Diana West, BA, IBCLC
Originally published January 2015 and republished with the express permission of the author.
I was a new mother struggling with low milk production and a baby who wouldn’t nurse when the first effective “consumer grade” breast pumps were invented. I’d been renting a hospital-grade pump to remove my milk, but the idea of owning a good quality pump that was more portable enticed me to buy a double-sided electrical model. It looked so cool! It was in a black bag designed to look like a briefcase so it could be carried to work discreetly. I wasn’t working, but I loved the way it made me feel efficient and smart. I was in the first wave of breastfeeding mothers to flock to this type of pump, and millions have been sold over the years.
Knowing what I’ve learned since those days, my heart sinks to think I put such stock in a cool looking pump when my own two hands could have done a better job. But expressing my milk by hand never crossed my mind then. My impression of hand expression in those days was as a last resort when a good pump wasn’t available. My mind has changed quite a bit since then.
I now see hand expression as far more powerful than pumping in many ways. Research has shown that it can be more effective at removing milk in the first days after birth when the colostrum is thick and the breasts are swollen.1 Pumping colostrum leaves only sprays on the side of the bottle that are hard to give to the baby, but hand expression into a spoon saves every drop. Hand expression can also be used as a technique during and after pumping to increase caloric content2 and remove more milk.3 It can be more reliable than a pump when electricity is scarce. It’s quieter than a pump when privacy is needed. It’s certainly less expensive than a pump. But I think the most powerful aspect of hand expression is the way it affects our perception of our breasts and what they can do.
Many young women have an uncomfortable relationship with their breasts before they become mothers. They’re usually aware of the sexual aspects of their breasts before they think about their ability to make milk. As an erogenous zone, women often feel it’s more appropriate for their partners to handle their breasts than to touch them themselves. There can be a delicate balance between breasts as sexual power and targets of sexual vulnerability.
Many women have discovered that learning how to hand express during pregnancy helps them feel more comfortable touching and handling their breasts. I jokingly call this “making friends with the girls” when I suggest the idea to a client. That usually makes her laugh and lightens the mood, but there’s some real truth to it. One study found that learning hand expression during pregnancy increased mothers’ confidence and readiness for breastfeeding.4 Another study found that it increased not only breastfeeding confidence, but also how long they breastfed.5 Experimenting slowly with hand expression to figure out what it takes to get drops of milk can be empowering, especially during pregnancy before there’s any pressure to express milk for the baby.
In my experience, there’s no one right way to hand express. When I was nursing my first baby almost 20 years ago, I remember being taught the Marmet Method of Milk Expression, which was developed by Chele Marmet, one of the pioneers of the lactation consultation field. Over the years, there have been several other official methods, many of which are now demonstrated on YouTube. But I think hand expression methods are best used as a starting point to figuring out what works best on your own individual breasts. We’re all different, and what works for you might be different than what works for me. The one movement that I find helps no matter what else you do is to move the skin over the breast tissue instead of sliding your fingers over the skin. You’ll also almost always get milk to spray by compressing just behind the areola where there’s a sort of “sweet spot.”
Getting to know the landscape of your breasts and the way they work can help you start to think of them as your breasts. You may feel a slowly growing pride as you see that they can feed and soothe your baby. You’ll start to appreciate their superpower. After a few days of nursing, you may realize that your breasts are your connection to this baby with whom you are falling so deeply in love. That’s the power of hand expression.
LLLGB Hand Expression of Breastmilk
LLL USA, Working and Breastfeeding: My Experience with Hand Expression
Stanford School of Medicine demonstration video: Hand Expression of Breastmilk.
Maya Bolman, IBCLC and Ann Witt, MD, FABM, IBCLC. The Basics of Breast Massage and Hand Expression.
The Womanly Art of Breastfeeding, 8th edition. Schaumburg, IL: La Leche League International, 2010, 292–293.
1 Ohyama M, Watabe H, Hayasaka Y. Manual expression and electric breast pumping in the first 48 h after delivery. Pediatr Int. 2010 Feb;52(1):39-43.
2 Morton, J., et al. “Combining hand techniques with electric pumping increases the caloric content of milk in mothers of preterm infants.” Journal of Perinatology 32.10 (2012): 791-796.
3 Morton J, Hall JY, Wong RJ, Thairu L, Benitz WE, Rhine WD. Combining hand techniques with electric pumping increases milk production in mothers of preterm infants. Journal of Perinatology 29.11 (2009): 757-764.
4 Forster DA, McEgan K, Ford R, Moorhead A, Opie G, Walker S, McNamara C. Diabetes and antenatal milk expressing: a pilot project to inform the development of a randomised controlled trial. Midwifery. 2011 Apr;27(2):209-14.
5 Flaherman VJ, Gay B, Scott C, Avins A, Lee KA, Newman TB. Randomised trial comparing hand expression with breast pumping for mothers of term newborns feeding poorly. Arch Dis Child Fetal Neonatal Ed. 2012;97:F18-23.
Diana West, BA, IBCLC, is an LLL Leader and one of the co-authors of the LLLI books The Womanly Art of Breastfeeding and Sweet Sleep. She is co-author with Lisa Marasco, MA, IBCLC, of The Breastfeeding Mother’s Guide to Making More Milk, and with Dr. Elliot Hirsch of Breastfeeding After Breast and Nipple Procedures. She is also author of the Clinician’s Breastfeeding Triage Tool and Defining Your Own Success: Breastfeeding After Breast Reduction Surgery.