Hand expression is a technique in which breastfeeding mothers or care providers use one or two hands to apply gentle pressure to the breast to express milk (Flaherman 2013, KellyMom.com).
Maximize hand expression efficiency by first stimulating the letdown reflex. A “let down” is a reflex that is initiated when the nipple is stimulated, sending a signal up to the brain to release the hormone oxytocin, which then travels through the bloodstream until it reaches the mammary gland. There oxytocin binds to small muscles surrounding the milk-producing cells leading toe milk secretion through the milk ducts towards the nipple.
While nursing, a baby stimulates the let down reflex via a combination of suction and compression of the nipple. A pump stimulates a let down only through suction. Mothers who are hand expressing can stimulate a let down by tapping, gently rolling or pinching or pulling on the nipple (Australian Breastfeeding Association).
Initiating a let down can take a few minutes, because it takes oxytocin about 90 seconds to be released from the brain and travel to the mammary tissue to squeeze the milk-producing cells. It helps to alternate the ‘nipple tapping and pinching’ with hand expression movements while waiting for milk to start flowing. (Australian Breastfeeding Association)
Each mother’s breast anatomy is unique, so there is likely a special place on your breast where you should place your fingers to yield the most milk in the shortest amount of time.
One version of hand expression involves the following actions: a mother forms a “C-shape with her ipsilateral hand (on the same side as the breast she wants to express milk from), places her thumb 2–3 cm above her areola and her fingers 2–3 cm below her areola. To initiate expression, the mother presses gently back towards her chest wall, exerting continuous pressure without eliciting any pain. This is key. Hand expression should not hurt, although the fingers and hand might get tired. The thumb and fingers are pressed toward the chest wall, and then brought together and pressed gently forward, so that they push on the ducts beneath the areola. Ideally, when compressing the breast tissue the fingers should meet together in the place where the baby’s gums would fall while nursing.
Milk should be expressed as the fingers come together when compressing the breast tissue. Using a cycle of pressing and releasing and rotating her fingers around the areola, a mother can aim to capture all of the ducts until a maximum volume of milk has been expressed (Flaherman 2013). It is not always necessary to rotate the fingers around the areola and many mothers feel their breasts empty without ever moving their fingers from one position.
According to La Leche League, there are a variety of techniques that can be used to express breastmilk, but the key is that hand expression should not be painful for the mother.
If you have questions about hand expression and would like a live video consultation with our CEO, an international board-certified lactation consultant, please let us know.
For more information on teaching hand expression to increase early milk production, view Dr. Jane Morton’s videos on the Stanford Medicine Newborn Nursery webpage. You can also view instructional videos on hand expression and breast massage from Maya Bolman, RN, IBCLC here.