Hand expression is the most effective tool for emptying colostrum from the breast when baby is sleepy or not efficient at the breast in the first 3-5 days after delivery. When baby isn’t latching immediately after birth, many hospital lactation consultants will have the mom start pumping. This is a great way to stimulate the breast, but many get discouraged from not seeing much colostrum come out with those first few pumps.
Colostrum is a thick, nutrient dense first milk. It starts in a small amount and moves slow to help baby learn how to practice sucking, swallowing and breathing without getting overwhelmed by a faster flow. Colostrum has been in the breast since 10-14 weeks gestation so it is ready for whenever baby is born, even if baby is born premature.
You can actually start practicing hand expression while you’re still pregnant. It is a phenomenal skill to practice in case you need to hand express after baby is born. It will also give you the confidence that you have milk and do not need to wait for “milk to come in” To start, you’ll want to gently prime the breast. Using your fingers like combs or in gentle strokes, massage the breast from back to front. The colostrum is made at the back. These gentle strokes and massages encourages the milk to move from the back of the breast, down the breast ductal system to the nipple at the front. You can also gently shake the breast to help stimulate the movement of milk. After a less than a minute of massage you’re ready to express your milk. There are multiple ways to hand express, and I will show you several different ways. You’ll want to practice different techniques until you find what works for you and your body. Some people can hand express with either hand, and some will find they need to use their dominant hand. There is no one right or wrong way, it is what works for you and your body. To start, take your hand in a C or U position. The breast is a circle, so either position is fine, and you’ll want to experiment with both until you find the sweet spot on your own breast that works for you to start seeing your colostrum come. You want your finger and thumb opposite of each other on the areola not too close to the nipple. You’ll bring your hand back into the breast and compress your fingers together, trying to make them meet behind the areola and nipple area. Compress and release. You may have to do this gentle compresss and release for a minute or two before you start to see the glistening drops of colostrum from the nipple. If you don’t see anything after a few compresses, go back to gentle massage. You can switch breasts often. Be mindful to bring your fingers together from equal points cross from each other on the circle of the areola. If you are asymmetrical, you won’t see any movement.
Usually the first time you try, you may see only a drop or two from each side. You cannot run out of colostrum or have colostrum change to mature milk until your placenta is birthed. As long as you are a low risk pregnancy and not on bed or pelvic rest, it is considered safe to hand express. This should not hurt. If you feel any pain or discomfort, stop and find a local IBCLC lactation consultant to help you practice. If you have questions about antenatal hand expression, make sure to ask your IBCLC lactation consultant during your prenatal breastfeeding consultation.
Breast pumps only use suction, so if you use some compressions on the breast with your hands to start moving the milk to fill the ducts, it might flow easier when pumping. Using the pump to stimulate your hormones and then ending with lots of hand expression will actually help you see milk move. Don’t get discouraged if you don’t see any colostrum the first few times you pump after birth. Pumps are not as efficient as your hands or your baby once they’re awake and alert.