Express Yourself! Hand Expression of Breast Milk
Hand expression is an invaluable technique that allows mothers to manually express milk without using a breast pump. Useful in preparing for, establishing, and maintaining breastfeeding, hand expression is a skill you will use frequently and be grateful you mastered!
When is hand expression useful?
Colostrum collection in pregnancy. Have your breasts started to leak towards the end of your pregnancy? If so, that’s good news! Your body is preparing to feed your baby. Starting at 37 weeks, hand express for 5-10 minutes on each breast a few times a day to collect colostrum and save it to feed your baby after birth. This is also a good way to master the skill of hand expression before delivery. The breast stimulation of hand expression may cause a few contractions, so hand expression during pregnancy should only be done if it is safe for you to have a vaginal birth.
Preventing infant weight loss. Breastfeeding takes practice, and it is normal for your baby to take a few days to learn to latch effectively. During this time, hand expression can be your saving grace. Colostrum, the first milk your body makes, is thick and sticky. Electric breast pumps are therefore not that effective at getting this milk out. Hand expression is much more effective than a breast pump when it comes to expressing colostrum. If your baby is not able to latch right away, is sleepy at the breast, or having trouble sustaining a latch, hand express! Collect your colostrum frequently and feed this back to your baby via a spoon or a syringe. This will help your baby have the energy to keep nursing and will prevent your baby from losing too much weight in the first few days after birth.
Supporting babies in the NICU. If your baby is premature, receiving specialized medical care or breathing support after birth, and being cared for in the NICU, it is likely they will not be able to breastfeed right away. Hand expression is a great way to collect colostrum to be stored for later use. When your baby is able to start eating, they can be fed your colostrum using a bottle, syringe, or feeding tube. Collecting your colostrum is an incredible way to support your baby's health as colostrum protects preterm babies from infection and supports their growth.
Establishing your milk supply. The hormone prolactin is responsible for establishing a good milk supply. It is released by the pituitary gland when your breasts and nipples are stimulated through nursing, pumping, or… hand expression! Evidence shows that effective breast stimulation within the first hour after birth has a significant positive impact on breast milk production long term. But the first hour after birth can also be a very busy time! Especially if you deliver by cesarean section, experience any postpartum complications, or your baby needs additional medical support. If you are not able to attempt breastfeeding within the first hour, don’t worry. Hand expression is a quick, no-supplies-needed solution to getting that early breast stimulation. The benefits of hand expression continue as you and your baby learn about breastfeeding together the first week postpartum. In order to establish a good milk supply, frequent breast stimulation (every 2-3 hours around the clock!) is essential. If you are having trouble latching, your baby is sleepy, or you are separated from your baby, use hand expression liberally to ensure adequate stimulation.
Help with engorgement. Many women experience temporary engorgement after their milk comes in. Engorgement can cause swelling in the areola and flatten out the nipple, making it harder for your baby to latch and empty your breasts effectively. Hand expression is very useful in this scenario. Hand express before a feeding to soften your breasts enough to latch your baby on deeply.
Convenience, cost, and accessibility. Hand expression does not require any equipment. It is a free, convenient option when you are on the go or when a breast pump is not unavailable
How to Hand Express
Wash your hands and get comfortable: find a comfortable upright position and have a clean container ready to collect your milk like a small cup, spoon or syringe.
Massage your breast: gently massage the breast to help stimulate milk flow. Use your fingertips and palms to apply gentle pressure, moving in circular motions around the breast.
Position your hands: place your thumb above the nipple and your index and middle fingers below it, forming a "C" shape with your hand. Your fingers should be about 1-2 inches behind the areola (the darker area surrounding the nipple), not directly on the nipple itself.
Express milk: gently press your fingers back towards your chest (not towards your nipple), then squeeze your fingers together, then release. Repeat the process until milk begins to flow from your nipple, this may take a few minutes. As the milk begins to flow, collect it in your clean container. During late pregnancy and early postpartum, expressing only a small amount of colostrum (drops to a teaspoon) is normal and wonderful. As lactation progresses, expressing larger amounts of milk will be possible.
Alternate breasts: after expressing from one breast, switch to the other breast and repeat the process.
Store milk: once you’ve expressed the desired amount, transfer the milk into a storage container and refrigerate or freeze as appropriate. If you’re not planning to use the milk immediately, make sure to label it with the date and time.
Illustration by The Educated Birth
For a video detailing the technique and usefulness of hand expression, check out First Droplet’s video on Hand Expression: