How and when to hand express

Woman hand expressing to help milk flow

When to Hand Express

Before mechanical breast pumps were readily available, nursing mamas would use hand expression to remove milk from the breast. Even if you now have a pump at your disposal, hand expression is still a useful skill to know and learn.

The following scenarios are all appropriate times to hand express:

  • In the first 3-4 days after the birth of your baby, hand expressing your colostrum (the first milk) for a few minutes after each feeding will provide extra stimulation for your breasts, which helps to stimulate your overall supply.
  • If your baby is not feeding well in the beginning, hand expressing breastmilk is especially important. You can give your baby the expressed drops of colostrum (using a dropper, spoon or small medicine cup) to encourage your little one to feed.
  • Premature, low-birth-weight or sick babies who are unable to suckle at the breast, will need expressed milk until they are able to nurse. Or if your baby is simply having difficulty latching or suckling, hand expression can be used until your little one gets the hang of breastfeeding.
  • Manual expression of milk can also be used to relieve breast engorgement. Since an extremely full breast may make it difficult for your baby to latch, you can express a little milk to help soften the breast, making it easier for your little one to feed.
  • After using an electric pump is a great time to further empty the breast and boost milk production!
  • Personal preference! Some nursing mothers find mechanical breast pumps to be uncomfortable, ineffective or expensive. Manual expression is more convenient for some – no need to carry special equipment (which also means fewer parts to clean) or look for an electrical outlet.

How to Hand Express – the Marmet Technique

Developed by a mother who needed to express her milk over a long period of time for medical reasons, the Marmet technique mimics the actions of a breastfeeding baby and is the most recommended method of expressing breastmilk by hand.

  1. Position your thumb and first two fingers (the pointer and middle fingers) about 1 to 1.5 inches behind the nipple. Your thumb pad will be in the 12 o’clock position and the pads of your pointer and middle fingers will be on the other side at the 6 o’clock position, forming a “C.” Your thumb and fingers should be in line with the nipple.
  2. Push straight into your chest without spreading your fingers apart. If you have larger breasts, you may need to lift and then push your fingers into the chest wall.
  3. Roll your thumb and fingers forward (like you’re taking fingerprints). This rolling motion of the thumb and fingers will compress and empty the milk reservoirs around the nipple.
  4. Repeat this rolling motion to drain the reservoir – position, push, roll.
  5. Rotate your thumb and finger position around the “clock” to milk the other reservoirs. Be sure to use both hands on each breast.

Keep in mind that milk supply will increase over the early weeks following your baby’s birth and the amount you express will also increase as you get better at hand expressing.

While other methods exist, the Marmet method minimizes the damage to breast tissue, bruising or even skin burns that may result from other techniques – especially if you are hand expressing on a regular basis.

The Marmet technique is considered safe, but if anything feels uncomfortable or painful, you should always reach out to a healthcare provider or lactation specialist.

Videos of hand expression can be found here and here

What to Do

Be prepared

Wash your hands well and find a clean container to collect expressed milk. Many mothers express milk directly into a bottle or breastmilk storage bag. You may feel more comfortable starting with a cup that has a wider mouth to minimize spills.

Try to find a comfortable space where you feel relaxed – this will help with milk flow. If you are away from your baby, looking at a photo of your little one or even smelling their clothes or blanket can help stimulate milk flow.

You can try sitting or standing (whichever is more comfortable for you), as long as you are in an upright position, slightly leaning forward. This way, gravity is working for you.

Try massage

Try placing a warm wet towel on your breasts for a few minutes before massaging – many women find the warmth helpful. Then massage your breasts to help stimulate the flow of milk. Start by moving your fingers around your breast, pressing firmly in a circular motion (similar to a breast examination). Be sure to lift your fingers off your breast as you move around the nipple – a sliding motion could cause skin burn. Lightly stroke your breasts from the chest wall to the nipple – continue to do this around the breast. Then, shake your breasts gently while leaning forward so that gravity can help the milk eject.

Express milk in place of a full feeding

Massage and express from each breast about three times using this pattern.

  1. Express each breast for about 5 to 7 minutes.
  2. Massage your breasts for about a minute.
  3. Express each breast for about 3 to 5 minutes.
  4. Massage your breasts for about a minute.
  5. Express each breast for about 2 to 3 minutes.

These timeframes are just guidelines. Pay attention to the flow of milk and switch to the opposite breast as the flow slows down. Your own timing and efficiency will improve as you practice the technique.

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