Hand Expressing Breast Milk

Hand expressing breast milk is a very useful skill, it’s easy to learn and it’s free! This article shares tips and videos to help you get your milk flowing and the circumstances when it is particularly useful.

Mother kissing baby

Prepare the breasts

Before hand expressing breast milk, some mothers have found it can help to “prepare” the breasts (and trigger a let down) in one or more of the following ways:

  1. Warmth across the breasts before expressing can help milk start to flow
  2. Holding your baby skin to skin or lightly dressed helps to raise oxytocin levels which can help trigger the let-down
  3. Massaging the breasts by gentle stroking, rolling, kneading and tapping movements with warm hands can help to get the breast ready for hand expressing breast milk. Some mothers use a soft baby brush to massage the breast. Examples of massage techniques are shown in the following video from Maya Bolman (1:03). Continue watching from 1:45 to see her suggested hand expressing technique; notice how the fingers are just behind the nipple and the helper uses one hand and then both hands.

If you can’t seem to trigger a let down and your baby is latching on, practicing hand expressing after your baby has already got your milk flowing can be helpful.

Hand expressing breast milk

Successful hand expressing involves triggering a let down of milk and then squeezing into the breast, with fingers placed behind the nipple, to compress the milk ducts and release milk. You could compare this to squeezing a tooth paste tube behind the nozzle (you don’t squeeze the actual nozzle!). Exactly where to place your fingers for the best effect is individual to each mother and trial and error.

Videos of hand expressing

The easiest way to explain how to hand express is to watch it being done.  The Maya Bolman video above and the following three videos show slightly different tips and techniques.

Using massage

In a clip from Stanford University Jane Morton describes her preferred hand expressing technique at 7:14. She places fingers further behind the nipple than other videos might show, she reminds mothers to alternate expressing between the breasts, to take a rhythmical approach and to use hands to massage the breast.

Demonstration on a knitted breast

Unicef UK’s Baby Friendly Initiative video demonstrates hand expressing breast milk on a woolly breast (two minutes 36 seconds long). The narrator reminds mothers not to let fingers slide across the breast:

One handed technique

The following short video from Ammehjelpen (Norwegian breastfeeding support) is one minute 20 seconds long, and is also recorded in Norwegian. The clip shows a one handed technique and a mother hand expressing both breasts at the same time. Moving the hands around the breast helps to stimulate and empty all the milk glands:

There are several variations to try for hand expressing breast milk. Experiment to find the technique that works for you.

When is hand expressing breast milk useful?

Hand expressing is not always needed if breastfeeding is going well, but can be useful for any of the following situations:

#1 Baby won’t latch

If a baby won’t or can’t latch straight away after birth, or mother and baby have to be separated for medical reasons, freshly hand expressed colostrum (the first breast milk) can be fed by spoon or syringe to keep baby well fed until they can latch. Early hand expressing in the first hour after birth—and regularly thereafter—can help future milk volumes as well as stimulating the milk supply to come in as soon as possible 12. Typical volumes of colostrum are too small, thick and sticky to collect with a pump.

Expressing colostrum

Global Health Media’s video provides tips for collecting colostrum, the first breast milk after giving birth, and how to collect it on a spoon. The video shows suggested finger positions to use, what is happening within the breast when you express, and plenty of tips to get your milk flowing.

#2 Severe engorgement

If a mother has severe engorgement in the early days after birth, hand expressing can gently remove excess milk. Using a pump at this time can pull more fluid into the area and add to the engorgement. Engorgement or a blocked duct can be relieved at any time with hand expression too. Pumps are not always a necessary purchase! If a mother is struggling to get her milk to let down see Engorgement Relief When Milk Won’t Flow.

#3 Low milk supply

If a mother has a low milk supply, both hand expressing and pumping are great ways to drain the breasts to stimulate them to make more milk. Hand expressing after pumping and hands on pumping together can provide as much as 48% more milk 3. Hands on pumping is described by Jane Morton MD from Stanford School of Medicine in this Hands on Pumping video (see 5:15).

#4 Diabetes

If a mother has diabetes, some hospitals advocate learning to hand express and collect prenatal colostrum in the weeks just before the baby is born. This provides a supplement to keep the baby fed if there should be a drop in his blood sugar or any other complications requiring supplementation. LLLGB explains:

In the first 24 hours after birth, babies of diabetic mothers risk developing low blood sugar levels (hypoglycaemia). A baby needs colostrum to maintain his blood glucose levels. Exclusive breastfeeding has been shown to reduce the risk of a baby developing diabetes later in life.

For a review of the safety issues and when it is appropriate to express colostrum antenatally see Expressing Milk Before Birth, Breastfeeding USA, 2013  and Antenatal Expression of Colostrum, ABA, 2015.

#5 Storing breast milk

Before hand expressing breast milk for storage, wash your hands and check that any equipment used to collect milk is clean. See How Long Does Breast Milk Last for more information on breast milk storage.

Summary

Hand expressing breast milk is a good skill to master to support breastfeeding. Hand expressing can help to build a milk supply, provide supplements for your baby, breast milk to store, and relieve uncomfortable engorgement. There are several helpful videos to explain how to hand express.

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