Breast compression

What is hands-on pumping?

Breast compression, or hands-on pumping, means squeezing the breast by hand to help the milk move toward the nipple. It is used to help empty the breast and maintain or increase the milk supply. Breast compression is done by grasping the breast close to the ribs, pushing the fingers forward for a few seconds, releasing, and repeating. It can be done while expressing or by alternating between compression and expression. It can also be combined with “power expressing,” expressing repeatedly over a short period. Some mothers compress while breastfeeding, but we have found limited use for this. If mothers wish to do this, they need to make sure it doesn’t affect the baby’s ability to breastfeed and the baby takes in enough milk. It may help hospitalized premature babies who do not feed effectively.

A) Describing breast compression

Breast compression, or hands-on pumping, means squeezing the breast to help the milk move toward the nipple. It is used to help empty the breast and maintain or increase the milk supply by supporting, stimulating, or replacing the let-down (Alekseev 2019; Jones 2001; Morton 2009).

Expressing can be less effective at getting milk from the breast than breastfeeding. Mothers who express may find combining it with breast compression helps but it must be done safely and not cause pain.

While breast compression can be done before breastfeeding, we have found limited use for this.

B) How to do breast compression

All mothers are different. You may need to experiment to see how best to do this. One method for breast compression is done as follows:

  1. Using your thumb and fingers, grasp the part of the breast closest to your ribs.
  2. Squeeze and push the fingers forward on the breast for a few seconds and then release.
  3. Repeat steps 1 and 2 as long as it helps the milk flow.
  4. To ensure the milk flows well and to see where the pressure is most effective:
    1. If expressing, watch the milk flow or spray.
    2. If breastfeeding, listen for the baby’s swallows and heavy breathing.
  5. Move the position of your thumb and fingers around the breast if the flow is very slow.
  6. If this is painful:
    1. Decrease the amount of pressure you are putting on your breast.
    2. Move the position of your thumb and fingers around the breast.
  7. Stop breast compression if:
    1. The breast is soft and no more milk comes out.
    2. You have been breastfeeding or expressing on that breast for 20 minutes.
    3. It is ineffective.
    4. It remains painful.

Mothers can compress one breast at a time or if both hands are free, can compress both at the same time.

Breast compression should only be done if it increases the amount of milk removed.

C) Combining breast compression and expressing

Breast compression can be done while expressing or by alternating between compression and expression. It can also be combined with power expressing, expressing repeatedly over a short period.

1) Using breast compression during expressing

You can use breast compression while single expressing using:

  1. Manual expression
  2. A hand pump
  3. A single electric pump
  4. A constant suction pump

If you are pumping and you have small breasts, you may find that the breast shield covers too much of the breast to allow for compression.

Breast compression can break the suction of the pump. If this happens regularly, compression should not be done at the same time as pumping but can be alternated with pumping.

2) Alternating breast compression and expressing

a) Simple alternating

Some mothers alternate breast compression and expressing. They may stop expressing once the milk flow stops and then use breast compression for 30 seconds to get the milk moving again.

b) Combining double and single expressing, compression, and power expressing

Others choose different techniques. The following is a more complicated and demanding approach to expressing used to maximize supply and should be stopped once the milk supply is no longer increasing. It uses combining double and single expression, compression, and power expressing:

  1. Compress both breasts for 1 minute before expressing.
  2. Double express for 10 minutes or until the milk flow stops.
  3. Compress both breasts for 1 minute or until the milk starts to flow.
  4. Single express one breast while compressing for 5 minutes.
  5. Single express the other breast while compressing for 5 minutes.
  6. Power express by moving from the right breast to the left breast and back until the milk flow is very low or has stopped. Combine this with breast compression if this is helpful.
  7. This entire process should not take more than 40 minutes.

D) Breast compression while breastfeeding

Breast compression can be done while breastfeeding to help the baby get more milk, but our clinic has found limited use for this technique.

If you choose to use breast compression while breastfeeding:

  • Always ensure that your baby is taking in enough milk.
  • Use a breastfeeding hold that allows you to have one hand free.
  • Make sure it doesn’t affect the baby’s latch and ability to breastfeed. This is more likely if you have smaller breasts.

Breast compression can be tiring and painful if done for an entire breastfeed. Instead, consider breast compression when the baby’s sucking slows and the baby has limited swallows.

This technique is sometimes used while breastfeeding premature babies who are in hospital and are closely monitored. Breastfeeding scales are usually available, so you can confirm the baby’s intake by weighing the baby before and after breastfeeding and can see whether breast compressions while breastfeeding result in the baby getting more milk and how best to do them.

Mothers in this situation will also need to express after breastfeeding. They can use breast compression while expressing and see what effect it has on the milk amounts. If there is no increase in the amount of milk with breast compression, it is unlikely that breast compression while breastfeeding is helpful.

E) When breast compression while breastfeeding will not help

1) Avoid relying on breast compression for underfed babies

While breast compression occasionally helps an underfed baby get milk from the breast, we generally do not use it while the baby is breastfeeding.

Underfed babies who suck weakly at the breast and have a medical need for supplementation with milk may get more milk with breast compression. However, unless it is combined with before- and after-feed weighing, you cannot be certain the baby has taken in enough milk. For example, you may have a low milk supply. In that case, breast compression will not give the baby more milk.

Breast compression can also cause a weak baby to let go of the breast. Re-latching is tiring for weak babies, so this approach may result in the baby getting less milk.

Weak, newborn babies are at particular risk of starvation and other complications of hunger. If you are not using before- and after-feed weighing to monitor your underfed baby’s milk intake, please use other, more effective ways to supplement your baby. Furthermore, they quickly respond to supplements and within a day or so will breastfeed vigorously, taking in whatever milk is present in the breast. Breast compression is not necessary for babies who breastfeed vigorously.

2) Vigorous babies

Babies who can latch and suck effectively are unlikely to benefit from breast compression. 

3) Babies with latching problems

Babies who cannot latch will not benefit from breast compression. Their mothers need to use other approaches to get more milk into the baby.

References

Alekseev NP, Ilyin VI. The Mechanics of Breast Pumping: Compression Stimuli Increased Milk Ejection. Breastfeed Med. 2016 Sep;11:370-5
 
Jones E, Dimmock PW, Spencer SA. A randomised controlled trial to compare methods of milk expression after preterm delivery. Arch Dis Child Fetal Neonatal Ed. 2001 Sep;85(2):F91-5
 
Morton J, Hall JY, Wong RJ, et al. Combining hand techniques with electric pumping increases milk production in mothers of preterm infants. J Perinatol. 2009 Nov;29(11):757-64