Breastmillk Hand Expression

The term ‘Hand expression’ means using one’s hands to obtain the milk.

‘Hand expression should be in every lactatingimagesCAQB0HE0 woman’s repertory of skills. A woman can forget the hand or personal pump at home, or a power failure may render her electric pump useless, but hands are always readily available. Contrary to popular belief that hand expression is time consuming ‘it is a skill that simply needs to be acquired. Hand expression costs nothing and is a skill that can be mastered with only a little practice’…. (Breastfeeding the Newborn. Biancuzzo)

Hand Expression: Is a workable option for almost every mother that is learning how to remove breast milk from her breast for different reasons, since it provides a mother with a way to relieve fullness or express her milk for her baby in any situation; some mothers prefer hand expression to using a pump because it feels more natural.

The feel of skin to skin may be more effective at stimulating a let-down or milk ejection reflex for some mothers than the feel of a plastic pump flange.

Once the technique is mastered, hand expression is convenient – nothing to purchase, wear out, break down, wash, store or transport. Once a mother acquires practice, hand expression can be quick and highly effective.

(The Breastfeeding Answer Book. LLLI)

It is a well-known fact that by combining Breast massage and Hand expression, results can be seen faster and in greater quantity.

Breast massage: whether planning to manually express or mechanically pump, preparing the breast for ejecting the milk facilitates the process.

The release of oxytocin and the ejection reflex are stimulated by external stimuli: a baby’s cry, a picture of the baby, or gentle handling of the breast (massage). Prolactin release and milk production are stimulated by suckling stimulation. Let down functions automatically with time and practice. (Bf guide for medical profession. Ruth Lawrence & Robert Lawrence)

Research Made in 2008 by Dr. Jane Morton, Director of Breastfeeding Medicine at Lucile Packard Children’s Hospital and Clinical Professor of Pediatrics at the Stanford University School of Medicine.

Jane Morton

Link to Stanford University Hand expression Video by Jane Morton

Doctor Jame Morton reached the following conclusion:

A low milk supply is the most common reason for mothers to stop breastfeeding,.

(1) We have learned that what we do (or don’t do) in the first 3 days after delivery, can have a major impact on future milk production potential. In our research, we found that milk production in pump-dependent mothers of preterm babies depended on the frequency they used hand expression in the first 3 days after delivery.

(2) Mothers who used hand expression more than 5 times a day in the first 3 days, yet pumped with the same frequency as other study mothers, expressed an average of 955 ml, about a quart a day by 8 weeks. This is more than a term 4-month old would need. Mothers also found consistent increases in production when they did not rely solely on pump suction alone to remove milk, but used “hands-on pumping”. This technique combines breast massage, compression, and hand expression with electric pumping, and does not require more time. Of the 67 study participants, several volunteered to demonstrate hand expression and hands-on pumping on the Stanford website.

(3) For mothers of term and late preterm babies, there is an important role for an alternative way to remove colostrum when the infant has not yet learned to latch-on and nurse effectively. About 50% of mothers will have some difficulty getting their babies to latch on well in the first day.

(4) While providing a mother with a pump may be the easiest solution from a nursing standpoint, a recent study suggests it is more effective to teach her to hand express milk after breastfeeding.

(5) At 2 months, mothers assigned to hand expression were more likely to be breastfeeding (96.1%) than mothers assigned to breast pumping (72.7%). (p=0.02)

A smaller study suggests more milk can be removed with manual expression than with a new, double rental-grade pump in the first 48 hours post-partum.

  1. Ruowei Li, Fein SB, Chen J, Grummer-Strawn L. Pediatrics 2008; 122(2):S69-S76.
  2. Morton J, J Perinatol. 2009 Nov;29(11):757-64. Epub 2009 Jul 2
  3. See: HandExpressing Milk — video and MaximizingMilk Production — video . Complete video, Making Enough Milk, the Key to Successful Breastfeeding, can bepreviewed and purchased at
  4. Dewey KG. Risk Factors for Suboptimal Breastfeeding Behavior, Delayed Onset of Lactation and Excess Neonatal Weight Loss. Pediatrics 2003;112:607-619
  5. Flaherman VJ, Archives of Disease in Childhood 2011
  6. Ohyama M. Pediatr Int. 2010 Feb;52(1):39-43
  7. Kumar A. J Perinatology 2010; 30:209-217

From my personal experience as a Lactation Consultant here in Los Angeles, in California it is very common that mothers will be given or loaned an e-pump in the hospital to start pumping colostrum for their babies in order to build their milk supply. It’s very frustrating and disappointing for the mother who already is going through a roller coaster of emotions when they use that e-pump and don’t see any results.

From my point of view, the characteristics of colostrum – thick, small in quantity – added to hours of labor, mother stress, body pain, and any unexpected situations, make the use of the e-pump very inefficient at milk extraction. It may be good to start stimulation and help building milk supply but not very efficient for colostrum extraction in most cases. Despite this, there are a few mothers that could be successful using the e-pump.

For most of those moms who weren’t able to get any colostrum with the e-pump, teaching them hand expression was one of the most rewarding and efficient techniques that helps them feel better in a couple of seconds.

Hand expression could also very helpful in the 2nd phase of Lactogenesis when the “milk comes in” and engorgement is present 3-5 days after delivery. Latching the baby at breast becomes challenging for the baby, and the area of the areola becomes more sensitive for the mom. Applying hand expression 2-5” before breastfeeding could be very beneficial to soften the areola, facilitate a deep attachment for infant at the breast, and help mom to feel more comfortable with that initial latch.

It is also helpful in treating breast fullness and engorgement after breastfeeding without causing too much extra stimulation, and giving the mom that little comfort to be able to wait until the next feeding.


Chele Marmet

The Marmet technique

This technique was developed by a mother who needed to express her milk supply over an extended period of time for medical reasons. She found that her milk ejection reflex did not work as well as when the baby breastfed, so she also developed a method of massage and stimulation to assist this reflex. The key to the success of this technique is the combination of the method of expression and this massage.

We don’t expect to see anything in the beginning. Infant stomach during the first 2 days is as small as the size of your baby’s fist. The quantity of BM that baby needs on those days is like 1 teaspoon of colostrum per feeding. For that reason, it is normal to collect drops or small quantity of BM per session.

Alternate frequently, going from one breast to the other every 1-2 minutes approximately.

By alternating sides, the burst and pauses of milk expression simulates the normal patron of sucking of a baby. The idea is to develop a rhythm like a baby nursing.

Initially, express each breast for around 15 min or more, until the breast feels softer and the flow of milk coming out slows down.

If I could have more time during my patient’spaula-face consultations I would love to teach this technique to every mother that I help, but too much information at once can be overwhelming for the new mother. I think this could be a great gift for any mother, since this technique can be useful in many situations. Learn how to do it with help one on one is definitely more efficient, but since I don’t always count with the gift of time, I decided to make this video as clear as possible with a very detailed explanation at every step.

This video shows a combination that alternates massage with hand expression – as suggested by the Marmet technique following the movements, steps, and finger position from Doctor Morton technique.