Why Hand Expression?

Lactation Consultants as a group talk a lot about Hand Expression. There are so many reasons why we stress this technique. Let's talk about how this technique can help boost milk supply and be your best friend throughout Lactation.

​What is hand expression? This is a technique to use your hands to effectively remove milk. It is an alternative to an electric or manual pump. (Link below for a great video on how to do this)

So why hand express?
1. Boost milk production (more on this in a minute)
2. Get some drops to entice your baby onto the breast
3. Feed your baby those liquid gold drops via a spoon when they are not latching well or sleepy
4. Soften the breast during engorgement to aid in latching the baby
5. Get some drops to apply milk to sore nipples. This helps prevent infection and speed healing. (see an IBCLC for persistent sore nipples or nipple damage)
6. Drain the breast instead of using an electric or manual breast pump (This is critical if one loses electricity and your pump does not have a battery)
7. Hand expression is a key part of managing plugged ducts

Let's talk again about milk production. There are many circumstances in which the baby is not nursing in the early days. It is then important to stimulate your milk production in other ways. In the first 3-5 days after birth the breast milk is very thick. When nursing effectively babies are very good at removing this early milk called colostrum. Babies create a vacuum and massage the ducts. An electric pump uses only suction. It is much less effective at removing the thick milk. Think of placing an electric pump flange on the end of a toothpaste tube. It would have trouble removing the toothpaste. (the nipple stimulation still triggers the oxytocin and prolactin to produce milk so this is why pumping is also recommended). But hand expression is able to remove many more drops of milk than the electric pump in these early days. The more milk removed, the more your body makes!

Combining hand expression with an electric pump is the ideal regimen to initiate a large supply if the baby is not going to the breast effectively 8-12 times every 24hr. In one study, it was shown that adding hand expression in addition to traditional pumping resulted in a large milk supply. "Mothers who used hand expression more than 5 times a day in the first 3 days yet pumped with the same frequency as other study mothers, expressed an average of 955 mls, about a quart a day by 8 weeks. This is more than a term 4 month old would need." (Morton et al., 2009) An additional study demonstrated a higher milk yield with hand expression. "Net milk yield per woman was 2 mL manually (median; range: 0–12.6 mL) and 0.6 mL (0–7.2 mL) by electric expression (P < 0.05)." (Ohyama, M., Watabe, H., Hayasaka, Y., 2010) 
 
Milk supply is determined by how much milk is removed from the breast. Early and frequent effective removal is the best way to achieve a healthy milk supply. Hand expression is an essential part of boosting supply in those early days and a useful technique for the duration of lactation. This technique takes a little practice but comes easily quickly.

Hand Expression Video
https://med.stanford.edu/newborns/professional-education/breastfeeding/hand-expressing-milk.html (Morton, 2006)

References

Morton, J., Hall, J., Wong, R. et al. Combining hand techniques with electric pumping increases milk production in mothers of preterm infants. J Perinatol 29, 757–764 (2009). https://doi.org/10.1038/jp.2009.87

Morton, J., Newborn Nursery
https://med.stanford.edu/newborns/professional-education/breastfeeding/hand-expressing-milk.html, 2006

Ohyama, M., Watabe, H., Hayasaka, Y., (2010). Manual expression and electric breast pumping in the first 48h after delivery. Pediatrics International. Volume 52, Issue 1. Pages 39-43.