Expressing by hand (hand expression) means that you use your hand to rhythmically press your breast so milk comes out.
There are probably as many ways of doing this as there are mums. The trick is to press the milk ducts behind your nipple. Many mums make the mistake of squeezing the nipple itself. You won't get any milk that way and it'll probably be painful.
- Wash your hands before you start. Find a suitable wide-rimmed container, such as a jug, for storing your milk. Either sterilise it in a steriliser or wash it well and scald it with boiling water.
- Sit comfortably, with your back straight.
- Place your little finger underneath your breast, against your ribs, and spread your other fingers slightly to support your breast. Your thumb needs to be on top, about 3cm or 4cm back from the base of your nipple. It should be just out of the areola.
- Adjust your fingers if you need to, so that your first finger and thumb are opposite each other, making a big C shape around your breast. If you visualise your breast as a clock you would have your thumb at 12 o'clock and your index finger at 6 o'clock.
- Your milk comes from deep within your breast, so your finger and thumb need to be well away from your nipple. Place them towards the edge the darker skin surrounding your nipple (areola). If you have a large areola, you may need to bring your fingers inside it.
- Gently squeeze your thumb and first finger together, hold the squeeze for a count of three, and release, but keep your finger and thumb in the same position.
- Repeat the squeezing and releasing until you see drops of your colostrum or breastmilk appearing at your nipple. Be patient, it may take a minute or two for milk to appear.
- Once you get the rhythm going keep pressing until the flow slows or stops. Then move your fingers around your breast and try a different section of your breast. Again, think of your breast as a clock and try 2 o'clock and 8 o'clock to get the ducts there, then 4 o'clock and 10 o'clock, and work your way around.
- Then go to the other breast and repeat. If your fingers feel tired, use your other hand.
Massage your breasts gently before you start expressing your milk and several times during the process to work your milk down to the nipple. Warm compressions or a warm shower may help you relax and prepare to express breastmilk.
Once you have had a bit of practice, you may find your milk sprays out. If this is the case try collecting your milk using a funnel inside your container. Scald the funnel first with boiling water.
It does take time to learn how to express by hand, but keep going. Many mums find that, once they become skilled at it, they can hand express a lot of milk in less time than it takes to use a manual or electric breast pump. Applying a warm compress on your breasts or having a warm shower just before expressing can help start the letdown reflex