Hand Expressing Breast Milk: How to Do It and When It Helps
Hand expressing breast milk is one of those skills that tends to get overlooked — overshadowed by breast pumps and gadgets — but it is genuinely one of the most useful things a breastfeeding mother can know how to do. It is free, it requires no equipment, and it works in situations where a pump simply cannot.
This post covers when hand expressing is helpful, how to do it step by step, and when it is worth starting before your baby is even born.
How Does Hand Expressing Work?
Breast milk is not released until it is needed. When your baby begins to feed, they stimulate nerves in the nipple and areola — the darker skin around the nipple — which send a signal to the brain to release milk. This is called the milk ejection reflex, or let-down.
When you hand express, you are mimicking what your baby does at the breast. You use your fingers to first trigger the let-down, and then compress the milk ducts behind the nipple to remove milk from the breast.
What to do before you start hand expressing
Before hand expressing, wash your hands thoroughly. If you are collecting milk to give to your baby, make sure any container or syringe is clean.
A few things can help milk flow more easily before you start:
Warmth — practicing in a warm bath or shower, or applying a warm cloth to the breast, can help the milk to let down.
Skin to skin or closeness with your baby — holding your baby skin to skin, or looking at a photo of them, raises oxytocin levels and can help trigger the let-down.
Gentle breast massage — using warm hands, gently stroke, knead, and tap the breast before you begin. This helps to prepare the breast for expressing.
How to Hand Express: Step by Step
Step 1: Place your thumb on top of your breast and your fingers underneath, positioned behind the nipple — roughly two to three centimetres back from the base of the nipple. Think of it like holding a tube of toothpaste just behind the nozzle. You are not squeezing the nipple itself.
Step 2: Gently push your hand back towards the chest wall, then bring your thumb and fingers together in a smooth compression. The movement is back and then together — not a sliding or pulling movement along the breast, which can cause soreness.
Step 3: Release the pressure completely, reposition if needed, and repeat in a rhythmic pattern. When the milk ejection reflex is triggered you may see fine sprays or drops of milk — this is the let-down.
Step 4: When the flow slows from one area of the breast, move your fingers to a different position around the breast to drain other ducts. You can also switch to the other breast and return — alternating between breasts can help keep the milk flowing.
In the early days, colostrum is produced in very small amounts and is thick and sticky. Drops can be collected in a clean spoon and transferred into a syringe, or expressed directly into a small sterile syringe. Every drop counts — even a tiny amount of colostrum is valuable for a newborn.
If you find it difficult to trigger a let-down when you first try, practice after a breastfeed while milk is already flowing. Once you have felt what works for your body, it becomes much easier.
Video Guides to Hand Expressing Breast Milk
Watching hand expressing being done is genuinely helpful. Here are three excellent free videos:
Global Health Media: How to Express Your First Milk — seven minutes, covers expressing colostrum into a spoon or syringe after birth, finger positions, and tips to get milk flowing: https://globalhealthmedia.org/videos/expressing-and-storing-breastmilk/
Unicef UK Baby Friendly Initiative: Hand Expression — two and a half minutes, demonstrates the technique clearly: https://www.unicef.org.uk/babyfriendly/baby-friendly-resources/breastfeeding-resources/hand-expression-video/
Stanford University: Using Your Hands When You Pump — includes an excellent demonstration of hand expressing technique from 7:14, and covers hands-on pumping: http://med.stanford.edu/newborns/professional-education/breastfeeding/maximizing-milk-production.html
When Is Hand Expressing Breast Milk Useful?
When Supplementing Is Needed
Sometimes a baby needs supplementation — whether in the early days or at any point during the breastfeeding journey. This might be because of significant weight loss, low blood sugar, low milk supply, illness, or a range of other reasons. When supplementation is needed, the WHO is clear that the order of preference is:
The mother's own expressed breast milk — always the first choice
Donor breast milk — where available through a milk bank
Infant formula — when breast milk is not available or not sufficient
This is one of the reasons hand expressing is such a valuable skill at any stage of breastfeeding — not just in the newborn period. If supplementation is ever recommended, being able to express your own milk means it can be offered first.
For Engorgement
If your breasts become severely engorged in the early days — very full, hard, and uncomfortable — hand expressing is more useful than a pump at this stage. Using a pump on engorged breasts can pull more fluid into the area and make things worse. Gentle hand expression to soften the breast before a feed, or to relieve pressure, is more appropriate. See the post on blocked ducts for more on managing engorgement and related issues.
To Support Milk Supply
If supply is low, combining hand expressing and pumping after breastfeeds sends additional signals to the body to produce more milk. Research by Jane Morton at Stanford University found that combining hand techniques with electric pumping increased milk production in mothers of premature babies by up to 48%. Even a short session of hand expressing after a breastfeed can make a meaningful difference over time.
When You Do Not Have Access to a Pump
Hand expressing is always available to you — it requires no equipment, no electricity, and no preparation. For occasional situations where you need to relieve pressure or collect milk and a pump is not available, it is an invaluable skill to have.
For Storing Milk
Some mothers become very skilled at hand expressing and use it as their primary method of collecting milk for storage — for when they are at work, separated from their baby, or offering a bottle. See the section on storage below for guidance on how long expressed milk keeps.
Antenatal Expressing: How to Harvest Colostrum Before Birth
Antenatal expressing — collecting and storing colostrum in the weeks before birth — is recommended in certain situations and can be worth considering more broadly.
Who is Antenatal Harvesting Recommended For: Current guidance recommends antenatal colostrum harvesting from 36 weeks for mothers with:
Any form of diabetes (Type 1, Type 2, or gestational diabetes)
A planned caesarean section
Polycystic ovary syndrome (PCOS)
Breast hypoplasia or previous breast surgery
A multiple pregnancy
Any situation where early separation or supplementation is anticipated
In these situations, having a supply of colostrum ready means that if your baby needs supplementation in the early hours — for example due to low blood sugar — your own colostrum can be used rather than formula.
Is Antenatal Expressing Safe? : Antenatal expressing from 36 weeks is considered safe for most mothers. There is no evidence that it triggers premature labour in mothers who are not already at risk. However, if you experience any uterine tightening or contractions while expressing, stop immediately and contact your midwife.
Always speak to your midwife or GP before starting antenatal expressing. Your maternity unit may be able to provide you with sterile syringes for collecting and storing colostrum — it is worth asking.
How to store antenatally expressed colostrum: Collect into a small sterile syringe (1ml or 2ml). Label each syringe with your name, date, and time. Store in the freezer in a clean sealed bag. Bring your stored colostrum to hospital in a cool bag when you go in for the birth.
How Long Does Expressed Breast Milk Keep?
General guidance for storing expressed breast milk at home:
At room temperature: up to four hours
In the fridge (back of fridge, 4°C or below): up to five days
In a freezer compartment inside the fridge: up to two weeks
In a separate fridge freezer (−18°C or below): up to six months
Getting Support
Hand expressing is a skill that is much easier to learn with guidance than from reading alone. If you are struggling to get milk flowing, not sure if you are doing it correctly, or want to learn before your baby arrives, I am happy to help.
I offer antenatal breastfeeding consultations at my clinic in Listowel, Co. Kerry, home visits across North Kerry, and online consultations for families nationwide. You can also contact me at info@bobbidaly.ie with any questions.
