Hand Expression Of Breastmilk

If you are pregnant or breastfeeding. milk expression by hand is a useful technique to learn. It's a handy way to relieve engorged breast. You can also use it to stimulate milk production and provide milk for a baby who is not breastfeeding well or needs more milk.

Why Hand Expression?

• Skin-to-skin contact with hand expression encourages the milk ejection relax (MER) or 'let-down reflex'.
• Mothers usually get more milk using hand expression alone or complied with pumping that using just a pump.
• It requires no special equipment and is always available ,even in emergencies.
• Its convenient and free.

Hand expression is particularly useful if you need to express colosseum during late pregnancy (see this article for more information) or in the first few days after birth. It makes it easy to save every drop of precious colostrum.

If You Use A Pump

Whatever pump you may use, combining pumping with hand expression can help you express more milk more effectively.

• Breast massage and hand expression can be used at the beginning to get your milk flowing.
• Breast massage while pumping increases the amount of  milk you can express.
• Continuing to hand express can release milk remaining, even after the pump flow has stopped.
• And if your pump breaks down, or there is no electricity, you alway shave your hands.

Practice Helps

Hand expression is simple to learn and gets easier with practice. You may receive information and a demonstration of hand expression from you midwife. Developing your own routine, starting with relaxation techniques and stimulating milk flow, makes it easier too.

How Breasts Work

When milk is removed more often, your breasts feel soft and comfortable and produce milk faster. When milk is removed infrequently, your breasts may feel full but produce milk more slowly. Frequent milk removal is the key to gaining milk production whether you are breastfeeding or expressing. Expressing stimulates your breasts-though not as effectively as baby- to make and release milk.

Before You Start

Wash your hands. Have a suitable clean container available to collect your milk; colostrum can be expressed into a small (5ml) container or even onto a teaspoon for immediate feeding. Once milk production has increased milk may spray in several directs so a bowl, wide mouthed container or a bottle with a funnel might be more practical. 

Relax And Get Comfortable

Milk tends to flow better when you are feeling comfortable, relaxed and arm. Tension or anxiety inhibits milk flow. Relaxation techniques can help increase the amount of milk you can express. The sound of running water may help, or you could practice in the bath or shower. 

Seek privacy; try the breathing exercises you earned for use during labor; visualize flowing milk. Have your baby nearby, or thin of him/her. Use photos or recordings of your baby and smell his/her clothing. All these will help stimulate milk flow. Take a few deep breaths, drop you shoulders and please tension with each exhalation. Bending forward with your breast suspended means gravity can help milk flow.

How To Hand Express

One Basic Approach

1. Start by encouraging milk flow in both breast.
2. Then hand express from each breast until milk flow slows right down. If you need to increase milk production, continue expressing for a couple of minutes after milk flow has stopped.
3. Repeat these two steps at least twice more. You will find milk flow slows or stops sooner each time you repeat.
4. Most mothers adapt the above approach to suit themselves, so experiment to find what works best for you.

Step by Step

Encouraging milk flow

Stimulating you r milk ejection relax (MER or 'let-down') is key to expressing. It can take a few minutes. You may see drops of colostrum or breastmilk, or even experience a tingling sensation, but many mothers don't see any milk until they start actually expressing. Experiment with the following suggestions to find out what works best for you.

• Massage your breast starting at the top, using a firm circular pressure on one spot. After a few seconds, lift up your fingers to move to the next area on the breast. Spiral around the breast towards the areola and nipple.
• Storke your breast from the top of the breast to the areola and nipple. Light stroking with fingers is one option, or use a soft item with a light tick-like stroke. Continue this stroking motion from the chest wall to the nipple around the whole breast. She your breast gently while leaning forward so gravity can help your ;milk flow.

Hand Position

You can use either or both hands on one breast, or express both breasts at the same time. Hold your hand in the shape of a letter 'C', with your thumb and forefinger behind the base of you ripple, feeling for the change in texture of your breast. Move your fingers closer to, or away from your nipple to find the best place for you.

To Express

Start with the pad of your thong at the top of your breast, and your finger pads below.

How Long Will Hand Expression Take?

Allow plenty of time at first: the whole process may take 20-30 minutes, but you can always stop and start again later if you need to. Frequent short sessions are usually more effective that infrequent longer expressing sessions.

Switching between breasts several times as milk flow slows can help trigger further milk ejection reflexes. The more MERs you stimulate, the more milk you will be able to express and make.

Hand Expression Shouldn't Hurt

Squeezing, pulling and sliding fingers along the skin can cause discomfort, bruising and skin burns. Pain of discomfort inhibit the MER and are signs the something needs adjusting. If your breast feels engorged or tender try warm moist heat immediately before expressing. Start expressing from the most comfortable areas.

Removing milk from areas around a blocked duct can reduce the discomfort, making it easier to express from the tender area later. 

Source: https://www.laleche.org.uk/hand-expression-of-breastmilk/ Written by Sue Upston, Karen Butler and mothers of LLLGB

Traveling While Pumping

As I mentioned in my previous post, I was going to be traveling and I had some concerns about how I was going to keep my ice packs frozen. So let me give you the breakdown of my trip.

We took a little mini vacay from Los Angeles to San Diego. So we weren't on the road for very long. Just about 2 hours or so. Typically, I like to pump every 3 hours and I had just pumped before we left. So I didn't have to pump again until after we checked in and got comfortable in our room. Our room was equipped with a small fridge. So that was perfect for keeping the milk I pumped cool. I had brought icepacks with me to take with me the next day. We planned to visit the San Diego Safari Park. I had called the hotel ahead of time to see what arrangements we could make to keep my icepacks frozen. They told me that they had a walk in freezer and that all I would have to do was put all my ice packs in a bag and label it with my room number and they would freeze it for me. When I checked in, I again asked about the freezer and they confirmed the same information with me. They took my icepacks and placed them overnight in the freezer for me. I let them know I would be back in the morning to pick them up.

Not gonna lie, I was concerned that somehow someone was going to drop the ball and I was looking for a back up plan for just in case. Luckily I saw an ice machine just down the hall from our room and I was already of thinking of ways I would store ice in my little cooler. 

The next morning I go to the lobby to pick up my icepacks. It was a new person from the night before in the lobby. He looked up the notes in the computer system and confirmed what the previous person told me. That my icepacks were in a walk in freezer. He paged for someone in housekeeping to go get them and bring them to the lobby. 10 minutes passed. He got a call back saying they didn't have any icepacks in the freezer. He insisted they look again. Another 10 min pass and once again they told him there was nothing. This is where panic started to hit me. I kept thinking "How am I going to keep this milk cold?! It's like 90 degrees out and this milk will spoil asap. What am I going to do? I an NOT dumping this milk!" The man at the front desk told me that some employees didn't know where the walk in freezer was but that he knew and that he would personally go look but that he couldn't go because he could not leave the lobby unattended and everyone else was in a meeting. He called up housekeeping again and spoke to another lady who said they found some packs and would bring them to the front. 5 minutes passed and she came into the lobby with a box of who knows what. I don't even know what they were but they didn't look like icepacks. I had to tell them that was not my bag of icepacks. Another maybe 10 minutes passed and he found another employee who knew where the walk in freezer was and he went in the back and emerged 10 min later with my bag of icepacks. THANK GOD. All in all, I waited about 40 min in the lobby for my icepacks. It was a huge inconvenience because my whole group was waiting outside for me as we were leaving to go to the Safari Park. And of course our car and my sisters car was packed with impatient crying kids. 


This whole finding the icepacks thing took so long that it was time for me to pump by the time I got in the car to head to the Safari Park. I didn't want my group to wait for me in a hot parking lot while I pumped, nor did I want the first thing for them to do once we entered the park was to wait for me to pump before they could see any of the attractions. So I decided to pump in the car on the way over there.(I was NOT driving) I realize it probably wasn't the safest thing to do. In the event we were in an accident I probably could have gotten seriously injured. However lucky for us, the hotel wasn't that far from the Safari Park and we weren't even driving for that long. I was able to pump discreetly while not making anyone wait for me. I finished pumping just as we pulled in, so it all worked out. (This was a first for me and probably a last too)

I had looked at the Safari Park's website ahead of time to see what kind of accommodations they had for nursing mothers. I read that they had a couple of first aid stations that had private rooms that some mothers use for pumping and nursing. In theory that sounded great. However once you get there you will know that this park is HUGE. And only having two locations dedicated to pumping/ nursing mothers isn't really convenient. (This is my second visit so I already knew before going that these rooms weren't going to work) But if you recall what I did in my travels last month, I used handicapped bathroom stalls to pump. This was going to be no different. Only it would be at a zoo. With no air conditioning. And it was about 90 degrees out. Plus Id be doing it with children some of the time.

PUMP BREAK #1

Because I was with a group, I decided I could push my pump breaks as far as every 4 hours instead of 3. However if I found the opportunity to pump at around 3 hours I would take it. My first stop for pumping went off without a hitch. My husband took the kids to play in a little playground while I took the stroller (which had all my pumping supplies) into the nearest bathroom. There was a handicapped stall but there was no outlet. That was quite alright as I always travel with my portable battery pack for my pump. The stall was HUGE. It was large enough for me to bring the stroller in the stall with me. I still had plenty of walking room too. This stall also had a changing table in it. Perfect to set up my pumping station. Also since this was around noon it wasn't too hot yet. So I appreciated a nice cool bathroom even if it didn't have any air conditioning. My pumping sessions usually take about 20-30 min. However I didn't want to have my group wait for me so long each time. And I also didn't want to occupy a stall for so long and keep other people waiting. Thankfully the bathroom was empty when I got there. No one was waiting for any stalls. About 10 minutes into my pumping I heard a mom come in with her kids. I overheard her talking to her children and said "we are going to wait for the big stall." Yikes. At that moment I felt the pressure to hurry up. I maybe lasted another 4-5 min before I heard her start to get impatient. I ended my session a little early and started to clean up. Clean up can take a bit. I need to disconnect everything. Put it away. And then put the milk in my storage cooler. By the time I was done she had already left. Oh well. 

PUMP BREAK #2

Another 4 hours later was my second pump session. This time I was in a totally different area of the Safari Park. And this time I also had my two daughters with me, ages 7 and 18 months. I already knew this session was going to be more challenging because I had some of my children with me. This bathroom did have a handicapped stall but it did not have a changing table. The stall was also MUCH smaller. I had to get creative. Luckily it had a little windowsill where I placed the pump. It was at the perfect level too so that I could stand to pump. Otherwise I would have been forced to put it on the floor and had to hunch over while pumping. Not fun. By this time it was around 4:00 in the afternoon and it was HOT. As I was standing there pumping, beads of sweat were dripping down my face and well, pretty much everything else too. My 18 month old was getting very impatient in the stroller. I had to try desperately to entertain her long enough for me to be able to get a decent pump session in. I gave her everything from my phone to toilet paper to play with. (She liked the toilet paper better lol) My other daughter was just bored and complained the whole time. Yippee. Thankfully no one else needed to use the handicapped stall. I was able to get a 20 min session in. 

By the time we left it was time for another pump session. We had already checked out of the hotel as we were only staying for a night, but someone else in our group was staying an extra day. So I used their room bathroom and had one last session before heading home on another 2 hour car ride back to Los Angeles. My icepacks were still cold. The milk was still good. And by the time we got back home and unloaded the car, it was time for another session. Everything worked out perfectly and I never missed a pumping session. Im so proud about that. 

Flying with breastmilk

I didn't think there were many new things I would encounter on my breastfeeding journey since Ive been doing it so long, but I was wrong. 

I had flown before just once while lactating, although I wasn't producing nearly as much milk as I am now. I suddenly found myself in a situation where I had to take a last minute flight out of town for a day. Naturally I would have to bring my pump and also pump while I was traveling. I wanted to share my tips and tricks that Ive learned along the way with you. But keep in mind, I do not travel a lot. I hardly fly. And Im in no way a pro at flying while pumping. There are plenty of other moms out there who have much more experience. So if you are one of those moms, feel free to comment below with any additional tips you have.

First thing I did was call my airline to get info from them. I happened to be flying Alaska Airlines. Of course they state the TSA's guidelines of the 311 rule that can be found here.

Breastmilk and formula however are considered an exempt liquid and you should be able to take larger quantities onboard.... within reason. Now its the "within reason" part that causes problems. I have heard my share of horror stories of moms having really hard times getting breastmilk though. I don't know the actual percentage of those who hit obstacles but there are plenty. The stories Ive heard include them telling moms they can't bring it at all and make them dump their milk. Ive heard that they go through a testing process that ruins the milk. Ive heard of moms being taken to private rooms and humiliated with exams and being forced to pump in front of a TSA agent. These stories are terrible. I think part of it has to do with the particular Agent(s) you are dealing with. The airport you are at may even have a part of it. There really are so many factors. Odds are that everything will be ok but I knew that these types of things happen unfortunately. So it made me nervous. I also contacted TSA directly and spoke with an agent. They can be contacted at the number below:

So again, I can only speak for my particular experience. The TSA agent I spoke to was the one who told me breastmilk is an exempt liquid that can have higher quantities that the 311 rule. There is no exact limit though as to how much you can bring. The "within reason" rule is really subject to your TSA agent. Thankfully I pumped before getting to the airpot from my departure. I was able to bring my breast pump on my carry on without a problem at all. You can also bring small coolers with get ice packs. Not a problem. I know some moms even bring larger coolers packed with dry ice to check in. I personally do not have experience with that but if anyone does I would love to hear how you do that (Ive also seem moms ship their milk back home, so that may be a good alternative option for some). 

Once I got through TSA though I needed to pump at the airport. Again it really depends on the airport. I flew out of LAX last minute and was pressed for time. I found online that they did have lactation rooms however I didnt see any while I was there. They weren't easy to spot or at least not near my gate. My alternative was finding a bathroom to pump in. Not ideal but I made it work. My first tip is to find a handicapped stall. I have found that the majority of them usually have an outlet in them. Thankfully I was able to use my luggage to keep my pump off the floor. There really was nowhere to put my bottles and cooler, so as much as Id like to keep if off the disgusting floor, I did for a moment have to put the full bottles down to avoid spilling them. You just have to be real careful not to contaminate the milk. 

I flew into Seattle to the Tacoma Airport and finding a handicapped stall with an outlet proved to be much harder. The first bathroom I saw was totally closed due to repairs or something. The second bathroom I found had 3 handicapped stalls and none had an outlet. And the third bathroom I found had its handicapped stall out of order and locked. I was pretty desperate at this point. I finally found a family bathroom. It was there that I found an outlet. It actually had 2 outlets. Some have benches and counters to put your supplies on as well. Mine didn't have a bench but it did have a little ledge under the mirror which was perfect to place my pump on and to put my bottles on. If I had not found one then I probably would have just asked for a lactation room or something similar for an employee to direct me to. But thankfully it worked out for me. 

 Now here is another thing to think about. I personally was not staying in a hotel. And even if I was, not all hotel rooms have a fridge or a freezer. I needed both to freeze my ice pack and to keep my milk cold. I was a little worried as to how I was going to do that. I actually went from the airport to a hospital to see a family member. I explained my needs to the hospital staff and they were more than accommodating. Willing to freeze my ice pack and keep my milk cold. They didn't have a problem with me asking for my cooler ever 3-4 hours to add my milk to the bottles. They were absolutely wonderful. I was also concerned that my supply would take a hit since I didn't bring any of my milk increasing supplements with me. (ok I actually did take 4 lactation cookies, but left the motherlove products and teas). To my surprise my milk actually increased. Probably because I was more on top of pumping and also because I didn't have my baby there to nurse in addition to pump. 

Getting back to the airport to fly back home I did have milk with me. About 12oz to be exact. I pumped about an hour before leaving for the airport. They say to get there two hours before your flight so that you can get through security. I followed the TSA's rules of letting them know I have breastmilk with me. Now here is where I find different info. Again, could be based on the airport you are at. On the website it says you have two options, either let them put the milk through the X-ray scanner or let them test it. Some moms have a problem with putting it through the X-ray scanner as there is some concern as to weather it damages the property of the milk. There is no solid evidence to support this as far as I know. So its really a personal choice. I honestly wasn't given a choice, they just took my milk for testing. Im not sure how they actually test it or what they are testing it for. I know that it took a couple extra minutes and they took it to a separate counter all in front of. They brought it back and said it was fine. I was so relieved. By the time I went through security it was time to pump again and I found a bathroom and pumped. By the time I got on the flight I had about 15-16 oz of breastmilk with me. They do not check any liquids after passing through the TSA so you don't have to worry about that. The actual airline will allow whatever you have. I had an agent from Alaska Airlines say that they honestly don't care what you bring on board. If you made it through TSA then thats all that matters.

I am going to be experiencing one more traveling while pumping concern in the next few weeks though. Im going to be taking a two day mini vacation out of town. The hotel we are staying at has a fridge in the room. Im not sure it comes with a freezer. I absolutely need one. So I will update the blog after my trip to let you know how it goes. I certainly hope the hotel accommodates me and is able to keep my ice packs frozen.