Hand Expression of Milk

Over the course of my career I have been privileged to observe hundreds of mothers happily breastfeeding their infants AFTER having had early and/or significant challenges with breastfeeding. In other words, breastfeeding doesn’t always get off to an easy start. However, with expert clinical assistance, time, patience and determination, most breastfeeding issues can be resolved. In the interim, expression of mother’s milk may be necessary to ensure a baby’s receipt of breast milk. When a baby is unable to or has trouble with attachment (or latching), it’s highly recommended that the mother begin pumping with a hospital-grade electric pump as soon as possible after birth. Pumping technology has advanced to the point that mothers can maintain a milk supply for months and even years. However, manual (hand) expression is still considered to be the most effective means of expressing colostrum, mother’s very important first milk. Hand expression of milk may also be helpful later when managing breast engorgement (another discussion for another day). Using the thumb and index finger in a systematic method of breast compression, we are often able to collect significant amounts of this thick, rich colostral milk for our babies. Spoons, syringes, feeding tubes or even tiny cups may be used for feeding this liquid gold to our little ones. I have included this link for step-by-step instruction of hand expression of colostrum, which you may find extremely helpful:

Hand Expression Video - Stanford University

Whether or not hand expression becomes necessary in the early days of breastfeeding, I recommend that all breastfeeding mothers develop the propensity to perform this handy maneuver. You never know when your breasts will express their need for some relief! Happy expressing!

One-Breast vs Two-Breast Feedings

I am often asked whether one breast or two breasts should be offered per feeding. This is a tricky question, and every mother/infant couplet should be considered individually. However, in the first couple of weeks after birth, a mother’s breasts may be somewhat engorged (normal fullness) as they begin to regulate milk production. Offering both breasts per feeding allows each breast some relief of pressure, and therefore comfort for mother. Later, after the initial couple of weeks, one-breast feedings may serve to balance the intake of fore-milk and hind-milk (a discussion all in its own).

Getting Started: The First Few Days

In many cases, the first few days of breastfeeding a newborn are quite different from what most of us have read or learned about breastfeeding. For example, we are told that a full-term baby will want to nurse about every two to three hours in the first few weeks. This is true. However, the first few days may throw us for a loop! Day one:Baby is often sleepy and may not awaken easily for feedings. This can be related to his tummy being filled with amniotic fluid (especially if born by cesarean) or by the store of fluids and nutrients transferred to baby in the days and hours just before birth. Day two:Baby is more awake and alert. His store of nutrients may now be depleting, and now he wants to nurse every hour! These are called “cluster feedings” and are baby’s way of letting mom’s breasts know that he will soon be ready for larger volumes. These frequent feedings not only help mom’s uterus to stay nicely contracted, but also allow baby to practice suckling before the voluminous transitional milk comes in. Days three to five: Mom’s transitional milk is coming in. Her breasts may change (blood and milk engorgement) and baby must re-learn how to latch to these “new” breasts. He must refine the way he suckles in order to handle the increased flow of milk. It is usually at this point that feedings begin to occur more consistently at two- to three-hour intervals. After the first few days, things begin to settle into more of a routine. Still there will be many more changes to adapt to. Life with a new baby can be challenging, yet wonderful. Just remember to eat, drink and sleep when baby sleeps, and let everything else go to pot!