below or checking out La Leche League’s website, also linked below. A Google search will also pull up many videos, websites and infographics to help guide you. I always recommend establishing a relationship with a lactation consultant early on in your lactation journey even if you feel everything is going well so that you have a support system. A trained IBCLC may be able to spot areas of improvement that you are not aware of and help you avoid unnecessary struggles for a more positive nursing/feeding experience for you and your baby.
https://www.mayabolman.com/videos/v/basicsofbreastmassage
https://www.mayabolman.com/videos/v/handexpression
https://llli.org/breastfeeding-info/hand-expressing/
I hope you find this information helpful and I wish you all the best with feeding your baby, however that journey looks for you!
Dr. Allie