A Step-By-Step Guide To Hand-Expressing Breast Milk

When you’re breastfeeding (chestfeeding), there are all sorts of things to take into consideration, like what medications are safe to take, how breast surgeries affect breastfeeding and what foods you can eat to increase the caloric content of your breast milk. But what about the actual act of breastfeeding itself?

Sometimes, breastfeeding can be a challenge, especially for first-time nursing parents. That’s where hand-expression comes in. The process of using your own hand or another person’s hand to remove breast milk from your breast is a skill that takes practice for both parent and baby. And although it’s not a necessary skill to master, it can be a helpful skill in some scenarios.

Pediatrician and breastfeeding medicine specialist Heidi Szugye, DO, IBCLC, explains when hand-expression is helpful and how to do it below.

What is hand-expression?

Hand-expression is a technique used to massage breast milk out of your breast and increase the flow of milk. Similar to using a pump or your baby’s mouth, hand-expression is a helpful technique to use for an effective breastfeeding experience and when you want to store milk between feedings.

When is hand-expression useful?

Hand-expression can be useful in a variety of scenarios, including:

• Antenatal expression: Sometimes, your Ob/Gyn or breastfeeding medicine physician may recommend hand-expressing breast milk prior to having your baby if you’re at-risk of a delay in your milk coming in or having a low milk supply. “This should only be done if approved by your Ob/Gyn and never before 37 weeks,” states Dr. Szugye.
• Increasing the volume of milk: Studies have shown that a combination of pumping breast milk and then hand-expressing after pumping has been correlated with a higher supply of breast milk. Studies have also shown that the same combination of pumping and hand-expression has been associated with breast milk that’s higher in caloric content.
• Assisting with a faster flow of milk while nursing: “If we have a baby that latches but is not really good at sucking and extracting the milk from the breast, sometimes, using your hand to help them get the milk out can increase the flow allowing them to transfer more milk,” notes Dr. Szugye.
• Enticing your baby to latch: Hand-expressing a little colostrum on the breast prior to your baby latching can sometimes entice them to the breast. “Colostrum is the earliest form of breast milk you produce during pregnancy. It contains the most nutrients and plays an important role in building your baby’s immune system,” says Dr. Szugye. “When a nursing parent is producing small volumes of colostrum and the baby is not latching well or can’t latch early on, hand-expression can be easier and more efficient than pumping.”
• When an electric pump is unavailable: Hand-expression is also a useful if you ever forget your electric pump or during power outages or natural disasters when access to an electric pump is limited.
• Weaning: “When weaning and you want to just empty the breast enough to be comfortable but not fully empty the breast, hand-expression can be convenient and effective,” advises Dr. Szugye.

What’s the difference between hand-expression and breast massage?

Hand-expression is different from breast massage because it’s designed to get the milk out of your breast. You should never aggressively massage your breasts with your hands or any other massage device. Instead, a very light-touch massage (like the pressure of petting a cat) might be recommended by your provider to aid in the drainage of swelling into the lymph nodes above your collar bone and in your arm pits when your breasts are engorged or swollen. Light touch can also help you achieve a letdown.

How to hand-express milk

Hand-expressing milk is a skill that gets easier the more you follow these steps:

1. Clean your hands.
2. Position your fingers one to two inches behind your areola with your thumb above the nipple and your other fingers below the nipple. The exact spot varies for each person, but in general, the best position is behind your areola and not on it. “Your hand should form a ‘C’ or ‘U’ shape,” instructs Dr. Szugye.
3. Press your fingers back toward your chest.
4. Gently compress your fingers and thumb together and roll forward to express milk.
5. Relax for one to two seconds, then repeat the process in a rhythm where you press, compress, release and repeat.
6. You can move your fingers around your areola as well to empty additional ducts in a second position.
7. Massage and stroke your breast to warm it up again.
8. Press your fingers back toward your chest.
9. Compress your fingers together to express milk.
10. Follow the rhythm in this second position for three to five minutes.
11. Move your fingers to a third position.
12. Express milk for one to two minutes.

It takes time and practice to get this technique down. If it doesn’t work the first couple of times, try again after a small break. If you’re still having challenges, your Ob/Gyn or a breastfeeding medicine specialist can help walk you through the process or help you find some alternative solutions.