How to hand express breast milk

What is breast milk hand expression?

Breast milk hand expression – also called manual expression – means using your hands to express milk from your breasts (instead of using a breast pump). Using a rhythmic compress-and-release technique, you can stimulate your milk ducts to release breast milk for your baby.

Why would I want to hand express milk?

There are many good reasons to hand express milk:

1. To encourage your baby to nurse. "I find that women use hand expression a lot in the newborn phase, when they're working on getting a baby to latch," says Kate Shand, an international board-certified lactation consultant, board-certified physician assistant, and member of the BabyCenter Advisory Board. "Expressing a bit of milk on the end of the nipple can help baby get a taste and know where to latch."
2. To soften your breasts to make it easier for your baby to nurse. If your breasts are full and hard, it can be difficult for your baby to latch on. Expressing a little milk before breastfeeding can make it easier for your baby to get a good latch.
3. To help you feel more comfortable. If your breasts are engorged, hand expression can remove enough milk to relieve the pressure. (Don't express too much or you'll stimulate your breasts to produce even more milk, though!) Even if you're just a little overfull from being away from your baby for longer than usual, hand expression can help.
4. To increase your milk supply. As with pumping, hand expressing milk can stimulate lactation. This can be especially valuable when you're first establishing your supply.
5. To use as backup in an unexpected situation. "Hand expression can be helpful in emergency situations when you may not have access to a breast pump or electricity for a breast pump, or if you are away from your baby unexpectedly," says the Centers for Disease Control and PreventionOpens a new window.

How to hand express breast milk

Expressing breast milk by hand is simple once you get the hang of it, but it does take some practice. There are different techniques, with no one "right way," so experiment until you find something that works well for you.

Here's one common technique to get you started:

1. Wash your hands and sit in a comfortable position. If you'll feed the milk to your baby later, have a clean container for collecting it.
2. Gently massage your breast, starting at the top and moving down toward the nipple.
3. With your thumb on the top and your other fingers underneath, place your hand in a C-shape position around your breast, keeping your fingers an inch or two from your nipple.
4. Gently push your fingers and thumb back toward your body.
5. Compress your breast by bringing your thumb and fingers together, keeping them on your breast and applying gentle but steady pressure. Then move your thumb and fingers back to their starting position. It may take a few compressions for the milk to start flowing.
6. If you want to feed it to your baby, collect the milk that sprays from your nipple in the clean collection cup. Try not to let the milk touch your hands before landing in the container.
7. Continue until you've met your goal (you've softened your breasts to help your baby latch, for example).
8. If you want to express all of your milk, rotate your fingers and thumb around your nipple every few compressions to make sure you hit all of your milk ducts. When you're not getting any more milk, switch breasts.

Be patient. "It may take up to half an hour at first to sufficiently relieve both breasts," says the American Academy of PediatricsOpens a new window (AAP). "With practice, you will probably be able to shorten this time considerably and the amount of milk you collect will increase from perhaps 1 ounce per session to a full bottle or more."

Unless you're refrigerating the milk, use it within 4 hours for the best quality. Once refrigerated, it's best to use breast milk within 4 days. And if you freeze it, it's best within 6 months. Learn more about storing breast milk safely.

Benefits of hand expression

Not everyone has success at hand expressing, and it does take time. But there are benefits. Hand expression:

• Is convenient – no equipment is needed, and you can do it almost any place, any time
• Is quiet (no noisy pumps!)
• Is free (no pumps or supplies to rent or buy)
• Helps you get more familiar with your breasts and alert to any changes or problems, such as tenderness that might signal the beginning of mastitis
• Saves every drop of colostrum for your baby (see below)

Should I hand express colostrum?

In some instances, it can be helpful to hand express colostrum during pregnancy and right after your baby's born. (Colostrum is the precious first milk that your body makes specifically for your baby.)

The colostrum will come out in very small amounts, but your baby will need less than a teaspoon at first. If you plan to express and store colostrum, ask your doctor, midwife, or a lactation consultant for small, sterile syringes for storing the colostrum. Express into a spoon, and then draw the colostrum up into the syringe.

Be sure to label the syringe with the date it was expressed. You can express – and store in the same syringe – a few times a day, if you like. Between sessions, store the syringe in a plastic bag in the refrigerator. If you express at home before your baby arrives, you can bring the colostrum to the hospital with you in an insulated container.

You certainly don't have to express colostrum for your baby before they arrive. "It's important to note that expressing colostrum before birth is not something that you have to do," says Shand, "Nor is it something that will make or break your ability to make milk once your baby arrives. So don't stress if it's something that you would rather not have on your 'To Do' list."

Here are a few reasons expressing colostrum before your baby arrives might be helpful:

• If you learn to hand express colostrum, you'll already be confident enough to use the skill for your newborn. For example, you might express a small amount and put it on your nipple to encourage your newborn to nurse.
• Expressing colostrum will ensure your baby has colostrum right after birth if you're unable to breastfeed right away. Stored colostrum can also be important if you develop problems with your milk production after birth.
• If you're given medications that aren't compatible with breastfeeding (this would be rare), the stored colostrum can still be given to your baby.

Expressing colostrum for just a few minutes each day won't trigger contractions, but talk with your doctor or midwife first if you're at risk for early labor. And if you have any cramping when you start expressing, stop right away and talk with your doctor or midwife.

After delivery, your newborn may latch on and nurse like a pro from the get-go. Or they may not. Hand expressing colostrum can be helpful if:

• Your baby has difficulty feeding or is in the neonatal intensive care unit (NICU) in a situation where they can't be breastfed. Expressing the colostrum will also help continue building your milk supply, and help you avoid engorgement and mastitis.
• Your newborn is having trouble latching on because your breasts are too full. Give them the expressed colostrum, and encourage them to latch on afterwards.

Tips for hand expression

Try these tips to make hand expression easier:

• Make sure you're in a comfortable, warm place and that your hands are warm. Some women like to practice in a warm shower.
• Get in the mood with deep breathing, soft music, a scented candle, or whatever you find relaxing.
• Try placing a warm towel on your breasts before trying to express milk. This sometimes helps with letdown.
• Look at a picture of your baby, smell their blanket, or listen to their sounds while expressing. This also often helps with letdown.
• Don't squeeze your breast hard, and don't slide your hands over the skin, which can cause irritation. Keep your fingers in one place and slide the skin over the milk ducts underneath. Hand expression shouldn't hurt.
• Don't squeeze your nipple. You won't get any milk, and you can hurt yourself.
• While expressing, lean forward slightly over the cup, so gravity can help.
• Use a wide-mouth cup to collect the milk, which can spray beyond a narrow container. (If expressing colostrum, use a spoon.)
• Try expressing in the morning, when you'll probably have the most milk.
• Try expressing when you're breastfeeding your baby and your milk has already let down. You can try expressing from the second breast as soon as you're done nursing from the first, or even at the same time your baby is nursing, if you have help.
• Ask a nurse or lactation consultant for pointers on hand expression at the hospital before you leave, or contact a lactation consultant once you're home. Or, a friend who's done it can show you how.

Learn more:

• The benefits of breastfeeding
• How to prevent engorgement overnight
• Supplementing with formula
• How much breast milk does a newborn need at each feeding?