Want a powerhouse technique to improve breastfeeding? Learn hand expression!
Although expressing milk with our hands is not new - after all, before pumps, this was the only way to remove milk other than with a baby - it’s having a bit of a moment and I am HERE for it.
Years ago, when I would ask lactating parents if they knew how to hand express, I would often get very confused looks. Like I had 2 heads and was asking them if they wanted to go for a ride on my pet giraffe.
Nowadays, not everyone knows how to hand express, but they have at least heard about it as a technique, and thankfully, I am no longer getting those strange looks. (At least not for that reason. 😆)
I consider hand expression to be among the “Big 3” in lactation. These are foundational principles or techniques that give you the best chance of optimizing breastfeeding or pumping success. The other 2 are early, frequent and effective feeding and skin-to-skin contact with baby.
Skin-to-skin contact and frequent and effective feedings as a way to establish milk production and to get breastfeeding off to an easier start have been validated in studies for decades. For a long time, these have been the heavy hitters in the field of lactation science. Hand expression is quickly joining these as another very important tool.
We have a growing body of evidence supporting hand expression as a driver of breastfeeding success, especially when it’s started in the first few hours after delivery.
Studies show that the timing of early colostrum expression impacts future milk production significantly. Researchers have found that women who hand expressed in the first 6 hours after birth continued to have much higher production compared to women who did not start hand expressing until at least 6 hours after birth.
“The establishment of milk production is time sensitive and dependent on very early, frequent and effective colostrum removal for subsequent production. ”
Another very cool benefit of hand expressing milk, compared to pumping, is that the milk expressed is higher in fat. This is particularly helpful when feeding a premature or low birth weight baby, but is beneficial for all babies. This is true regardless of when you first begin hand expressing.
What about the impact on breastfeeding rates? A large number of breastfeeding parents intend to breastfeed, but of those, only a quarter continue through 6 months. Women who are taught hand expression breastfeed longer than those who are not.
I’ve seen this in my own practice - both in the hospital and in the community. Women who are comfortable with hand expression are more confident in their body’s ability to make milk and in their hands to remove it. The function of their breasts seems less mysterious to them, and I attribute that to how up close and personal they get with milk removal.
In the past few years, the maternity team at my hospital has been teaching hand expression to as many new parents as possible. We also started an initiative to teach expectant parents to hand express at the end of pregnancy, and if possible, collect the drops of colostrum to save for baby as a supplement.
I believe that these early lessons in hand expression have been helping parents to feel more empowered in their body’s ability to make milk, while having a quick and effective way to provide a supplement to their baby. Confidence in one’s own milk production also prevents people from feeling the need for unnecessary formula supplementation, which can easily start the slippery slope of lowering milk production.
By now you may be asking, “Why would I hand express after delivery if my baby is with me and breastfeeding well?”
Great question! If your baby is on your body from the time of birth, and is actively feeding at the breast, you are getting breastfeeding off to a great start. Congratulations! 🥳
In these situations, I would still recommend adding in a few minutes of hand expression after most breastfeeds, as an insurance policy for your future milk production. Maybe your baby will get sleepy later and not want to breastfeed. Maybe your baby will develop issues with blood sugar.
The point is, you just never know what may happen, and adding in some hand expression in the first few days carries no risk (if you do it correctly) and provides many benefits.
Now let’s talk about other reasons that you may want to incorporate hand expression into your lactation journey:
More effective pumping:
Whether you are an exclusive pumper (either by choice or as a temporary solution such as if your baby is in the NICU), or a part-time pumper (pumping when at work or in order to to be able to give occasional bottles), adding hand expression into your pumping routine will help you level up your milk output as well as the nutritional quality.
Remember that hand expressed milk contains more fat than milk expressed with a pump, and hand expressing after a pumping session usually yields more milk than the pump alone. Pumps rely on vacuum power to draw milk out, while hand expression uses massage. The combination of the two is much closer to what babies do at the breast.
Increasing your supply:
If your production is on the low side, adding hand expression to your daily routine will help you make more milk. This can be done after nursing or pumping or whenever it works for you. You don’t need to spend a lot of time doing this either - 5 minutes of hand expression after some of your pumping or nursing sessions can make a difference.
Engorged breasts:
When breasts are firm and swollen, the ducts that carry milk are compressed by surrounding lymphatic fluid and milk doesn’t flow as well. Babies have a harder time latching to an engorged breast (it’s hard to get your mouth around a basketball, y’all). When there’s swelling, pumping tends to be ineffective and can just pull more lymphatic fluid into the nipple and areola.
You guessed it - hand expression to the rescue! A combination of moving lymphatic fluid back and bringing milk forward with your hand can help reduce engorgement very effectively.
You are unexpectedly away from your baby and have no pump:
Things happen. The electricity goes out, you get stuck at the airport or in traffic, your quick appointment was much longer than expected. Time for some hand expression! If you can find a private space, you can move milk and prevent problems like engorgement, plugged ducts, and supply dropping. If you have a cup, you can save this milk for later if you want.
If you’re pregnant and planning to breastfeed:
Maybe you had low production with your last baby or maybe you’ve been told that you have risk factors such as diabetes, hypothyroidism, PCOS, a history of breast surgery or there are concerns about your breast anatomy.
Even without risk factors for low milk production, you never know what your delivery will be like. Things like a postpartum hemorrhage, a long induction, medications in labor and excessive IV fluids in labor can all negatively impact the first few days of your breastfeeding journey.
Learning how to hand express at the end of pregnancy and planning to hand express frequently in the early days postpartum can set you up for a more robust milk supply later.
You may not be able to control your pregnancy and birth, but you can teach yourself a technique ahead of time that is highly associated with breastfeeding success.
I strongly encourage all pregnant people who are planning to breastfeed to start practicing before the birth. The reason for practicing early is that although hand expression is not complicated, it is a skill that takes practice.
Here’s an analogy to explain why practicing ahead of time is helpful:
Say you want to learn how to knit. At it’s most basic, knitting is pretty simple, but we would never expect to pick up yarn and knitting needles and be able to produce a hat on day 1. Now imagine how it would feel to learn how to knit if you had someone yelling at you to hurry up.
This is what happens when we learn how to hand express after the birth, when baby may be crying and you have been up all night. Heck, you may have been up for days, lost a liter of blood and had surgery. This is not the best learning environment.
Instead, you can learn ahead of time and already have the ability to effectively hand express soon after your baby is born.
If you are pregnant and want to learn hand expression, it’s recommended that you talk with your OB provider beforehand, but it’s considered safe for low-risk pregnant people, starting around 36-37 weeks gestation.
Hand expressed colostrum in syringes.
Usually when you hear about this practice, the goal is to collect colostrum, also known as colostrum harvesting.
Saving colostrum for your baby can be especially helpful for people with diabetes or gestational diabetes, partly because their babies will probably be getting blood sugar testing done in the first day (or more) of life. If the baby’s blood sugar is low, having an already collected food source will help them get extra as they are working on breastfeeding.
Regardless of whether you want to collect colostrum or not, learning the skill of hand expression should be the main goal. If the drops are not big enough to collect, don’t worry about it. And please know that the amount of colostrum you are able to express in pregnancy is NOT a predictor of how much milk you will make after delivery.
By now, I hope you see the value of learning how to perform this basic skill. For understanding the technique, the following video is one of the best ones out there. Give yourself time to learn and be patient with yourself. Some people start in the bathtub, where they are already warm and relaxed. Find what will work for you and always remember to reach out to an IBCLC if you have any questions.
