How to hand express

Here you can find out about how the body works to produce breast milk and how to hand massage and hand express breast milk. This is a useful tool to learn how to hand express and why. This is something your health professional should be able to teach you to do if they are trained under UNICEF Baby Friendly Initiative. See STORING EXPRESSED BREASTMILK for guidance of how long breast milk can be stored. There are differing guidance available, dependant on the source, but we have given you a good overall instruction.

The Anatomy & Physiology of the Breast

The breast tissue is made up of a number of structures that branch and interweave into the nipple openings. These structures produce the milk and allow the let down and expulsion of milk in the right hormonal conditions.:

 

Understanding the Breast

  • Areola

    • Dark area that includes the nipple (Mammary Papilla) and nipple openings.

    • The change in skin colour acts as a visual guide for the baby to find the nipple.

  • Montgomery Tubercles

    • The bumps that excrete a fluid that smells and tastes like amniotic fluid.

    • This helps the baby find the breast by the familiar taste and smell.

  • Milk Ducts

    • These are generally just behind the areola.

    • The position of these can vary from breast to breast and person to person.

  • Bunches of Milk Cells (Alveolus)

    • There are approximately 10-100 Alveoli in each Lobe of the breast.

    • There are approximately 15 -20 Lobes in each breast.

  • Milk Cells (Acini Cells)

    • These cells produce milk when Prolactin hormone is released, stimulated by touch and induces mothering instincts.

    • These cells are surrounded by muscle cells (Myoepithelial Cells) that contract, by the release of the hormone Oxytocin, which is stimulated by feelings of love and happiness.

    • When the muscle cells contract the milk is squeezed from the Milk cells and travels into the Ductules.

How to hand express

To enable the milk to let down it is important to stimulate the hormones; oxytocin and prolactin, mentioned in the previous section. We use our senses to stimulate feelings of love; smell, touch, look and sound.

Ways to stimulate Oxytocin

  • Have your baby near you.

  • You could have your baby skin to skin with you.

  • Your partner could hold your baby but sit near you.

  • Your partner could have their arm around you.

  • If your baby is not with you, you could have something of theirs to smell, or a photo to look at.

  • Massaging your breast by gently stroking your breast, or by rolling your fists gently around your breast, or tapping lightly with your fingers tips all over the breast and you can try tweaking or rolling your nipple (although sometimes your nipples may be too sensitive for this).

  • Massage for a good 5 to 10 minutes when you first start.

How to start Hand Expressing

  • Cup the breast in your hand, holding you thumb and fore finger in a “C” shape.

  • Starting just behind the Areola, use your thumb to walk backwards.

  • Stop when you feel the texture of the breast change, this should be where the milk ducts are.

How to express milk

  • Place the finger(s) and thumb opposite eachother.

  • Firmly press the breast against your chest wall so it doesn’t wobble about.

  • Compress the breast and release. You may need a few tries to work out the pressure needed.

  • Repeat, keeping the rhythm of “press” and “release”.

  • It may take a minute or two for the milk to start to flow, be patient and relax.

  • Avoid sliding your fingers on the skin.

When the flow subsides

  • Rotate your finger and thumb to another section of the breast.

  • Then when you have worked around the breast move to the next breast.

Why hand express?

Hand Expressing can help in those First Days

  • To encourage your baby to the breast by the smell and taste of the milk.

  • To help kick-start your milk cells to produce milk.

  • To relieve your breast if they become Engorged.

  • To reassure you that you have milk.

  • To collect milk for your baby if they are unable to feed or you are separated from them.

Hand Expressing can help in the long term too

  • This can prevent or manage problems of blocked ducts or Mastitis.

  • For social reasons, such as wanting to go out for the evening and leaving your baby to be fed by someone else.

  • If you have to return to work.

  • Or if you have to stay in hospital without your baby, or your baby has to stay in hospital with out you.

Antenatal Collection of Colostrum

  • Sometimes your midwife may discuss with you the possibility of expressing your colostrum while you are pregnant.

  • This can be useful if your baby is predicted to be at risk of having low blood sugars when they are born.

  • Obviously you would always allow your baby to latch and feed themselves after birth, but these at risk babies need to be fed in the first 30 mins if possible.

  • Not all babies will be ready to latch at the breast straight away. Therefore, with these at risk babies, if you have collected colostrum, they can have this via a syringe or cup, until they are ready to latch (this would only be given by a trained maternity staff member).

  • This can also prevent, or at least reduce the need for the introduction of formula if the blood sugars are low.

  • Ask your Midwife for a Colostrum Collection Kit.

Storing expressed breastmilk

Storage

Defrosting   

                

How Long?

5 hours

5 days

2 weeks

6 months

Defrosting

In a fridge for up to 24 hours

Some babies will drink defrosted milk straight from the fridge and this is ok

Warming

Where

Temperature

Main body of the fridge at 4°C or less

Ice compartment of a fridge

Larder Freezer

Warming

Place bottle in a jug of warm water, or hold under a running hot tap (take care not to scold yourself) to bring the milk to room temperature

Don't use a microwave to heat up or defrost breast milk, because it can cause hot spots, which can burn your baby's mouth