Expressing breast milk by hand

Hand expressing is a very useful skill that all breastfeeding mothers should try to learn. The midwives on the postnatal ward should teach you how to hand express your breast milk before you go home. Your community midwife will also be able to help you with this; at the very least you should be provided with a leaflet that shows you how to express your breast milk for your baby.

Hand expression is particularly useful in the very early days of breastfeeding when, for example, your baby may be sleepy or tired and/or not that interested in breastfeeding and you need to be able to give them your colostrum (the first breast milk). Being able to express a few drops of colostrum onto your nipple can encourage your baby to want to start suckling at the breast. Because colostrum is very concentrated and only present in small quantities, every drop is very precious and using a breast pump would mean that your colostrum would be wasted in the breast pump tubing. This is why the midwives will encourage you to hand express and catch the colostrum using a special sterile infant feeding syringe. This allows you and/or the maternity staff to give your baby small amounts of colostrum into the side of their mouth. The maternity staff may also suggest using a small baby feeding cup for collecting your breast milk; when at home, you will need to collect your breast milk in a sterile container.

Hand expressing will help to stimulate your breasts to start lactating (producing milk) and it is also great for a mother’s self-confidence to see for herself that she is providing milk for her newborn. It is also very useful should you and your baby be separated eg your baby needs to be cared for in the Neonatal Unit (NNU). Hand expressing can also help to relieve over full breasts (called engorgement), so that the areola (the area of breast that your baby takes into their mouth) is softened and they can attach/latch onto the breast and suckle more easily. It is also a good skill to have if you don’t want to buy or use a breast pump.

How do I hand express?

New mothers can sometimes feel a little apprehensive about hand expressing their breast milk for their new baby. It is however, a very easy skill to learn. The trick is to remain relaxed because if you are feeling tense or anxious this will impede your milk flow (called the ‘let down’ reflex).

Technique for hand expressing

Hand hygiene is paramount, so always wash your hands before you begin hand expressing
Make sure you are sitting comfortably and ensure that your back is well supported. If you have had a caesarean birth or have had an episiotomy or perineal tear and have sutures(stitches), you may wish to take pain relief before you start hand expressing, because you are likely to be sitting for around half-an-hour when hand expressing
Gently massage the whole of the breast with your finger tips, including gentle rolling of your nipple between your thumb and first finger for around 30 seconds – this action encourages the ‘let down’ reflex
Using your finger tips gently feel down your breast towards your nipple and the edge of the areola; you are looking for a change in the texture of your breast tissue beneath your skin. Milk ducts may feel like small pea-like structures just beneath the surface of your skin. If you can’t detect a change in the texture of your breast tissue, aim for the edge of your areola
If you have large areolas you may need to bring your fingers slightly closer to your nipple, away from the edge of your areola. If you have small areolas, you may need to move your fingers out slightly
Make a ‘C’ shape with your fingers by placing the first finger under the breast on top of the milk ducts; bring the thumb onto the top of the breast so it is positioned opposite the first finger. Your other fingers can be used to support your breast
Without changing the position of your finger and thumb, gently press backwards into the breast tissue, bringing your fingers together. Do not slide your fingers over your skin, as this can cause damage to the delicate breast tissue
Maintaining this gentle backwards pressure, press the thumb and first finger together and forwards for a count of two. This action helps to ease the breast milk towards your nipple. It should not be painful
Release the pressure for a count of two; this allows the milk ducts to refill; then continue to repeat the action in a steady rhythm. The milk may take a couple of minutes to start flowing. At first you may only see one or two drops, but continuing to express will stimulate your lactation and, as you become more practised, your milk will begin to flow freely – dripping or spurting from your nipples
When the milk flow slows down, try moving your fingers around to express from a different segment of your breast and repeat the action. When the milk flow reduces or stops flowing, swap to the other breast and begin the same process again. Keep alternating breasts until the milk flow reduces or stops altogether

What do I do if I can’t express any milk?

Firstly, do not panic – 98% of women can breastfeed very successfully, so it is probably a matter of technique or your emotions (how you are feeling) that is affecting your milk flow. If your milk doesn’t seem to be flowing; try adjusting the position of your fingers so that they are positioned closer or further away from your nipple. Also, try some breast massage before you start hand expressing. Ensure you stay relaxed and calm because if you are feeling tense or anxious the ‘let down’ reflex will be impeded. If you are still encountering difficulty; contact your midwife, health visitor or local breastfeeding counsellor. There are plenty of people who are available to offer guidance and support so you needn’t struggle in silence.

How can I maintain my milk supply?

Ensure you do breast massage, areola and nipple stimulation before you begin to hand express.

A warm bath or shower, or the application of heat (eg hot flannels/towels) on the breasts before you begin hand expressing can all help to encourage your breast milk to flow.

Skin-to-skin contact with your baby, cuddling your baby close to your breasts, or spending time with your baby whenever possible prior to hand expressing will help to stimulate the ‘let down’ reflex. This is particularly important if your baby is on the NNU and is too small or unwell to breastfeed.

While expressing from the one side, stimulating the other breast in preparation is useful. Wearing breast shells will catch any milk that drips out of the other breast.

If you and your baby have been separated because your baby is being cared for on the NNU, it can be helpful to have a photograph or an item of their clothing to look at, as these items and the smell of your baby can make you feel closer to them, which will aid the ‘let down’ reflex.

If you are expressing for your premature or unwell baby on the NNU you should try to express at least 8 times over a 24 hour period. This should include at least once during the night, because this is when Prolactin levels (the hormone that stimulates milk production) is higher. You should also begin to hand express as soon as you are able to following your baby’s birth.

Double-pumping (ie expressing from both sides simultaneously) when using an electric breast pump can be helpful. See our information on ‘Expressing your breast milk by pump’.

Hand expressing your colostrum is the gentlest way of obtaining breast milk in the first few days; however, once your ‘milk is in’ (usually around day three after the birth) you may wish to consider using a breast pump instead.

References and further reading

Becker GE, Cooney F, Smith HA (2011). Methods of milk expression for lactating women (Cochrane Review). (Assessed as up-to-date: 20 June 2011). The Cochrane Database of Systematic Reviews. Issue 12.

Blenkinsop A (2004). Sock it to me. Using a breast model to enable women to establish lactation. In: Wickham S ed. Midwifery: best practice 2. Edinburgh: Books for Midwives. 159-161.

Bolman M, Saju L, Oganesyan K et al (2000). Recapturing the art of therapeutic breast massage during breastfeeding. Journal of Human Lactation 29(3):328-331.

Breast model helps teach hand expressing (2001). Baby Friendly News no.9, December:7.

Flaherman VJ, Gay B, Scott C et al (2012). Randomised trial comparing hand expression with breast pumping for mothers of term newborns feeding poorly. Archives of Disease in Childhood: Fetal and Neonatal Edition 97(1):F18-F23.

Freeman P, Mannel R (2007). Milk expression and pumping. Journal of Human Lactation 23(3):281.

Geraghty SR, Rasmussen KM (2010). Redefining “breastfeeding” initiation and duration in the age of breastmilk pumping. Breastfeeding Medicine 5(3):135-137.

Glynn L, Goosen L (2005). Manual expression of breast milk. Journal of Human Lactation 21(2):184-185.

Jones K (2002). Benefits of breastfeeding and breast pumps. British Journal of Midwifery 10(3):181-182.

La Leche League GB (2007). Hand expression of breast milk. Nottingham: LLGB. 2 pages.

Lang S (2002). Breastfeeding special care babies. 2^nd edition. London: Bailliere Tindall. 235 pages.

Morton J, Hall JY, Wong RJ et al (2009). Combining hand techniques with electric pumping increases milk production in mothers of preterm infants. Journal of Perinatology 29(11):757-764.

Uecker AE (2001). Answering questions about breast pumps. Leaven 37(1):12-13.

UNICEF (2005). Breastfeeding your baby. London: UNICEF. 16 pages.

Worgan RE (2000). Expressing/pumping breast milk. In: Walker M. Core curriculum for lactation consultant practice.Sudbury: James and Bartlett. 582-606.