A Complete Guide to Hand Expressing Milk & Colostrum Harvesting

Last Updated: June 11, 2024
Liesel Teen, RN-BSN

By Liesel Teen

BSN, RN, Practicing Labor and Delivery Nurse

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Hand expressing milk as a nursing mother is such an important technique to learn and utilize! But if that’s true, why do so many mamas NOT hand express?

Honestly, I think it’s because of lack of education and understanding of just how valuable this tool is in your breastfeeding toolbox.

I mean, think about it. Mamas have been nursing babies for WAY longer than the double electric breast pump has been around. And you better believe they were leaning into hand expression as an effective way to remove milk from the breast.

So why bother with hand expressing milk? Hand expressing breast milk can be used to:

  • Increase supply
  • Reduce engorgement
  • Remove clogged ducts
  • Get milk flowing to entice baby
  • Collect extra hindmilk at the end of a nursing or pumping session
  • Take the place of a full nursing/pumping session, if done properly
  • And even work MORE effectively than a breast pump for some mamas

Ready to dive into the ins and outs of hand expressing milk? Once you learn more about it you’ll see how beneficial it really is!

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What is hand expressing?

Alright, I’ve already hinted at just how handy (hah!) hand expression can be, but let’s back up a bit. What exactly is hand expressing breast milk?

Well, hand expressing is the act of using your own hand to remove milk from the breast.

It’s SUCH a valuable tool for all nursing mamas to learn, so let’s learn more about it and the RIGHT way to do it.

Facts about hand expression

  • It takes about the same amount of time as pumping once you know what you’re doing
  • You can do it anywhere, anytime, as long as you have clean hands and something to catch the milk. You can even use a towel to express into if you’re really in a pinch to remove milk and just want to avoid a clogged duct/mastitis
  • Researchers found that hand expressed milk has a higher fat content than milk pumped with an electric pumpsay what?! And you can still reap these benefits by just hand expressing at the end of your pumping session
  • Hand expressing before nursing can help get the milk flowing for impatient babies. It may also entice a sleepy newborn into latching on
  • If baby is still learning to latch or unable to latch immediately after birth, hand expressing colostrum is a wonderful option. The in-hospital lactation consultant can support you with this
  • Premie moms often struggle with building up a milk supply because their babies cannot nurse. A Stanford/Packard research team found that these moms may have greater success with building their milk supply when they use a combination of electric pumping and hand expression
  • If you have a clogged milk duct or mastitis, hand expression can be key to removing a clog

Hand expression tutorial

Before you begin hand expressing, you’ll need to make sure you have clean hands and a clean container to catch your milk.

What container to use to collect milk during hand expression?

  • A milk bottle or pumping bottle works well for this if your milk is already in. But really – any clean container will do!
  • If you’re just starting out, a bowl can give you a wider area to catch the milk
  • Use a medicine cup or tablespoon if you are hand expressing colostrum. You can then feed colostrum to baby via a syringe or small spoon
  • If you are hand expressing to reduce engorgement, you may choose to hand express into a towel just to take the edge off until baby’s next feeding

Once you’ve got your collection method ready and clean hands, you’re good to go.

Steps for effective hand expression

  1. Try to get as relaxed as possible and visualize your milk flowing. You may want to look at pictures of your baby, think about your baby, or even have your sleeping baby nearby to help you letdown
  2. Massage your breast gently to stimulate milk flow before beginning hand expression
  3. Take your hand and make it into the shape of a C
  4. Put your C-shaped hand onto your breast, just outside of your areola. Position your hand with your thumb on top and other fingers below
  5. With light pressure, move your hand back towards your chest to stimulate your milk ducts
  6. Then, when you’re hand reaches your chest, compress and start pushing your C-shaped hand back towards your nipple. With this motion, you should see milk spray out!
  7. Release the compression without removing your hand from your breast, and repeat from step 4. Each time, rotate your hand position slightly so that you are stimulating different milk ducts. (Think about positioning your hand as a C, backward C, U, up-side-down U – you get the idea!)
  8. During a hand expression session, Breastfeeding USA recommends switching between your two breasts after every 5 or 6 compressions. The goal is to empty both breasts simultaneously.
  9. Typically, you can empty both breasts in a 20-30 minute session (perhaps a bit longer as you’re learning, and shorter as you become more efficient)

I think what’s most important is to realize that you don’t simply squeeze the nipple! This is a surprisingly common misconception! It’s all about stimulating and compressing the milk ducts just outside of the areola.

Which makes sense if you stop and think about it, right? If baby has a good latch, they’re not just taking the nipple into their mouth, but the whole (or at least most) of the areola!

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Hand expressing breast milk tips

Okay, now that you know hand expressing basics, here are some more tips! These will help increase your output, improve your efficiency, or troubleshoot a certain issue like a clogged duct or fussy baby.

  • Try leaning forward a bit while hand expressing, gravity can help with your collection accuracy and get all of the milk into your container! Some mamas say the gravity can help them with a letdown, and others swear by it when hand expressing to relieve a clogged duct
  • Apply warm heat and massage your breast before you begin a hand expressing session to help with output and stimulate your milk flow. I LOVE using the LaVie for this, but you can also use a warm towel and a baby brush or comb on your breast to stimulate milk ducts
  • Take the tutorial above as a general guideline and play around with positioning and pressure to find your “sweet spot”. Ideally, you want to see milk spray out of the nipple after a compression (vs. just dripping)
  • If you’re using hand expressing to relieve a clogged duct, try doing it in the shower, underwater in the bath, or even while hovering over a bowl of warm water
  • Hand expression shouldn’t hurt! It should feel comfortable, and even relieving if you are engorged
  • If hand expressing to relieve engorgement, just express enough to take the pressure/pain away, but don’t fully empty the breast. This can signal to your body to make more milk, and create a cycle of oversupply
  • Hand expression can be used to increase supply by expressing for 5-10 minutes after a feed or pumping session. Make sure to collect this super nutrient-dense, fat-filled milk for baby!
  • If baby is too worked up to latch due to colic or because of missed early hunger-cues, try hand expressing a bit of milk and putting it on their lips, or feeding it to them via syringe or spoon. This may help calm baby enough to get a good latch
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Hand expressing breast milk vs pumping

You can use hand expression in lieu of pumping, or in conjunction with your pump. But yes, it’s true! Hand expressing milk can be just as effective as an electric pump – and for some mamas is even more effective.

If you are a mom that just doesn’t get much out of the pump (but you have no other indications of low supply when you’re feeding your baby at the breast) hand expressing might work for you!

This is because hand expression more closely mimics the way baby removes milk from the breast than a pump does. Hand expression gives your breast the push and pull input to stimulate milk flow (like a baby’s suction and tongue pressure) whereas a pump simply pulls and utilizes negative pressure.

Use the two techniques together

But you also don’t have to use these two techniques independent of each other! You can add hand expression into your pumping routine.

Most often, mamas will hand express right after pumping for 5-10 minutes to build up their supply and yield more of the fatty hindmilk.

Some also start with hand expression to get their milk flowing and even stimulate a letdown manually.

Colostrum harvesting during pregnancy

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Something that’s getting a lot of buzz in the pregnancy world is the idea of antenatal hand expression! For those that don’t know, this is the act of hand expressing colostrum before you’re due – often referred to as colostrum harvesting.

So, colostrum is baby’s first food that your body produces. It’s different than breastmilk and is referred to as the perfect first sustenance for baby.

Colostrum contains the perfect balance of fat, proteins, and nutrients for human babies, it contains very high levels of antibodies to help develop baby’s immune system, and it even works as a laxative to help baby pass their meconium poops.

Colostrum is the liquid that your body produces before your mature breast milk comes in sometime between days 2 and 5 after birth.

Why harvest colostrum during pregnancy?

Now, back to the idea of hand expressing colostrum BEFORE baby arrives. This is a trend that’s growing in popularity here in the US, and has been quite popular over in the UK.

By having a small store of colostrum in your freezer before baby arrives, you may be able to avoid the early introduction of formula and increase breastfeeding success rates if baby needs more in the early days than your body is producing. Below we discuss more benefits.

Here are some specific situations where a store of colostrum could be used in the early days and even weeks after birth:

  • A large baby who needs more sustenance to stabilize their blood sugar
  • Babies who are born with tongue ties or have difficulty latching can be fed colostrum via syringe
  • Babies with colic that cannot calm down enough to latch to the breast – in some cases, feeding a little colostrum with a syringe can help them calm down enough to eat at the breast
  • Can provide additional sustenance for babies when mamas milk takes a bit longer to come in
  • Amazing for babies who need to go to the NICU
  • Can promote exclusive breastfeeding and avoid early formula use if mama and baby need to be separated for any reason
  • All around helpful to have on hand to boost baby’s immune system and get them more of this liquid gold

How to do antenatal hand expression?

Mamas are encouraged to hand express and collect colostrum in their final weeks of pregnancy. Most sources recommend starting the practice of colostrum harvesting around week 37 of pregnancy.

You can use the same method of hand expression described earlier in the article, but here are some additional tips:

  • Use a very small bowl or even a tablespoon to catch the liquid
  • Use a 1-2 mL oral syringe to move the colostrum from the container into a breastmilk storage bag to be frozen, or you can freeze the colostrum right in the syringe
  • Colostrum will keep in the back of the fridge for 2-4 days. You can add colostrum from a few days worth of hand expression sessions and freeze larger amounts together
  • You can aim to do antenatal hand expression 2-3 times per day
  • Because there is a slight risk of hand expression causing the spontaneous start of labor, it’s not recommended for women that are at risk for preterm labor. This is also why you should wait until 37 weeks to practice antenatal hand expression
  • Some mothers won’t produce much colostrum prior to their baby’s birth, but others are able to collect quite a bit! Neither reflects your liklihood to succeed at breastfeeding – so don’t stress if you aren’t able to harvest colostrum during pregnancy!

Bring colostrum with you to the hospital

If you do decide to try antenatal hand expression, don’t forget to bring it with you to the hospital! I also recommend making a note of it on your birth plan so that hospital staff is aware that it is available for baby.

Many labor/recovery rooms have mini fridges with freezers, but check on this ahead of time! If yours doesn’t, the hospital will likely be able to store your colostrum for you, but again, check on this!

You should also bring up your wishes to do antenatal hand expression with your provider during your third trimester prenatal appointments to discuss the pros and cons for your unique situation.

Where to turn for help with hand expression

To get really good at hand expressing, you just have to practice and see what works for you! A good lactation consultant can really help with this.

If you’re reading this BEFORE you have your baby, be sure to go over hand expression with your lactation consultant during your hospital stay. I seriously can’t recommend this enough!

But if you’re reading this in real-time, I highly recommend going to a lactation support group or meeting with an LC one-on-one. Live input on how to make your hand expressing as effective as possible makes a BIG difference.

The bottom line on hand expression

As you can see, it’s SO worth it to learn how to hand express breast milk effectively. Not only is it important for so-called emergency situations where you’ve gotta remove milk SOMEHOW, but it also has a ton of benefits in its own right!

And hey, you might even be one of those mamas that can hand express more effectively than an electric pump! It’s true. Some mamas just don’t respond to an electric pump but do really well with hand expressing or manual hand pumps (like the Haakaa) instead.

Additional sources:

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Liesel Teen, RN-BSN

Liesel Teen

BSN, RN, Practicing Labor and Delivery Nurse

As a labor and delivery nurse, I’ve spent countless hours with women who felt anxious — even fearful — about giving birth. I want you to know it doesn’t have to be that way for you!

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