Hand expression gets a bad rap. It's often described to me by clients as sticky, messy, difficult, and inconvenient. Still more clients complain that it hurts, and no milk comes out. Bummer! Why would anyone even try hand expression if that's how it is, let alone using it as their sole method of milk removal when not nursing?!
I lecture on hand expression, and the way Maya Bolman described it in one of her many papers on therapeutic breast massage sticks with me...an art. I couldn't agree more! Yes, maybe it's a bit more work at first, but lots of things are hard at the outset! Like art, you get big rewards for your efforts.
Did you know that hand expressed milk has 60% more fat in it?
Did you know that hand expression (when taught well) can be as effective as a hospital-grade double electric breastpump?
Did you know that hand expressing while pumping can give you more milk-- both in the immediate session and long term?
Hand expression doesn't have to be a pain in the tuchus! You can learn to do it, and with practice, do it well.
Here are some easy steps to remember:
1) Prepare ahead of time. Have your phone, your baby, whatever you might need nearby you, in case your needs change mid-letdown! I suggest a hand towel, an empty cereal bowl, some warm water in a different bowl, and a hot pack be part of your set-up. Imagine a mini-spa day for your boobs.
2) Don't press too hard! Breasts are tough, but they prefer to be treated gently. Look at the back of your hand- now press on a vein and see how hard you need to push to collapse it- that's all the pressure you ever need to use on your breasts while hand expressing! Go gently- you'll get more milk, I promise.
3) Move around frequently. Don't leave your hands in one spot too long. You have milk-making tissue all over your chest! In fact, I like to teach parents that if they were to draw an owl on their chest, they have a good idea of where the breast tissue lies on the chest.
Think about it:
4) Start your hand expression in a rhythm. Bodies like rhythms. I don't know why.
5) Get comfy. Find a position that you can hang out in for a little while (maybe 15-20 minutes) and lean just slightly over the cereal bowl so that gravity can do its thing. This way you won't get as sticky when the droplets cling to the underside of your breast and go all over your hand like sweat in a spacesuit.
6) Massage before & after. Rub the breasts all over, gently stroking toward your nipple area. Milk hides everywhere in the breast, look for areas that feel more dense to the touch. Try to gently "drag" those areas toward the nipple.
7) Patience! It might not start immediately, but it will get going eventually. If milk's not flowing steadily with your rhythmic expression after a few minutes, take a break & use your hot pack. Relax and think happy thoughts. Or take a little nap...whatever happens first (tired new parents take catnaps any & everywhere...this is normal)! Then try again after about 5 minutes.
8) Try to watch something funny while you express your milk. The parents who watch funny things almost always get more milk. It's a combination of the stress-relief and the lack of focusing on the milk expression that help. Don't get work done- just watch half an episode of Arrested Development and call it good.
To store your milk, pour it from the bowl into a glass container and save it like you would any expressed milk! Use glass if possible because some of the fat gets lost in plastics- it clings to the sides due to the porous nature and the microscopic bits of oil leached out of plastics- the fat likes to bond to that and get stuck! If you use plastic milk collection bottles, you'll notice a line of fat that is indelible after a long while. It's that bond in action! It isn't harmful, but losing your fat isn't nice, if we can avoid it. However, freezing calls for plastic- luckily most of the breastmilk storage bags on the market are coated with a lipophobic/hydrophobic coating inside that keeps those fats & water from getting stuck. Yay for nanotech!
When to use hand expression:
You'll hand express if you need to be apart from your baby for a time, or if you're trying to drain the breast for the baby. Sometimes babies aren't efficient eaters- in this case, until the problem with latching or transfer can be fixed, you'll want to hand express after feeds to make sure you keep up your supply!
It's a supply and demand system, like a bakery. Imagine if you wanted 4 dozen rolls for a dinner party- you'd have to call in advance and make that order! Let's say you order it, and pick it up. Everyone's happy. Now let's say you forgot to order another 4 dozen for your next dinner party- do you think they'll have the rolls ready when you go pick them up? Heck no! Supply get "established" when the bakery learns your order, and starts making 4 dozen rolls every day for you- until you quit showing up to pick them up. If you leave rolls in the bakery- they'll make less rolls for you next time...and that's pretty much how supply works, too! Your body is the baker, and your actions are you. This is all getting very meta so I'm going to stop.
Hand expression in the early postpartum:
Immediately after giving birth, you'll want to feed your baby at the breast, skin on skin. If your baby can't or won't feed at the breast for some reason, you'll want to start hand expression. You can express that awesome colostrum onto a spoon or into a medicine cup and suck it up with 1mL syringes to be stored for your baby. You will only see tiny amounts of milk at this stage- you won't want to hook up a pump, because you'll lose all that awesome colostrum to the mechanism of the pump apparatus. The little teeny droplets will just smear on the sides & get stuck- which is useless to baby! Hand expression is the way to go.
Prenatal expression:
Some studies have shown that prenatal expression can be useful in parents with gestational diabetes- this way you'll have on hand some extra awesome colostrum to help stabilize baby's blood sugars if needed. It hasn't been shown to cause early labor- so don't worry too much, unless you're on pelvic rest. You'll use a spoon to collect the milk and 1 mL syringes to store it. Date and freeze them individually if you can.
Get partner involved:
Partners! I hereby dub thee "official breast m̶a̶s̶s̶e̶u̶s̶e̶ massage therapist!" Yay! You can help with hand expression and gentle breast massage by stroking lightly toward the areolas when your partner is expressing. You can use breast massage for engorgement by heating up the breast with a hot pack, using a food-grade oil to help your hands not cause friction discomfort, and have your partner lie on their back and stroke toward the armpit. (Almost) No one hates touching boobs, so it's a win-win-win.
I hope this little guide was helpful. Keep practicing! You'll get a handle on it, soon.
-Bryna Sampey, IBCLC