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Hand Expression of Breast Milk: Why does it matter?

Pregnant mothering massaging her breast in preparation for hand expression

The skill of hand expression is an incredible tool for a mother – especially when she intends to exclusively breastfeed. By definition, hand expression is the use of the hands to move milk (colostrum or mature milk) out of the breasts, to be collected and fed to the infant.

For most women, hand expression can begin prenatally, during the last few weeks of pregnancy. While research shows that for healthy pregnancies, it is safe to start at 36 weeks, most healthcare providers will recommend starting at 37 weeks.

Getting to Know Your Breasts

In a culture that tends to sexualize breasts, it’s rare that a woman grows up with an embodied knowing of the wisdom and magic that’s woven into our innate ability to produce the most nourishing food for our infants. In fact, many women step onto their mothering journey, completely disconnected from their bodies. As the body changes throughout pregnancy and in preparation for breastfeeding, a variety of sensations invite reconnection with the natural processes unfolding within us.

Hand expression invites us further into awareness – bringing us into deeper connection with all the ways the breasts are showing us a readiness for milk making – growth, heaviness, darkening of nipples and areolas, more pronounced Montgomery glands (those are the little bumps on the areola that secrete a special fluid to moistens and protects the skin), sensitivity of the nipples.

Prenatal Hand Expression

Beginning hand expression in the last few weeks of a full term pregnancy, has been shown to increase confidence for exclusive breastfeeding and reduce the likelihood of perceived low milk supply (one of the most common reasons mothers stop breastfeeding).

When a mother starts with hand expression, I usually recommend practicing the first few times in the shower. In addition, taking a few, slow, deep breaths and feeling the body’s connection with gravity can help keep the nervous system in a state that supports milk flow.

At this stage of pregnancy, the breasts are producing colostrum – baby’s first milk - a highly concentrated, sticky milk that’s packed with nutrients and digestive and immune support. During hand expression, mothers may notice small drops of colostrum gathering on the nipple or they may not – either way, hand expression is effective in preparing the breasts for baby’s arrival and the rest of their breastfeeding journey.

If there are colostrum drops gathering, they can be collected and stored for future use. All the details about colostrum collection and storage are included in my Prenatal Hand Expression and Colostrum Collection Guide, along with a link to a Hand Expression how-to video.

Postpartum Hand Expression

After baby arrives, there are a few scenarios for which hand expression can be supportive:

A baby being finger fed colostrum with a syringe

When baby is latching and sucking, hand expression provides a mother with an effective way to express additional colostrum to offer to her baby after each time they latch, minimizing baby’s postpartum weight loss and optimizing mama’s milk production.

If a baby is not latching well or is unable to latch at all, hand expression moves the colostrum out of the breasts, to feed to baby and the addition of pumping helps to stimulate the breasts to support the transition to producing the higher volume mature milk. For infants who are premature or ill, expressed colostrum protects them from necrotizing enterocolitis (a serious and sometimes life-threatening inflammation of the intestines) while also improving their long-term health outcomes.

When care providers are concerned with the baby’s weight loss or blood sugar regulation, supplementation is often recommended. It’s normal for babies to lose 5-7% of their birthweight in the early days postpartum but a 10% weight loss raises concern. Remember – supplementation for weight loss or unstable blood sugar doesn’t have to be formula. It can be colostrum that the mother collects after each time the breast is offered to baby or colostrum she expressed and stored prenatally,

Hand Expression + Pumping = Hands On Pumping

A mother expressing breast milk with an electric pump

Whenever I'm working with mothers who are pumping, we always discuss a hands on approach. Research has shown that combinaing hand techniques with the use of an electric pump, often at the end of a pumping session can help increase the amount of milk expressed from the breasts and increase the fat content of the expressed milk.

In summary, the benefits of learning hand expression have the potential to positively impact a mother's breastfeeding journey - from nurturing a connection with her own body to supporting the establishment of her milk supply and optimizing the likelihood of exclusively breastfeeding. You'll find more information about this topic in my Prenatal Hand Expression and Colostrum Collection Guide. And, if you have questions that are specific to your feeding journey - whether you're pregnant and preparing to breastfeed or baby has arrived and you're struggling, I am available for private consultations.

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