Hand Expression: Breastfeeding's Best Kept Secret

If you’re a breastfeeding mom, you likely know how valuable a pump can be when you and your baby aren’t together at feeding time or when you want to boost your milk supply after breastfeeding. Now imagine if you didn’t need a pump to do it.

Hand expression is the art of using your hands to mimic what a baby does at the breast in order to express milk. And, it can be a life saver, says lactation consultant Kim Schimmel, RN, IBCLC.

“It’s a great skill to have in situations when baby isn’t suckling well at the breast, when you need to relieve a full breast without a pump, or when trying to soften breast tissue,” she says. Additionally, it can help boost milk supply.

Many breastfeeding moms aren’t aware of how hand expression works and its benefits. Below, Schimmel answers some of the most common questions.

How does hand expression work?

Thankfully, it’s not hard, but it is a learned art. When I teach moms how to hand express, I start by having them make either a “C” or a “U” with the thumb and index finger placed about one to one and a half inches away from the nipple. Press into the chest wall toward the rib, then compress the thumb and index finger together. Keep repeating the same motion–press in, compress together, release. Click here to see a visual example of how hand expression works from the Centers for Disease Control and Prevention (CDC).

It may take a minute or two before the milk starts to appear. Massaging the breast tissue first helps to “wake up” the breast and usually results in more milk out sooner.

How can hand expression help after delivery?

Hand expressing is a great tool to use when establishing milk supply. We are just now learning how important EARLY stimulation is in regard to bringing in a full milk supply. Babies seem to receive a bolus of colostrum in the first feeding due to hormone levels after birth. Although most babies are awake and alert after birth, and will latch if given the chance, there are some babies who are sleepy or unable to latch right away. In these cases, expressing the colostrum onto a clean spoon or a cup within the first hour or two can boost supply greatly. Some studies are showing that hand expression (when done correctly) can be even more effective than pumping in removing colostrum in the first 48 hours.

Many times, I have walked into a patient’s room where a mom is struggling and doubting she has enough breast milk for her baby. In moments like this, teaching hand expression can make all the difference. I see their confidence change right at the moment they use hand expression and see that golden drop of colostrum appear.

How can hand expression boost milk supply?

Women can also use their hands together with a pump to boost supply if they are pumping. After pumping, you can try hand expressing to completely empty the breast. This can also be done after nursing your baby. A good rule to remember is: The emptier the breast, the quicker the body works to replace the milk. Hand expression helps to empty the breast fully to make this happen.

Are there other benefits of hand expression?

Hand expression can be especially beneficial in the beginning days, both to wake a sleepy baby, or calm a frantic baby with an unorganized suck. In either case, a few milliliters expressed onto a clean spoon can be fed to the baby to wake or calm their senses. Very often, the baby will latch right after.

Breast compression is a wonderful hands-on method to keep a sleepy baby awake when feeding at the breast. It is done by using hands to put more pressure behind the milk ducts. This results in a higher flow of milk to keep sleepy babies alert and actively feeding. 

Hand expression is also a great tool to help with engorged breasts. Often, the pump won’t respond to engorged breasts because when the breast tissue is extremely tight, the pump is unable to move the tissue to get the milk flowing and trying may result in more inflammation.

In these cases, the breasts are usually more responsive to hand expression. Start with a warm compress and massage the breast tissue very gently, stroking from the nipple toward the axillary for lymphatic drainage, then add hand expression. Moms usually feel relief within a few minutes when the milk starts flowing. Once softened, you can then put baby to breast.