Hand expression breast milk

Hand expressing is a worthwhile skill for any mom to learn. Note though, that like most other skills it is something that you develop. Many mothers try once or twice and then decide that this is not working, while meanwhile they just needed to practice a bit more. For that matter, this is also the case when using a breast pump.

Hand expressing is especially useful under these circumstances:

• Engorgement and mastitis often responds better to hand expressing than to a breast pump. It is also less likely to cause further overstimulation and supply.
• Should you need to express colostrum for a premature baby or a newborn baby not latching, hand expressing sometimes work better. This as the amount of colostrum may be so small that it literally gets lost in the mechanics of a pump.
• Should your breast pump fail, or should your electricity fail and leave you with an uncharged pump battery.
• If a feeding is delayed for whatever reason, and your breasts feel full and uncomfortable.
• If you are in an environment where you don’t feel comfortable with the noise of a breast pump.

Steps for successful hand expressing

There are different techniques to hand expressing, and you can experiment to find which works best. Here is a few tips, and below some links to videos that we find helpful. If you struggle you can also get assistance from a lactation consultant.

1. Firstly, wash your hands and keep a sterilized container at hand to collect the milk.
2. Try to be comfortable and relax. It can help to look at a photo or video off your baby. Alternatively listen to music or put on your favourite TV show in the background.
3. Start off by kneading your breasts and gently massaging from the outside towards your nipple (the emphasis on gentle, massage and hand expressing should never be painful). You can also tickle or gently tap your breast. If your breasts are engorged you can use some coconut or olive oil to make this more comfortable.
4. Apply heat to your breasts for 2-3 minutes, either with a warm cloth or a wheat bag. This is generally a helpful tip to get milk flow going.
5. Position your hand on your breast in a C-hold, thus with your thumb on top and your other four fingers cupping the breast from the bottom. Your fingers should be behind your areola; you can experiment with how far back works best for you.
6. Gently press inwards towards your chest wall, and then roll the fingers forward, thus ‘working’ milk from your milk ducts towards the nipple. Some recommend squeezing gently towards the nipple while others will only press and roll behind the areola.
7. If you have someone to hold a container you can add a third finger from your other hand. Alternatively, put a bigger bowl of container in front of you and lean forward over it so that the milk drips directly into it – it doesn’t need to be a bottle.
8. It may take a few minutes before milk starts flowing. For some moms this may be in drips and drops, while for others some milk will squirt out. Lean forward to collect the milk.
9. Keep expressing in rhythmic movements, occasionally rotating your hand so that you reach the breast at all angles.
10. Once the milk flow slows down, then repeat steps 3 and 4 before expressing on the other breast.
11. You can move between breasts a few times to ensure that you get out everything (note that with engorgement you only need to express to relieve the worst pressure).

Please note: if you are expressing with engorgement and mastitis, make sure to not use deep pressure that hurts your breasts. If no milk comes out it would be better to rather stop and just let your breasts rest. You can have a look at our series on Engorgement, Mastitis and Other Breast Tissue Complications for more information.

Helpful videos:

Lastly, a wonderful South African video on Hand Expressing of Breast Milk by Dr Ellenor Meyer and the University of Pretoria. The video was recorded in Shona (English subtitles) at a UP community-oriented primary care (COPC) clinic and storage recommendations consider the storage facilities in an informal settlement. https://www.youtube.com/watch?v=P1j-fqs_vO4

The basics of breast massage and hand expression by Maya Bolman (IBCLC) and Ann Witt (MD, FABM, IBCLC)

Hand expression of breast milk, a video by Dr Jane Morton from Stanford University is a fantastic resource, especially for moms expressing colostrum for a newborn or a premature baby. https://med.stanford.edu/newborns/professional-education/breastfeeding/hand-expressing-milk.html