Hand expression is a useful tool for breastfeeding moms. Hand expression would be removal of milk from the breast using only the hands, not any sort of pump or other removal device. Some mothers are able to hand express complete feedings for their babies, although this is uncommon to hear.
But hand expression can be regularly useful when small amounts of milk are needed for blending with solid foods, mixing with medications, clearing plugged ducts, reducing milk supply, avoiding overactive letdown, or in unexpected situations when you are separated from your baby without notice or longer than you expected.
Expressing Small Amounts
The most common way that I have used hand expression is for adding small amounts of breast milk to baby cereals, to thin mashed vegetables or fruits in the early days of solid foods, or when using small amounts of breast milk for medicinal purposes. Sure I could pull out my single-side hand pump (I use the Medela Harmony), but then I have to clean all those pump parts! It's easy to throw a little mashed or pureed food in a bowl and then hand express a little at a time until the food is the consistency you need.
If using breast milk to treat diaper rash, eye infection, ear infection or other appropriate issue, you can hand express right onto the treatment site (very convenient at the changing table!) or into a small bowl or dropper.
Hand expression can also be great if you need to give your baby a prescription medication (for example, for GERD or reflux). This is something that mothers are often conflicted about to begin with, and having to pull out the pump every time to mix breast milk with the medication just adds insult to injury. It's an easy time for mothers to turn to formula, which can just compound issues for the baby. Just hand express right into the bottle or medicine doser, along with the medication, and all ready to go!
Clearing Plugged Ducts
Hand expression is a great tool for clearing plugged ducts and avoiding mastitis. Getting in a warm shower and expressing gently while pushing from behind the plug with the other hand is a great way to clear a plug. You could also do this with a hand pump, but it's not the most convenient in the shower, and the pump horn can sometimes interfere with the part of the breast you need to access to clear the duct.
Overactive or Forceful Letdown
It's extremely common in the early weeks, or even months, of nursing for mothers to experience a huge rush of milk during letdown. This can cause the baby to choke, pull off the breast or occasionally even throw up if milk intake is too fast. A common recommended solution is to pump the breast very briefly to allow the milk to let down and "take some off the top" before latching the baby on. But again, what a hassle! I prefered to just grab a burp cloth (I kept PILES of those Gerber "Cloth Diapers" that aren't really cloth diapers, just cotton cloths) and would hand express onto them for a few minutes with the same result.
Unexpected Situations and/or Reducing Milk Supply
Hand expression can be a life saver if you are unexpectedly separated from your baby for longer than expected. For example, if you run out for an errand and your car breaks down, or you go out for a quick meeting at work without your pump and the meeting runs long. Hand expression for just a few moments in a bathroom sink, or onto a burp cloth, breast pad or even a paper towel can be a great way to reduce the discomfort from a delayed pumping or feeding, and reduce the likelihood of a resulting plugged duct (or major leakage!).
One caveat – using this method too often may result in a reduction of your milk supply. Keeping up supply in absence of your baby requires emptying the breast. Removal of small amounts of milk for comfort is telling your body that that milk is not needed for the baby, so the next day at that time, your body will produce less. Especially in the early weeks and months of breastfeeding, you body can be incredibly responsive to these sorts of cues as it works to adjust to your baby's rapidly changing needs.
Reducing milk supply in this way can, however, be used strategically. Working mothers, for example, can use a combination of hand expression and extended pumping to adjust their pumping timeline. For those with jobs like teachers, where you may need to develop a pumping schedule that differs from your baby's feeding schedule with a caregiver, it may be possible to "train" your body to increase production when you want it and lower production when you don't. Hand expression for relief would be the "reducing" part of that equation. (See my "Increasing Low Milk Supply" article for a sense of how increase supply at a specific time using your pump – but I'll plan to do an article specific to this topic in the future).
Hand expression can be a useful skill in the breastfeeding mother's toolbox. For tips of how to successfully hand express, see my article on "Hand Expression of Breast Milk – Methods" (coming soon).
When you need a little more milk, more quickly, I really like the Medela Harmony Hand Pump. And for frequent, efficient removal of milk and/or for long separations from your baby, I definitely recommend the Medela Pump in Style.
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