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Why should I learn hand expression if I already have a pump?

Updated: Jul 17, 2020

Here is some info on a vital skill that they may have left out of your prenatal class.

How it's helpful in the early days

  • low-tech, don't have to bring a pump to birth centre/hospital

  • more effective at removing colostrum versus a pump anyways

  • gives baby some extra calories between feeds at the breast by offering it by cup or spoon

  • helps your uterus contract, preventing hemorrhage

  • helps you develop a good milk supply (the more milk you remove in the early days = better milk supply ongoing)

  • helps to relieve engorgement, softening the breast tissue proximal to the nipple and allowing infant to latch when it was previously impossible due to hard breasts that are typical on day 2-5 postpartum

  • helps you become acquainted with your anatomy and newly lactating breasts/chest and helps you understand the physiology of it all.

How the skill is helpful ongoing

  • You're able to remove milk without a pump if your pump breaks or is dirty, or you just want to keep things low tech

  • you can relieve painful engorgement/prevent massive leaks while you're out for the night or seperated from babe without hauling a pump around

  • if you get a plugged duct you can use hand expression and directed massage to help dislodge it

  • can use hand expression post-pumping to fully empty breasts and collect more milk. "Empty" breasts = more milk to be made (aka supply & demand). Did you know that pumps don't remove all your milk? That's a whole other can of worms.

  • in an environmental disaster/emergency situation you have a backup way of removing milk and offering it to baby if you exclusively pump and feed via bottle. All you need is any sort of clean receptacle to collect milk.

  • can use this skill to help manage overactive letdown

At the very start

It's almost a default for new parents to buy or register for a pump even before baby comes. Pumps certainly have a role to play for folks that will be doing a good amount of expression and bottle feeding, but they aren't absolutely necessary. I am always baffled when new or expecting parents tell me all about the new pump that they chose and why, but haven't yet learned the age-old skill of hand expression. No judgment folks!! How were you to know? Let's learn.

Right after you or your partner gives birth, if no medical intervention is necessary, baby will likely be placed on your upper chest and within 30-60 min will attempt to make their way down to your chest/breasts with the help of some strong reflexes and instinct. Baby will then work at expressing your more viscous and stickier first milk (colostrum) loaded with antibodies, stem cells and all sorts of good stuff. Getting viscous colostrum out of small ducts (and having made the transition from womb to world) is hard work for baby so often their seriously pooped after the initial feeding. This is the perfect window to start hand expressing for a couple reasons.

  • Sucking/expressing at the breast releases oxytocin that helps the uterus to contract (to reduce bleeding by constricting blood vessels) and involute (get smaller and raise back up to its original position after labor). Hand expression will help speed up this process and could help reduce bleeding.

  • More milk out, more milk in. The more milk you and baby express in the early days = the more milk producing cells you will stimulate to develop, which will lead to a better supply long-term. This specifically speaks to days 2-14ish but getting in great habits and doing some hands on learning in the first few hours after birth ensures that you can continue to queue your body into knowing that it better lay down enough cells to feed your baby plenty of milk.

After birth, if baby is dozing and you're awake why not utilize first some breast massage and then hand expression to move colostrum out, queuing your body to make more. You can then offer this to baby by painting it on their lips, giving it with a spoon, a medicine cup or with a syringe. The colostrum that you express into a clean container is so full of antibodies and protective cells that it can be stored at room temperature for 5 hours--so you often don't have to worry about storing this "liquid gold" in a birthing centre or hospital fridge.

WARNING!!!!!! You may just get drops when you first start hand expression right after birth. That is not only OK but perfectly normal. Do not be discouraged, I repeat do not be discouraged. Right after birth your colostrum flow is typically slow and small in volume. At birth a baby's tummy has a capacity of approximately 5-20mL, that is teeny tiny, so a small amount is all they need each feed.

If baby is on the breast/chest a LOT in the first hours and days and it's feeling comfortable

maybe hand expressing isn't necessary for you. But for those still figuring out latch, not

seeing much milk transfer between breast/chest and baby or those wanting to supplement baby with some extra colostrum may really benefit from using hand expression.

For those separated from their infant in the first hours or days of life: expressing

your milk is something that you can have control over when things are stressful and

unknown. It can give you something to focus on and be a healthy distraction from

medical chaos. Expressing your milk effectively can be empowering-- knowing that you

are able to provide a medically compromised baby with antibodies, stem cells, protein,

carbs, etc. can allow you to care for your baby even if he/she is not in your arms. If

you've already had a lot of medical intervention in your labor seeing another machine

like a breast pump can be exhausting or even triggering. Using hand expression in this

instance may be more soothing.

If your infant was born premature and you're on a frequent pumping regime, you can make those sessions in the early days really count by using hand expression after pumping to really drain the breast leading to a bountiful return of milk--as discussed above it's all about supply and demand. Some people don't let down to a piece of electronic machinery as well as physical touch and manual expression. In these cases a mixture of pumping (with a hands on method where you are massaging your breasts/chest while the pump is on, followed up by hand expression for an additional 5 min or so, or until the milk flow stops entirely can help express milk when the pump isn't working to its full potential.

This sticky and amazing substance we call colostrum only hangs around for a couple days before you transition to full blown milk.

Why continue to use hand expression after those first few days?

Personally, I absolutely love hand expression. When I had my baby I was separated from her for 3 nights in the early days due to health complications. I panicked, I hadn't bought a pump yet and had to head back to hospital. I didn't know how I was going to collect this milk for her pre-departure and while in hospital. I knew how to hand express but I had never considered using it for larger amounts of milk collection--i knew it more as a way of managing engorgement and as a way of further draining the breast/chest post mechanical pumping. I was determined at the time so I started hand expressing. At first I only got a few drops but as I continued and fell into a rhythm the milk started flowing. I couldn't believe how easy it was after i got to know my breasts a bit and what kind of manual expression they respond to (changing up finger positioning can make a big difference and this can take a sec to figure out, but stick with it). I've used hand expression to collect many oz's of milk on it's own and in tandem with a pump wherein I hand express firmly for 5 min per breast post pumping (which is a dynamite duo). I also use hand expression when I am out with my pals without baby and I am feeling engorged. I sneak off to a washroom or private area and hand express in a sink, toilet, or a clean mason jar if I am not drinking and want to bring this milk home for baby to drink later so long as i can get it in a fridge within a few hours (unless I also remembered an ice pack and a tiny thermal bag).

Those who have an overactive letdown can use hand expression for a few minutes prior to latching to "take the edge off" the force of the initial letdown which is often the strongest and often upsets baby or makes it hard to manage the flow without first getting that initial letdown out of the way.

So how do I do it??

There are some amazing resources online. I want you to watch these videos to understand the positioning, rhythm and method of this form of milk expression.

For a great vid on breast/chest massage & hand expression check out by Maya Bolman, IBCLC and Ann Witt, MD's great video:

(jump to 1:00 for instructions and video of hand expression).

Another helpful vid for learning:

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