A How-To Guide on Hand-Expressing Breast Milk

Sometimes, breastfeeding (chestfeeding) can be challenging, especially for first-time nursing parents. That’s where hand expression comes in handy.

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 for an effective breastfeeding experience, as well as when you want to store milk between feedings.

Hand expression can take up to 15 to 30 minutes at a time, or until breast milk slows to a drip from one breast. When that happens, you can switch to your other breast and repeat the same process. Most often, shorter sessions can be more effective than longer ones. And the more you practice hand-expressing milk, the easier milk production becomes.

To help you get started, pediatrician and breastfeeding medicine specialist Heidi Szugye, DO, IBCLC, explains how to hand-express breast milk, as well as when you should — and shouldn’t — start the technique.

Tips on how to hand-express milk

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

1. Clean your hands with soap and water to reduce the spread of germs and other bacteria to the surface of your breasts.
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 few rounds, try again after a small break. If you’re still having challenges, your Ob/Gyn or a lactation consultant can help walk you through the process or find alternative solutions.

Hand-expressing colostrum

Colostrum, the first milk produced by your breasts during pregnancy, is highly concentrated with nutrients and antibodies that strengthen your baby’s immune system and provide additional benefits. In some cases, you can hand express colostrum as early as 37 weeks of pregnancy if you’re at high risk for preterm birth, low milk supply or when certain health conditions are present.

If you’re interested in hand-expressing colostrum, talk to your healthcare provider first because hand-expressing before giving birth can sometimes lead to contractions and/or preterm labor.

“Storing colostrum before birth has not been shown in studies to make milk come in faster or prevent low supply long term,” shares Dr. Szugye. “It does get people comfortable with the skill of hand expression and potentially allows for giving their own breast milk if needed for supplementation early on. Those with risk factors for delay in milk coming in such as a C-section delivery or gestational diabetes may find it of benefit.”

Reasons to hand-express breast milk

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

• Antenatal expression: Sometimes, your Ob/Gyn or breastfeeding medicine physician may recommend the hand expression of 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 who 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 contains the most nutrients and plays an important role in building your baby’s immune system,” reiterates 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 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,” says Dr. Szugye.

Hand expression vs. 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 collarbone and in your armpits when your breasts are engorged or swollen. Light touch can also help you achieve a breast milk let-down.

Is hand-expressing milk the same as pumping?

Using a pump instead of hand-expressing or in combination with hand expression is most effective when you’re producing higher volumes of milk. Hand expression is often preferred over pumping preterm and soon after birth because colostrum tends to be thicker and richer, and because pumping increases your risk for inducing labor. Hand expression can also be done at different angles and in different rhythms to help improve milk flow, whereas pumping provides a consistent approach to the technique.

Storing milk

Hand-expressing milk between feedings — especially during peak times of the day when prolactin, the hormone that helps with milk production, is at its highest at night or early in the morning — can help make sure you have a bank of breast milk at your disposal.

Knowing how to store your breast milk is important information to have on hand, too. In most cases, breast milk can be stored:

• Up to four days in a standard refrigerator.
• Up to three to four months inside a standard refrigerator freezer.
• Up to six to 12 months in a separate deep freezer.
• In an insulated cooler bag with frozen ice packs for up to 24 hours while traveling.

Milk it for what it’s worth

Hand expression is a process that takes rhythm and dedication. Although there are recommendations for how long you should breastfeed, it doesn’t always work for everyone and that’s OK. If you have to supplement formula or donor milk for a time and try to relactate down the line, that’s always an option, too.

However you decide to nurse your child in the first few weeks of life and beyond, the important thing is making sure they get every ounce of nutrition they need to grow and thrive.