Breastfeeding Newborn & Infant Pregnancy & Birth Thrive

Hand Expression of Breastmilk

Illustration of mother hand expressing her breastmilk
Written by Moorea Malatt

Illustration by Joni Rae Latham

I was grateful to have been gifted a breast pump when I was engorged on day 3 of my baby’s life. When the near-mastitis resolved, I was left with this really ugly giant eye sore that sounded like a sing-songy machine from Charlie and the Chocolate Factory.

I used it occasionally, with much frustration. I knew my baby got plenty of milk from me when we nursed and yet I couldn’t get anything out of myself from that pump. It was a high quality “hospital-grade” pump. It worked for my friends! I tried others; no better. I became one of those crazed ladies protecting my liquid gold like it was her child’s college fund; scraping that last drop from under-boob on the side of the pump flange and waiting for it to trickle in; yelling at anyone who neared any bottle I set down.

Still, I was luckier than some of my friends. I didn’t have breastfeeding challenges that required a pump and when I did use the pump it didn’t hurt. But when I decided I needed to start leaving some milk so I could have some time away for my work, I just wasn’t getting much milk at all. It stayed that way for months until I met an IBCLC  who suggested that maybe I was one of those women who did not respond to the pump.

I thought about it. The pump didn’t compress the breast like a baby’s tongue onto the roof of her mouth to squirt the milk out, it simply just pulled and pulled. It was nothing at all like my baby.

I massaged and squeezed my boobs and got 3 times the milk output. My life changed, I became a hand expression evangelist and have been one ever since, continuing into becoming a lactation educator. Women have been hand expressing for centuries.

The Benefits of Hand Expressing Breastmilk

  1. Do it anywhere, often in the same amount of time. When you get really good at it, you can get the same amount of milk in the same amount of time as a pump without the extra baggage.
  2. Preventing plugged ducts and mastitis. Once I mastered hand expression, I didn’t have mastitis or clogged ducts anymore. I could feel immediately if a hard spot was starting and concentrate my expression on loosening it with massage. My expression included breast massage and I could just turn my hand slightly to access and empty all of the ducts, not just the ones the pump pulled on the most. It is much harder to empty all ducts in the breast with a pump flange.
  3. Produce more milk over time. Skin-to-skin contact (hand to breast) better stimulates milk production as skin contacts the feeding receptors in the in the areolae.
  4. It can be much more comfortable than the sucking of a pump.
  5. Pumping equipment (the hand) does not have to be maintained or replaced.
  6. A 2011 UCSF study found that parents who express milk by hand breastfeed longer.
  7. Get to know your body, your breasts, and your milk production.

Still, most nursing folks don’t think to learn hand expression or else don’t want to. Women are generally made to feel that touching ourselves, even if it is not sexually, is somehow gross or wrong. Some people feel it is akin to milking a goat or a cow, but we are mammals after all! If you choose to move past those feelings, watching tutorial YouTube videos of women demonstrating it may help you see that it mainly looks  functional or like self-care or cancer detection massage. The videos are great for anyone who wants to actually see it done after you read this! You will see some slightly different techniques to try.

Some people don’t want to hand express because they are survivors of sexual assault and it feels uncomfortable and triggering. A mechanical pump will be the best bet for that family if they choose breastfeeding.

I highly suggest that moms who work out of the house use a combination of hand expression and pumping for maximum volume. Hand expression and massage can prep the breasts, then the pump can keep it going. Hand expression at the end again can make sure the breast is evenly emptied.

How to Express by Hand Successfully

  1. Wash your hands and take 3 deep breaths to relax.
  2. A few feather-like tickle massage strokes down your breast will elicit oxytocin, relaxation, and let-down.
  3. Massage breast before expressing, and intermittently during expression. Massage all the way from your armpit down, and in gentle circles around your breast and toward your nipple. You can do some more squeezing-type movements if it feels helpful and comfortable or if you have a plugged duct or a hard spot.
  4. Get an open milk bottle or a milk bag with a top that stays open.
  5. Form a “C” shape with your hand on the same side as the breast you will express. The top of the “C” on your right hand is your thumb. You may also massage and express the second breast with your dominant hand if you want the strength and dexterity.
  6. Press into your breast a bit, with your thumb slightly above your areola.
  7. Compress your breast between your thumb and fingers, bringing yoru fingers and thumb closer together, squeezing the breast. You can add some extra compression with the second hand on the top of your breast if needed.
  8. Pull down toward the nipple just a bit. You can end the stroking motion about halfway down your areola or a bit further but you do not need to touch the actual nipple. You may need to do this a few times before milk starts, depending on your own unique let-down timing.
  9. Continue this three-part motion while holding the bottle so that it catches the milk. You can move your hand around the circle of your breast in different positions, as well as take breaks before massaging a bit more.
  10. All breasts are different! Some are large and have very large areolae, some are smaller and require you to compress and roll down almost the entire breast. As long as you don’t feel pain, you can experiment and see what works for you!
  11. Try not to lean forward too much and strain your neck, instead, tilt the bottle to catch the milk. If you have sore nipples, don’t scrape the bottle under your nipple to get the last drop–that may irritate your nipple. Just rub the last drop into your nipple instead. I really liked putting a washcloth or napkin under my breast or on my lap to catch any drips.
  12. The best tip I have for breastfeeding, electric pump, and hand expression is always to relax. You can think about swinging on a hammock on vacation, call a good friend on speakerphone, think about your sweet baby sleeping, breathe, and even take a few bites of your favorite snack between squeezes!

About the author

Moorea Malatt

Moorea Malatt ( “Mo-ray-uh Muh-lot”)
Certified Lactation Educator, Postpartum Doula, and Parent Educator. She is the founder of SavvyParentingSupport.com, an online resource for gentle for gentle sleep learning and gentle discipline and gentle potty learning. She is the author of online learning programs and articles. She leads sold-out workshops and provides private phone consults for naturally-minded parents of kiddos newborn-4years. Moorea has appeared on podcasts, and in person giving talks at baby fairs.
As a parent, she overcame finally severe sleep deprivation with her own breastfeeding-friendly gentle approach after she learned everything there was to know about sleep due to her daughter’s sleep disorder.
Before all of this, she was a songwriter. After her daughter’s birth, she wrote, sang and played guitar on an album of songs called, “Whip It Out: Songs for Breastfeeding"

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