How and When to Hand Express Breastmilk

Read time: 6 minutes

What to know about hand expressing breastmilk:

• Understand the potential benefits and disadvantages to hand expression

• Know when it may be beneficial to hand express breastmilk

• Learn how to hand express

• Tips to get you started with hand expressing

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.

Potential benefits of hand expression

During the first week or so after birth, hand expression may help produce more milk than an electric or manual pump.¹ Additionally, using hand expression has been shown to help increase output when combined with pumping, particularly in the newborn phase.²

When hand expressing breastmilk, you can use your hands to help massage milk out of places that a breast pump may not be able to empty.

And finally: There is no pump cleaning required when it comes to hand expressing milk!

Potential disadvantages of hand expression

For some women, hand expression may not produce quite as much milk when compared to pumping.^4,5 Especially when used beyond the first couple weeks after baby’s birth.

Hand expression often takes more time, especially if you are looking to express both breasts.⁴ In fact, some electric pumps are able to express both breasts simultaneously, allowing you to multi-task while you pump.

If your little one is not able to breastfeed at the breast, a hospital-grade double-electric pump is generally the best choice for establishing and increasing breastmilk supply.^6,7

Read more: Top Tips for Pumping Breastmilk

When can hand expression be used?

Having this skill can be useful in many circumstances.

During the first 3-4 days after delivery

Hand expressing your colostrum (the first milk) for a few minutes after each feeding will provide extra stimulation for your breasts, which in turn helps to stimulate your overall supply.^8,9

If your baby is not feeding well in the beginning, expressing breastmilk is especially important.¹ 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.

For a baby born prematurely

Premature, low-birthweight, or sick babies who are unable to suckle at the breast will need expressed milk until they are able to nurse.¹

In this case it is important to hand express often, at least 8-12 times per 24 hours. This will help you get enough milk for your baby as well as help the body establish a milk supply.^7,10

However, once the first week or so has passed and your mature milk begins to come in, switching to an electric pump may help your supply develop to better meet baby’s growing needs.^6,7

Learn about: Pumping Breastmilk for a Baby in the NICU

If your breasts are engorged

Manual expression of milk can also be used to relieve breast engorgement at any age or stage after birth.¹¹ This may be done between feedings for comfort or even briefly before one.

An extremely full breast may make it difficult for your baby to latch. To help, you can express a little milk to soften the breast before breastfeeding, making it easier for your little one to feed.¹²

To help stimulate the let-down reflex

Sometimes babies get frustrated when milk does not start to flow as quickly as they’d like. When this happens, hand expressing can be done until the body lets down milk (called the Milk Ejection Reflex), then baby can be latched once milk is ready to go.¹³

After pumping with an electric pump

Hand expressing after using an electric pump is a great way to help stimulate your milk production. Studies have indicated that some women who hand express after pumping may boost their breastmilk output by up to 48%.^2,8

Learn about: How to Choose the Right Breast Pump

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.

Need some help figuring out if you need to hand express or how to do it? Reach out to our team of registered dietitian nutritionists and lactation consultants for free! They’re here to help on our free to live chat from Monday – Friday 8am-6pm (ET). Chat Now!

How to Hand Express

Hand expression should not hurt.¹³ If it does, your technique may be too rough. It’s important to avoid bruising or damaging the breast tissue, which could lead to a lowered milk output.¹⁴

Always wash your hands before hand expressing and have a clean wide-mouth container on hand to catch the milk.^13,15

First, trigger your let-down reflex

Gently massage your breast in small circles or strokes starting at the back of the breast and working your way toward the nipple. This helps stimulate your let-down (when milk starts to flow). Repeat these gentle movements all around the breast.^13,16

Remember that it may take a few minutes before milk starts to come out. Once your let-down begins, start to hand express.

Steps for hand expressing breastmilk

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 above the nipple and the pads of your pointer and middle fingers will be on the other side (under the nipple) at the 6 o’clock position, forming a “C.” Your thumb, fingers, and nipple should be in a line. Support your breast with your other fingers.

2. Push straight back into your chest without spreading your fingers apart. If you have larger breasts, you may need to lift the breast and then push your fingers toward the chest wall.

3. In this back position, gently squeeze or compress your fingers together (maintaining their position about an inch or so behind the areola). Catch drops of milk in the container. Then release.

4. Repeat in a rhythmic motion: position fingers, push back, compress together, release.

5. Rotate your thumb and finger position around the “clock” to milk the other reservoirs. Be sure to use both hands on each breast. Feel for full milk ducts to express those – they will feel like peanuts or tiny balloons.^13,15,16

Learn about: Safe Storage of Pumped Breastmilk

Tips to help get you started with hand expressing

How much milk will I get when I hand express?

If hand expressing for a full feed, during the first day after birth you may only get about 1 teaspoon of colostrum each time you hand express.¹⁹ Your baby’s stomach is small, so this is a good amount for each feeding. Every day you will begin to produce a bit more.

Your 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.

Once your baby is around 6 weeks and beyond, they will be taking in approximately 4 ounces of breastmilk each feeding.^20,21

Videos of hand expression can be found here https://med.stanford.edu/newborns/professional-education/breastfeeding/hand-expressing-milk.html .

Getting your milk flowing

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, listening to a video of them crying or babbling, or even smelling their clothes or blanket can help stimulate your let-down and milk output.¹⁷

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

Position your breast over the container you’ll be expressing into. During the first few days, it may be easier to catch the drops of colostrum as they come out of the breast with a small cup.

How long should I hand express for?

Expressing after a feeding

If you are hand expressing after a feeding, express for about 4 to 8 minutes total per side.

Split this up into intervals: First massage for a let-down, then hand express for 2 to 4 minutes, then switch sides. Repeat if needed.

Expressing in place of a full feeding

If you are hand expressing in place of a full feeding, you’ll want to express for longer. Aim for 20 to 30 minutes total.¹⁵

Massage for the let-down. Then express for about 3 to 5 minutes each side, switching back and forth.¹⁵ You can stop a couple times between sets of expression to massage your breast gently for about a minute to help keep them stimulated.

Here is an example hand expressing pattern to use for a full feed:

• Express each breast for about 5 to 7 minutes

• Massage your breasts for about a minute

• Express each breast for about 3 to 5 minutes

• Massage your breasts for about a minute

• Express each breast for about 2 to 3 minutes¹⁸

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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For more on this topic, check out the following articles:

Top Breastfeeding Latching Tips

What to do about Sore Nipples while Breastfeeding

6 Breastfeeding Positions for You and Your Baby

Managing Leaking While Breastfeeding

What is Paced Bottle Feeding

Understanding your Baby’s Hunger and Fullness Cues