How to Hand Express Breast Milk

The hand expression of breast milk, also called manual expression, is a technique where you use your hands instead of your baby or a breast pump to get the breast milk out of your breasts.

Why Hand Expression Is Useful

You may wonder why anyone would want to express their breast milk by hand when they could use a breast pump. While most women will use a breast pump, especially if they need to pump very often, hand expression is still a valuable skill to learn. This technique comes in handy when:

• Your breasts become full and uncomfortable while you're away from your baby, and you don't have your breast pump with you.
• A source of electricity is not available, your pump stops working, or it needs new batteries.
• Your breasts are engorged and hard right before breastfeeding, so you express a little bit of breast milk to soften them and make it easier for your baby to latch on.
• You're collecting colostrum for your preemie or newborn and since there's only a small amount, you want to get as much as you can without losing any in the pump parts or tubing.

How to Express by Hand

Expressing breast milk by hand is a skill. Just like any other skill, you have to learn how to do it and practice it to become good at it and get the best results. You can follow these steps to express breast milk by hand.

1. Wash your hands with soap and water.
2. Get into a comfortable position and try to relax. You can place a warm towel on your breasts or gently massage your breasts for a few minutes before you begin, to help get the breast milk flowing.
3. Use a picture of your baby, a recording of your child making sounds, a blanket with your baby's smell, or other relaxation techniques like music to help stimulate your let-down reflex.
4. Take your hand and position it on your breast in the C-hold. That is, place your thumb on the top of your breast and your fingers underneath your breast so that your hand is in the shape of a C. Your thumb and your fingers should be 1 to 2 inches behind your nipple.
5. Hold a clean collection cup or breast milk storage bottle under your breast with your other hand so that your nipple is directly above it.
6. Begin to gently push your breast back toward your body with your thumb and fingers.
7. Bring your thumb and fingers together. Then, use a rolling motion as you move your hand forward toward your original starting position. The gentle rolling motion will move the breast milk out of the milk ducts.
8. Try to be gentle. Your breast tissue is sensitive and you can bruise it or damage it if you squeeze, pull, rub, or slide your fingers over your breast.
9. Lean forward a little bit to collect the breast milk that should be dripping or spraying out of your breast. Be careful to get the breast milk into your collection container without any of the milk touching your hands first.
10. Repeat steps 6 and 7 at a steady, rhythmic pace until there isn't any more breast milk coming out of your breast, or until you have alleviated the fullness of engorgement.
11. Switch breasts when the flow of breast milk stops. When you switch breasts, rotate your hand to another position around the nipple (C, U, backward C, upside-down U) and begin the process again. These different positions help to drain the breast milk from all the areas of your breast.
12. Give give your baby the milk you expressed right away or seal it in a breast milk collection bag or container and store it to use at a later time.

Pros and Cons

There are many positive reasons to learn hand expression:

• It's natural.
• It doesn't cost anything.
• Other than a collection container, it doesn't require any equipment.
• It's quiet.
• It's always available.
• If you express breast milk by hand before and after using a breast pump you may get just as much if not more breast milk than if you only pump.
• Learning how to use hand expression can help you become more comfortable with your breasts and more aware of what's normal and not normal, plus it could help you notice any changes in your breasts that need attention.

However, even though it's a useful skill, there are a few downsides to hand expression as well:

• It takes practice to become good at expressing your breast milk by hand, so you'll have to invest a little time into learning to use the technique and getting comfortable with it.
• Using a breast pump may be quicker and more efficient for you.
• Some women just have trouble with hand expression and can't get any breast milk.

Where to Find More Information

When you're in the hospital after the birth of your baby, ask your nurse or the hospital's lactation specialist to teach you how to hand express your breast milk. If you want to learn the technique, or you have any questions after you leave the hospital, you can contact your doctor, a lactation consultant, or a local breastfeeding group.