Hand Expression 

Hand expression can take several attempts to learn, so practice before you go back to work. Before beginning hand expression, wash your hands and have a clean container ready for milk collection. Some women use hand expression because there is no need for special equipment, it helps ease engorgement, and it is very cost-effective.

To hand express milk, position your fingers and thumb in a "C" shape about one to two inches behind the nipple and areola. Avoid cupping the breast. Using firm pressure, push into the chest wall. For a large breast, lift the breast before pressing.

Roll thumb and fingers forward to compress and empty milk reservoirs. Be careful not to press hard or you may bruise the breast tissue. Do not pull or stretch the nipple.

Repeat this action to express the milk. Position, push, and roll. After the milk ducts have emptied, adjust your hand position to empty other ducts, moving in a counterclockwise direction.

Expressing Breastmilk



To express milk manually, gently massage to start the milk moving down the ducts.  Work evenly around the breast, stroking repeatedly downward toward the areola. Starting about halfway up the breast, run your thumb firmly down.  As it reaches the edge of the areola, press in and up and the milk will squirt from the nipple.  Repeat all the way around the breast. Do not squeeze the nipple as this will close the ducts, nor continue expressing until you think the breast is empty.   Stop when  the milk starts coming in drips rather than jets.



The Knack of Hand Expression 

The knack in hand expression is finding exactly where the lactiferous sinuses are, and how deep. Imagine a pea inside a thin straw, and each breast having a cluster of 10-20 straws, each with a pea inside. The sinuses are softer than peas, more like little milk-filled pillows or tiny cylindrical squirt guns. When you've located the pillow, press the milk out with your thumb on top and forefinger or middle finger underneath, starting the movement on the chest-side of the bulge and rolling across the pillow toward the nipple side. The pillows don't move inside the straw. Another way of imagining the sinuses is weak spots in a garden hose that bulge out with collected water - if you step on the bulge, it squirts. The trick is to find the bulges - they're only about 1/4" long.

Start your search with your fingers around the edge of the areola, about 1.5 inches back from the nipple tip. Go closer to the nipple or back away from it till you find them. They may be on the surface or deep in the breast, like the core of an apple. Use enough pressure to squirt out milk if it's there. Once you've found them, you'll be amazed how easy it is to press out milk. It usually sprays across the room if your fingers are in the right place.

THIS is what "proper positioning" during breastfeeding is all about - getting the lactiferous sinuses inside the baby's mouth, over the tongue. (Or, conversely, getting the baby's mouth around enough of the breast to include the lactiferous sinuses.) The baby should be positioned with her upper gum ridge at or on the chest side of the milk sinuses; her tongue can press/strip the milk out of the pillows if her chin is up against the breast. Assuming the tongue is working well, of course. But that's another discussion. This fixes at least 80% of the BF problems I see.

If you get really, really good at this, you can palpate (feel) them in a non-lactating breast.

Linda Smith, BSE, FACCE, IBCLC, private practice in Dayton OH

© 1996 Linda J. Smith

lindaj@bflrc.com
 

 

HAND EXPRESSING YOUR MILK
The Low-Tech Approach: Hand Expression 

Expressing milk by hand works very well for some women. It's a handy skill to have when:

  • You are caught somewhere with full breasts and you don't have your partner or a breastpump, you'll be able to relieve breast fullness and avoid problems with engorgement.

  • You do not need to express milk regularly.

  • Your breasts are more responsive to the skin-to-skin feeling of hand expression than to plastic pump parts.

HERE'S 6 EASY STEPS TO EXPRESS MILK FROM YOUR BREASTS BY HAND:

  1. Position your hand on your breast, with the thumb above and fingers underneath, about an inch to an inch-and-a-half behind the nipple. If your breast were a clock, your thumb would be at 12 o'clock and your fingers at 6 o'clock. Don't cup your breast in your hand. Instead, your thumb and fingers should be directly across the nipple from each other. 

  2. Press your thumb and fingers directly back into the breast tissue, towards the wall of your chest. Don't move them further apart. Just press straight back into the breast. 

  3. Roll your fingers and thumb forward to squeeze milk out of the milk sinuses, which are located under the areola behind the nipple. Don't slide the thumb or fingers along the skin--this will quickly make you sore. 

  4. Repeat this sequence--position, press, roll--until the milk flow ceases. Then move your hand so that the thumb and fingers are positioned at 11 and 5 o'clock and do it again. Use both hands to work your way around one breast, then switch to the other side until you have emptied all of the milk sinuses. As soon as you see milk squirting from your nipple, you know you are compressing the underlying milk sinuses. (This position is also where baby's gums should be during efficient latch-on.) 

  5. The trick to hand expression is discovering where to position your fingers. Experiment until you find the right spot. Having someone show you how is very helpful, too. 

  6. Combining hand-expression with breast massage can be a very effective way to stimulate the milk-ejection reflex. Massage first, then express. Massage again, and repeat the hand-expressing routine.

When you hand-express, milk sprays out in all directions.

  • If you're expressing just to make your breasts more comfortable, you can lean over a sink or express into a towel.

  • If you want to save the milk, you'll need something in which to collect it. Some women manage to aim the nipple directly into a container with a wider mouth, like a coffee cup or a small jar. As the cup fills up, transfer the milk to a storage container. (See Storing Human Milk for suggestions.)

  • The Medela company makes a special funnel for hand-expression that collects the milk in smaller containers.

 

 

   

 

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