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How to… teach a mother the technique of hand expressing

Assisting a mother to hand express effectively can help her overcome many challenges that may occur during her breastfeeding experience, says Janet Beech, infant-feeding co-ordinator at Countess of Chester NHS Foundation Trust.

Midwives magazine: Issue 5 :: 2011

Hand expressing is an under-utilised skill. Since the launch of the UK Baby Friendly Initiative (BFI) in 1994, all breastfeeding women should be taught how to hand express their breastmilk (UNICEF, 2011).

Hand expressing antenatally
The reasons for hand expressing colostrum from 36 weeks’ gestation if not medically contraindicated are:
✲ It increases the mother’s awareness of how her breasts function
✲ It increases her confidence in handling her breasts and breastfeeding (Oscroft, 2001)
✲ Colostrum harvesting enables quantities of colostrum to be used to prevent episodes of hypoglycaemia in babies born to mothers who have diabetes maintaining exclusivity in breastfeeding (Clay, 2005)
✲ For babies diagnosed antenatally with cleft lip and/or palate or for other conditions such as breast hypoplasia, breast surgery that may indicate the possibility of early feeding problems and the increase in supplementation (Cox, 2006).

Hand expressing postnatally
The reasons for expressing during the postnatal period are:
✲ To stimulate milk supply if the baby is sleepy, or not able to suckle well at the breast
✲ For prematurity, or a baby in a neonatal unit separated from its mother for another reason. Mothers in this situation should be encouraged to express eight times, including at least once during the night, in 24 hours (UNICEF, 2011)
✲ To relieve fullness if uncomfortable or for engorgement, blocked ducts
or mastitis
✲ Prior to using a breast pump
✲ If the mother is returning to
work or is away from her baby
(UNICEF, 2011).

Teaching hand expressing
✲ Explain the technique accurately, using simple language in a logical sequence using a hands-off approach (UNICEF, 2011)
✲ Wash hands before starting
✲ Use a clean sterilised container to collect expressed breastmilk
✲ Stimulate the oxytocin reflex and prolactin release by encouraging the mother to be comfortable and relaxed, to do skin-to-skin with her baby, to gently massage the breasts using kneading, circular or stroking movements, use warm flannels, or shower, use of a soft baby brush
✲ If separated from the baby, have a photo or a piece of clothing the
baby has worn (Breast Feeding Network, 2004)
✲ Cup the breast using the thumb and index finger in a C shape in line with the nipple and feel a few centimetres away from the nipple or move down the breast until a change in the texture of the breast tissue is felt
✲ Maintain the C shape and push back into the chest wall then compress finger and thumb. Relax and repeat, developing a rhythm
and stimulating a normal pattern
of the baby feeding at the breast. Avoid sliding your fingers over the skin, tightening or dragging it, or pinching the nipple
✲ At first, only a few drops may appear but with practice milk will flow freely
✲ Once the flow has subsided, rotate finger and thumb around this area
of the breast and repeat
✲ Move to the other breast when rotation fails to bring renewed
flow, repeating the cycle again if required. If milk doesn’t flow, try more gentle massage then move finger and thumb nearer to or further away from the nipple
(NHS/UNICEF, 2011). 

The author would like to acknowledge the support of Gillian Hughes, senior lecturer in midwifery at the University of Chester.

Clay T. (2005) Colostrum harvesting and type 1 diabetes. Journal of Diabetes Nursing 9(3): 111-6.

Cox S. (2006) Expressing and storing colostrum antenatally for use in the new-born period. Breastfeeding Review 14(3): 11-6.

Department of Health. (2011) Off to the best start: important information about feeding your baby.  See: http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_125826 (accessed 16 June 2011).

Oscroft R. (2001) Antenatal expression of colostrum. The Practising Midwife. 4(4): 32-5.

The Breastfeeding Network. (2004) Expressing and storing of breastmilk. See: www.breastfeedingnetwork.org.uk (accessed 16 June 2011).

UNICEF. (2011) UK Baby Friendly Initiative. See: www.unicef.org.uk/babyfriendly (accessed 16 June 2011).