Manual milk expression, often called hand expression, is the process of removing milk using only the hands, without the aid of a pump. This method is useful when specialized equipment is unavailable, such as during power outages or travel. It is helpful for immediate relief of breast fullness or engorgement, which can make it difficult for a baby to latch, or for gently clearing a clogged milk duct. Hand expression is also often more effective than a pump for collecting colostrum, the antibody-rich first milk, in the days immediately following birth.
Preparing the Body for Expression
The effectiveness of manual expression depends on triggering the milk ejection reflex, often called the let-down reflex, which releases the hormone oxytocin. Since tension and anxiety can inhibit this reflex, finding a comfortable and private place to sit or stand is beneficial for maximizing milk flow. Applying warmth to the breast beforehand, such as with a warm washcloth or a short shower, can help stimulate the milk ducts and encourage let-down.
Gentle breast massage is a helpful preparatory step to encourage milk movement toward the nipple. Using fingertips, apply light pressure, stroking from the outer chest wall toward the areola and nipple, covering the entire breast surface. This action stimulates the nerves and prepares the milk ducts for drainage. To further encourage the let-down reflex, some people find it helpful to look at a picture of their baby, listen to a recording of cooing, or smell a piece of the baby’s clothing.
The Essential Technique: Manual Hand Expression
After preparation, the technique requires specific hand placement and a rhythmic motion. Begin by forming a “C” shape with the thumb and forefinger, placing them one to two inches behind the areola, where the milk ducts are located. The exact placement varies, but the fingers should be positioned on the breast tissue, not directly on the areola or nipple.
The physical action involves three steps: pressing, compressing, and releasing. First, press the thumb and fingers straight back toward the chest wall to engage the milk ducts deep within the breast tissue. Next, gently compress the thumb and fingers together, rolling them slightly forward toward the nipple to push the milk out.
Avoid sliding the fingers along the skin or aggressively pulling on the nipple, which can cause pain and bruising and will not effectively remove milk. The motion should be a consistent, rhythmic pattern of pressing back, compressing, and then relaxing the pressure to allow the ducts to refill. Milk may initially appear as drops, but once the let-down reflex is active, the milk should begin to flow in small streams.
To ensure all milk ducts are drained, the hand position must be rotated around the breast, similar to the hour markers on a clock face. After the milk flow slows in one position, move the thumb and finger to a new area and repeat the press-compress-release cycle. The expression process should alternate between breasts, spending three to five minutes on each side until the flow significantly slows, then switching back to encourage multiple let-downs.
Practical Collection and Troubleshooting
Before beginning expression, proper hygiene is necessary to maintain the safety of the collected milk. Hands should be washed thoroughly with soap and warm water, or an alcohol-based hand sanitizer can be used if water is unavailable. The collection vessel must also be clean; a wide-mouthed container such as a cup, jar, or bowl works well for catching the milk stream.
Once collected, the expressed milk should be stored promptly in a clean, food-grade container with a tight-fitting lid, such as a specialized storage bag or a glass or plastic container. Freshly expressed milk can be kept at room temperature (77°F or colder) for up to four hours, but it is best to refrigerate it as soon as possible. For longer storage, the milk should be frozen, and all containers must be clearly labeled with the date of expression.
If a person is only getting a few drops of milk, it does not necessarily indicate a low milk supply, as hand expression can be challenging to learn. If the yield is low, revisit the initial preparatory steps, such as applying warmth and massaging the breast, to encourage a stronger let-down reflex. Some people respond better to hand expression than to a pump, while others may find the opposite is true.
To establish a full milk supply, express milk frequently, aiming for at least eight times in 24 hours to mimic a newborn’s feeding pattern. Hand expression is effective for relieving immediate engorgement and collecting colostrum. However, a person may need to combine it with an electric pump if their goal is to sustain a large-volume supply for an extended period.