How to Hand Express

How to perform this Press, Compress and Release method to collect milk

Updated June 27th 2022

Hand expression is a valuable skill for all lactating parents to have. It is not cost prohibitive because all you need is your hands! It’s been shown that hand expression increases breastfeeding rates when compared to pumping at 2 months postpartum.

Hand expression is useful in the first 24 hours after birth as it can help assist with the transition from colostrum to copious milk production and assist with colostrum collection. Hand expression is a valuable collection method even for someone with a pump because colostrum can get stuck in the tubing of a pump due to the small volume that is produced and it’s thick consistency.

Hand expression can also be used prior to the birth of your baby. Provided your midwife or OB/GYN has cleared you, hand expression can be used as early as 37 weeks gestation to collect colostrum in advance of baby’s arrival. The reason you need to be cleared to do this is because the nipple stimulation can lead to early labour for some (thanks to oxytocin) and so, it’s not recommended for everyone. Always consult with your care provider.

Why would you want to collect colostrum prior to your baby’s birth?

Collecting colostrum while pregnant can be very helpful if you’ve previously struggled with breastfeeding or milk production. This ensures you have some additional nutritional support if your baby is having troubles effectively latching.

This is also a supportive technique if you have gestational diabetes as your baby can become hypoglycemic at delivery and having the extra colostrum on hand will support their blood sugar. If you’re expecting multiples it can be helpful as well. If you’ve had prior breast surgeries and are unsure how it might impact milk production, collecting beforehand can be invaluable.

Colostrum collecting before birth requires collecting and saving the colostrum in feeding syringes that are 1mL – 5mL. You can freeze the syringes. They should then be placed in a container or bag labelled with the date and your name. It might also be helpful to add your health card number to them. You can then bring the frozen colostrum to your birth.

Whether you are collecting colostrum prior to delivery or expressing milk after your baby’s birth, the method is the same.

The Method of Hand Expression
  1. With clean hands find a comfortable position, ideally resting with your back and body supported and massage the breasts in circles, working towards the areola. This will help stimulate the flow of milk.
  2. Either doing this yourself, or with a partner, the milk collection container should be placed underneath the nipple. A small cup, spoon or syringe will work to collect the colostrum.
  3. Your thumb and index finger should be placed on the breast about one inch above and one inch below the nipple. Your hand will create a “C” shape or a “U” shape. It’s important to measure from the nipple because areolar size varies significantly.
  4. Press your fingers back towards the chest wall (your rib cage), gently compress the breast tissue (squeezing, bringing your fingers together) and then release the compression. Repeat this over until you begin to see colostrum* or mature milk depending on which stage of milk production you are at. Go back and forth between sides. *if you’re expressing colostrum, hold the compression for about 3 seconds before releasing
  5. It’s important you always remain relaxed as it can take a few compressions before you see milk. In addition, you should always feel comfortable. If there is any pain or discomfort, you should adjust what you are doing until you are comfortable. It may also be helpful to have your baby nearby this will increase the release of oxytocin which stimulates milk let-down. The entire process may take 20-30 minutes.

If you are collecting colostrum PRIOR to your baby’s birth, you would perform hand expression twice a day for about 10-15 minutes and you would save the colostrum in feeding syringes which you can freeze and take to your birth. 

Grab my free colostrum collection guide

and set yourself up for breastfeeding success! This free guide includes access to a FAQs video as well as a video demo of hand expression.

Hand expression is just one of the topics covered in my prenatal breastfeeding course The Breastfeeding Before Baby Program. This program is designed specifically for pregnancy. Investing in a prenatal breastfeeding class before your baby is born helps get breastfeeding off to a strong start and can save you time spent online in the long run.

Alex Wachelka is a Lactation Consultant passionate about educating families and supporting you to feed your baby.

References:

Campbell, S.H., Lauwers, J., Mannel, R., & Spencer, B. (2019). Core Curriculum for interdisciplinary lactation care. Jones & Bartlett Learning.

La Leche League International. (2020). Hand expressing. La Leche League International. https://www.llli.org/breastfeeding-info/hand-expressing/

Newman, J. & Pitman, T. (2014). Dr. Jack Newman’s Guide to Breastfeeding. HarperCollins Publishers Ltd.

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