How to Hand Express Your Breastmilk

In a time when breastfeeding is thought of less and less as "natural and normal" and instead associated more and more with the need for gadgets and  technology, I want to talk to you today about the free and easy practice of using hand expression for removal of your breastmilk.

Hand expressing breast milk can be one of the most beneficial skills that you learn when breastfeeding.

Yet, it is not really talked about all that much. The breast pump has become the most popular tool of all time for breastfeeding. It certainly has lead to many breastfeeding parents being able to continue providing breastmilk for their babies. But, for most of history, most parents have been  able to provide breastmilk for their infants without ever using a breast pump.

Now, don't get me wrong, I am not against the use of breast pumps. In fact, most of the parents I support, use a breast pump at some point in their breastfeeding journey. I provide support for exclusively pumping moms, those who pump at work to provide milk for their babies,  moms who use a breast pump to work on increasing their milk supply and those whose babies are not yet efficient at getting milk from the breast.

But, what I do not see a lot of information about how to use hand expression or the benefits of using your hands to express milk. I would say that the majority of breastfeeding parents I work with have not been taught how to effectively hand express to release milk from their breasts. And most have not known about the many benefits of hand expression. 

For that reason, In this post, I am going to discuss some benefits of hand expression and show you how to hand express your milk. 

For a demonstration of hand expression, watch the youtube video on hand expression . 

What is hand expression? 

Hand expression is exactly as it sounds - using your hands to remove milk from the breast. Obviously, for many centuries, this was the.main way to express milk from the breasts, and for many, it is the most effective way to remove milk from the breast when baby is not present or able to remove the milk. 

There are many benefits to using your hands to express milk from the breast. The act of skin on skin touching increases your body's oxytocin response which leads to the milk being released from the milk ducts. This is often called the milk ejection reflex or the milk letdown (oxytocin causes the milk to  "let down".)

By using your hands you can feel the areas where compression of the breast is needed and you can evaluate what type of pressure and what location works best for removing milk most efficiently. It is gratifying for many mothers I have worked with to see that spray of milk from their breasts when they have been worrying if "they any milk." A breast pump shield or flange only provides pressure to the area right around the nipple and areola, but you have milk ducts that extend all the way to your underarm area. Your hands can provide. compression to those areas to help release the milk as you express the milk. . 

Using hand expression helps you to become comfortable your breasts and helps you to be more familiar with what your normal breasts feel like and how milk is best removed.

Combining hand expression with gentle massage may help to increase your milk flow. And combining hand expression with pumping increases the amount of milk released over  pumping alone. 

When should you use hand expression? 

During Pregnancy

If it is cleared by your obstetric provider, you can begin using hand expression in the last month of pregnancy to become familiar with how hand expression works. Some providers are cautious about using nipple stimulation before a baby is full term due to the potential for oxytocin to initiate uterine contractions. if you have a history of premature labor or you or your baby have any high risk factors, you will definitely want to get clearance by your OB provider prior to using hand expression during pregnancy. 

Prior to delivery, you have milk in the form of colostrum present. You might hear "when your milk comes in" or "my milk hasn't come in" but you already have milk before the baby is even born.  But, the pregnancy hormones keep you from producing large amounts of milk until after delivery. Once the placenta is delivered, your pregnancy hormones decrease and your milk making hormones take over to increase the supply of milk.  If you haven't been expressing your breasts, you just may not have seen the early milk called colostrum.  Not seeing it doesn't mean it is not there. 

Experimenting with hand placement and pressure and rhythm will help you to learn how to express that early milk. Some people even being collecting the colostrum that they express before delivery in tiny syringes that they can then feed to the baby in the early days after delivery. Discuss this with a lactation professional and your obstetric provider if you are interested in collecting colostrum before delivery. 

Immediately after birth

After the birth, you can begin using hand expression to become more familiar with your breasts and how to express milk. You will likely see small amounts - only drops  - of colostrum. It is thick and yellow and sticky. It is loaded with immune properties and this nutrition is all your baby needs - even though there is not a large volume. It is sometimes hard to convince people that this little bit of milk is a sufficient . But it is actually important that babies only have small volumes of milk. 

When a baby is born they have to learn the skills of breathing, sucking and swallowing and their tummies are very tiny  so this tiny amount of milk that they get in one feeding is all they need. Large volumes of milk - like you see in pictures, can overwhelm a new baby. Over the next few days and weeks,  babies gets more efficient in their sucking, swallowing and breathing skills and at the same time your milk volume is increasing - just the way that nature intended. 

Babies are designed to take in small amounts of  milk very often in order to get all the calories they need and to learn feeding skills. You can use hand expression immediately after delivery to help your baby take in these small frequent feedings.   Using hand expression, you can extract small amounts of your colostrum into a spoon and feed it to your baby. This is especially helpful for babies who are very sleepy and are having a hard time staying awake at the breast. Getting a little colostrum into the baby before breastfeeding might help the baby wake up a little and stay awake longer. Or you can offer little spoonfuls of colostrum between feedings. 

Here are some situations when hand expression may be helpful 

Baby issues

if baby is having trouble latching at the breast, or is jaundiced or at risk for having low blood sugar, or if  there are concerns about weight gain, providing this little extra colostrum with a spoon feeding may help baby avoid the need for supplementation. If baby is requiring supplementation, providing your own colostrum will help baby get more of your own milk and decrease the need for the supplement.

( Colostrum is also a  natural laxative and helps baby to have  frequent stools. This helps to eliminate the substance that causes jaundice in babies)

Separation From Baby

If you are separated from your baby ( i.e. your baby needs to go to the ICU or special care nursery) you want to start hand expressing and collecting your colostrum as soon as possible after birth and continue regularly until you are back with your baby. You can provide that colostrum that you collect for your baby.  The hospital staff can assist you with this. 

If you had interventions during labor and delivery

Sometimes when a birthing person has received a lot of IV fluids during labor (like for an induction or a C Section or antibiotics,) they may have some swelling of their breasts in the few days after delivery. These IV fluids often cause fluid retention.. Often, breastfeeding parents will notice that their breasts are feeing very full hard and painful They may notice that their nipples are flattened out more than usual. Someone may even tell you that you have "flat nipples'. Often, it is recommended that you use a nipple shield or begin pumping. 

You might find that hand expression is a more effective option for removing milk in this situation  than pumping.  Pumping relieves fullness from increased breast milk but it does not relieve fullness from fluid retention.  This is fluid is in the tissues, not the milk ducts. This fluid cause swelling which can actually prevent milk from getting out of the milk ducts. Think of the fluid as too many cars on the highway which keep the cars from being able to move. Too much fluid around the milk ducts keeps the milk from being able to flow.  Many lactation professionals, like me, recommend using hand expression to gently extract the small amounts of milk that are present in these first few days after delivery rather than a breast pump until the swelling decreases. (If you are having trouble with swollen painful breasts, contact a lactation professional right away for help.)  

 Early Engorgement

Typically, milk begins to increase in volume about 3-5 days after delivery. Sometimes the breasts will get very full feeling at that time. Firm full breasts are often hard for babies to latch onto. At this point in time, many people begin to pump to relive the fullness. I recommend first trying hand expression to release enough milk to relieve that uncomfortable fullness and to help soften the nipples and areola enough for baby to latch on. If you are still struggling, then you may need to use a breast pump. Hand expression is often easier and less painful on hard full breasts. 

For this reason, I always recommend using hand expression along with frequent feedings of the baby to in the very early days after delivery as the milk volume  begins to increase. 

As your milk increases in volume, and your swelling decreases, you can switch over to using the breast pump if you need it. (it is important to have a plan for how long and how much milk to pump and a lactation professional can help you with this plan)

If you are considering using a breast pump, make sure that you are working with a lactation professional who can help you with a plan so that you are both protecting your milk supply as well as assisting the baby with latching. 

Increasing milk supply

You can use hand expression to help provide more stimulation to your breasts to help increase the volume of milk you are producing. Frequent stimulation with improved milk removal sends your body a signal  to make more milk. Milk removal acts like putting in an order for the next feeding. 

Pumping and Hand Expression together

Hand expression also increases the amount of milk you remove from your breasts when you are pumping. Studies have shown that mothers who used hand expression at the end of a  pumping session were able to increase the amount of milk they removed. This shows that the breast pump is not always as effective at is needed at removing milk. 

Before feeding the baby at the breast

If your baby is having a hard time latching onto the breast or getting frustrated and pulling off quickly, they may have difficulty with how firm your breasts are. You might try using hand expression to relieve some fullness and then try again and see if baby can latch better. 

If your breastfeeding baby takes a bottle

Babies who drink from the bottle often get used to having milk immediately available when they begin sucking. This is quite different than feeding at the breast when baby needs to suck to stimulate your body to release the milk. If your breastfeeding baby has been drinking from the bottle, you might use hand expression to get the milk to relaase before latching baby at the breast. This may help your baby not get frustrated while waiting for the milk to release.

If your baby is very sleepy

Babies are often very sleepy after delivery. Sleepy babies will frequently latch onto the breast and then quickly fall asleep. Hand expressing milk first will ensure that baby is getting milk as soon as they latch onto the breast. This may help them stay awake longer. Sometimes giving that expressed milk in a spoon or cup before a feeding may be just enough milk  to get baby to wake up and feed more actively. 

You can see that there are many benefits to hand expressing your breastmilk. It is an easy skill to learn but does take some practice. If you are expressing and not getting milk, reposition your hands and try again. Watch the video for instructions. You have to find the best spot for your body that releases milk. it is always reassuring for breastfeeding mothers to see that milk being released. Seeing the evidence of your milk supply is gratifying. 

Some parents find that they are much more efficient at getting milk out than the breast pump and these parents will use hand expression to remove enough milk for the baby to feed. If you are needing to pump very frequently to initiate a milk supply or are providing milk for a baby who is not feeding at the breast, you will probably find that you will want to add in use of a breast pump once your milk supply is increasing. 

In the video above, you will find a demonstration of how to hand  express your milk. 

Important Tips for Hand Expression

Important information to keep in mind is that this is gentle practice. The right hand placement in the right location with a steady rhythm on your breast will produce the most milk, Squeezing your breasts really hard is not needed and can cause damage to your breasts tissue. Hand expression is all about getting into a gentle rhythm of compression of the milk ducts to release the milk. You won't get MORE milk by squeezing harder. Learn to treat your breasts with gentle touch.  

Seek Help From a Lactation Professional 

If you are struggling to make enough milk for your baby, if your baby is having difficulty latching onto the breast or staying awake at the breast you will find hand expression helpful. Also, if  someone has recommended that you use a breast pump or other equipment for feeding, I recommend that you try hand expression first. If it has been recommended that you provide supplemental feedings for your baby, hand expression should be started right away. In these circumstances, a lactation professional can help you develop a plan for meeting your breastfeeding goals while ensuring your baby is well fed. 

Hand expression is often overlooked but I always teach this skill to breastfeeding parents. it is an easy and free tool that is very valuable in helping make breastfeeding your baby a success.  If you haven't already, try adding hand expression into your pumping practice. . 

If you have a friend who might find this helpful, share this with them. 

And if you are in need of more professional lactation support, check out My Lactation Consult options here. I offer house calls, office visits and virtual visits. Your breastfeeding should be an enjoyable experience for you and if it is not, don't struggle alone, reach out for help today.