Hand expression is the technique of removing milk from the breast using only the hands. This method involves a specific rhythm of compression and release to encourage milk flow and manage lactation. Learning hand expression is helpful for breastfeeding parents as it provides a readily available means of milk removal in various circumstances. It relies on an understanding of breast anatomy and the milk ejection reflex.
Situations Where Hand Expression Is Useful
Hand expression is particularly beneficial in the early days after birth for collecting colostrum. Since the small, concentrated volume of colostrum is difficult to collect with a standard electric pump, hand expression allows every drop to be saved in a small container or syringe. Using this technique is also advantageous when a parent experiences acute breast engorgement. Removing a small amount of milk can soften the areola, making it easier for the baby to latch effectively.
This technique serves as a reliable temporary solution when a breast pump is unavailable or cannot be used. Hand expression ensures milk can still be removed to maintain comfort and protect the milk supply. Combining hand expression with pumping can also lead to a greater overall volume of milk output than pumping alone. It is a portable, free, and accessible method of milk removal, especially effective for collecting initial drops of milk.
Preparing for Hand Expression
Proper preparation helps stimulate the milk ejection reflex, or “let-down,” before starting expression. Begin by washing your hands thoroughly with soap and water to ensure hygiene. Find a private, comfortable space where you can relax, as tension or anxiety can inhibit the release of oxytocin, which governs the let-down reflex.
Gentle stimulation of the breast is the next step to encourage milk flow. Apply a warm compress or massage the breast using light, circular motions, moving from the chest wall toward the areola. Visualizing milk flow or having skin-to-skin contact can also help trigger the let-down. Once you feel a tingling sensation or see small droplets of milk, you are ready to begin expression.
Step-by-Step Hand Expression Technique
With a clean collection container ready, position your hand on the breast, forming a “C” shape with your thumb and index finger. Place your thumb above the areola and your index finger below it, about one to two inches behind the nipple. Avoid placing your fingers directly on the areola. The correct placement is where the breast tissue feels firm, signaling the location of the milk ducts.
The movement requires a three-part rhythmic action: press, compress, and release. First, press your thumb and fingers straight back toward your chest wall to stabilize the tissue and access the milk ducts. Next, gently compress your thumb and fingers toward each other, rolling them slightly forward without sliding them on the skin. This action encourages the milk to flow out of the nipple.
Finally, release the pressure and repeat the entire press-compress-release cycle in a rhythmic pattern. This action mimics the suckling motion of a baby, which is essential for effective milk removal. The process should not cause pain; if it does, adjust your hand position farther back from the nipple. Continue this rhythm until the milk flow significantly slows down or stops.
To fully empty the breast, you must drain all milk-producing quadrants by rotating your hand position around the areola. This rotational technique ensures that milk from different ducts is removed, helping to prevent blockages and maintain milk production. Once the flow stops on one side, switch to the other breast and repeat the entire process.
Safe Handling and Storage of Expressed Milk
After hand expression, the collected milk needs immediate and careful handling to maintain its safety and quality. Always use a clean, food-grade container, such as a specialized breast milk storage bag or a hard plastic or glass bottle with a tight-fitting lid.
It is important to label each container clearly with the date and time the milk was expressed. This ensures the oldest milk is used first, following the “first-in, first-out” principle. Freshly expressed milk can be kept at room temperature (up to 77°F) for a maximum of four hours. For longer storage, refrigerate the milk promptly, placing the container in the back of the fridge for up to four days.