Manual expression

What is manual expression?

Manual expression means using the hands to remove milk from the breast. It is less effective than double pumping for mothers who need to express frequently, but it can increase eventual milk production when done in addition to pumping within the first days after delivery. It is also useful when a mother finds it more effective than pumping or if pumping is not an option. Completely affordable and portable, it can be used to produce colostrum during the first few days, maximize milk production, and stimulate let-downs. It is very dependent on technique and may require some practice. 

A) Describing manual expression

Manual expression.

Manual expression is the use of your hands to remove milk from the breast.

Manual expression is less effective than double pumping for mothers who need to express frequently and regularly, such as those with premature babies or babies who cannot breastfeed effectively (Becker 2008).

However, during the first few days after delivery, manual expression, in addition to pumping, is very effective in establishing the milk supply and increasing the amount of eventual milk production (Morton 2009; Ohyama 2010).

Manual expression is also useful in these circumstances:

  • When it is more effective than pumping
  • If pumping is:
  • To obtain colostrum during the first few days after delivery
  • To help stimulate let-downs

Manual expression has several advantages over pumping. It is affordable and portable and all you need is a clean container to express into.

B) How to manually express

You will need a container such as a small bowl or cup, to catch the expressed milk. If you are expressing for a premature or newborn baby, if not already sterilized, you may wish to rinse the container with boiling water and dry it with a clean paper towel. Clean bowls, washed with hand-soap or in a dishwasher, are acceptable for older babies.

Manual expression combines with the let-down to push the milk out of the breast by putting pressure on the milk ducts.

  1. Wash your hands thoroughly with soap, rinse, and dry.
  2. Gently massage the breast for 30 seconds or so, starting from the area closest to the ribs.
  3. Place your fingers and thumb opposite each other, about five centimetres (two inches) behind the nipple.
  4. Put the container in front of the nipple to catch the milk.
  5. Push the skin of the breast back toward the ribs.
  6. Firmly squeeze the fingers and thumb (digits) together.
  7. Push the digits toward the nipple.
  8. As you reach the nipple, continue to compress the breast until the milk stops, which might take up to five seconds.
  9. Relax.
  10. Repeat steps 5 -7.
  11. Move your fingers and thumb around the breast periodically to maximize the amount of milk.
  12. Stop:
    1. Once the breast is soft.
    2. You have the expected amount of milk.
    3. 20 minutes have passed.

Some mothers manually express both breasts at once. They use a large clean bowl placed on their lap or on a pillow. This is more time-effective and may produce more milk as both breasts are stimulated at the same time. Double manual expression requires leaning forward and can become uncomfortable.

C) Problems with manual expression

Proper technique is very important. If you are not expressing the expected amounts of milk:

  • Review your proper technique.
  • Watch some online videos showing proper technique.
  • Maximize the let-down.
  • Address any pain or discomfort.
  • Use other ways to increase the expressed amounts.  
  • Get help from a breastfeeding specialist.

Regular manual expression may be tiring. 

References

Becker GE, McCormick FM, Renfrew MJ. Methods of milk expression for lactating women. Cochrane Database Syst Rev. 2008 Oct 8;(4):CD006170
 
Morton J, Wong RJ, Hall JY, et al. Combining hand techniques with electric pumping increases milk production in mothers of preterm infants. J Perinatol. 2009; 29(11):757-764
 
Ohyama M, Watabe H, Hayasaka Y, et al. Manual expression and electric breast pumping in the first 48 h after delivery. Pediatrics International. 2010; 52:39-43