Hand expression of milk
Hand expression is a useful skill to learn, and it’s a way of getting milk out of your breast with your hand only, as opposed to a pump.
Why might you need to hand express?
Several circumstances might warrant this.
One common scenario can be straight after the birth, usually around the second or third day, when it’s not unusual for many women to notice that their breasts have become overly full (engorged) as the mature milk comes in and the volume of milk increases.
If you become engorged, there is a general congestion happening, and your nipple and areola area are also likely to become engorged, and therefore, flatter.
Some babies struggle to latch on when this happens.
Hand expressing your milk will help your baby to latch on better, as it will make your nipple protrude better, and keep you comfortable as well.
If your baby is struggling to latch on well after the birth, hand expressing your milk is a great way to generate your supply, and your expressed milk can be given to your baby until he gets better at doing what he is hard-wired to do.
If you experience a blocked duct, hand expression, alongside massage and warmth, is a fantastic way to get rid of the blockage quickly.
You can even target the problem area with hand expression.
If you have an overactive let-down, where milk spurts out of your nipple too forcibly after your baby does the first quick sucks, you may find that this causes an issue for your baby.
He may cough or splutter, or even arch away from the breast very quickly, and be quite distressed.
In this situation, you can hand express just a small amount of milk (for just a few seconds) just before latching to allow the first fast bit of milk to come off the breast, and the flow to return to normal.
Your baby will then be more comfortable at the breast, and the flow more manageable.
It would be a good use of time to learn a little about antenatal expression of colostrum – where you hand express your milk just before birth, as you can use your milk in particular circumstances.
In the first few hours and days after birth, if you find that your baby isn’t latching on too well or not at all, then hand expression is the best thing to do for that first couple of days before you consider using a breast pump.
Hand express every two to three hours while your body is producing the first milk, colostrum, and at night as well.
Once the volume of milk starts to increase around the third day after birth, it is important to use a hospital-grade double pump every 2-3 hours (and once at night) if your baby still isn’t latching.
Before you do the hand expression technique, try to become as relaxed as you can.
This could perhaps involve watching the television, or having a hot drink, or reading.
Using warmth via a hot bath or shower, or warm flannels on your breast can be useful, as can massaging the breasts by kneading with your hand, all the way around the clock face.
Surprisingly, looking at a photograph of your baby or having a blanket that your baby has used near to you can also help generate the hormones that encourage your milk to let-down.
You will also need to use a wide-mouthed container to collect the milk.
Some women try to express into a bottle, but find this problematic as the milk shoots from the nipple in different directions!
It can be quite hard to catch, so it’s better to use a jug or bowl that has been cleaned well with hot soapy water or preferably sterilized.
Hand expression – the technique
Once you have relaxed, cup your breast with one hand.
With your other hand, you can pinch your nipple and work back from the nipple, squeezing until you find an area where the texture feels slightly different.
Some women will say it feels like a row of nodules or dots, and others describe it differently.
Once you’ve found the area, put your thumb on top of the breast, fingers underneath, and squeeze and release, squeeze and release, squeeze and release, and continue doing that, building up a rhythm.
At first, it can be disconcerting because you may see nothing – you may even find that you do the squeeze and release routine for one to two minutes before you see any milk coming out of the breast at all.
While it may be discouraging, be assured it’s normal, simply carry on. Squeeze and release, squeeze, and release.
Eventually, you will see drops. It could be tempting to give up at this point but keep squeezing and releasing at that same spot.
It’s important not to slide your hands down the breast.
Eventually, you will see milk shooting or squirting out of the breast. Keep going, and soon the squirts will subside.
To reiterate, do the squeeze and release action until you see drops. Keep going until you see squirts.
Keep going until the squirts have subsided.
At that point, you can rotate to another area of the breast, and repeat that whole sequence, then rotate again.
When you’ve been all the way around the breast, move to your other breast, and start again.
If you find that the place where you put your thumb and your fingers isn’t causing milk to come out of the breast, no matter how many times you’ve squeezed and released, then you can alter the position, move slightly towards the nipple, or further back, and try again there.
Sometimes it can take time to find the area.
Some women also find that they need to press into the chest wall first, and then do the squeeze and release.
Most women find that the more you practice the technique, the more finely tuned and natural it becomes over time.
Hand expression is an excellent skill to learn and very important, especially in the prevention of blocked ducts.
Review dates, references & further resources
Version 1.1 published in March 2019. Next review date: Jan 2022
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