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Learning to do hand expression in the first three to four days after your baby is born is important.  

Hand expression of colostrum for a few minutes after feeding gives extra stimulation to your breasts.

Although this extra stimulation is not essential, it helps you learn how to express, and you can use a few drops of colostrum to encourage your baby to feed. This is helpful if your baby is not feeding really well in the early days. You can also massage some colostrum onto your nipples for comfort. 

If your baby is preterm, try to start hand expression as soon as possible after birth or at least within the first six hours. Usually hand expression works better than a breast pump in the first 24 hours. After this time, combining hand expression and an electric breast pump will help you make more milk. Pumping at least eight times in 24 hours is recommended if your baby is not going to the breast and feeding well.

Hand expression takes practice

Don't be surprised if you don’t see anything the first few times you do hand expression. It can take time to get the sticky colostrum flowing.

Watch this video to learn more about Hand Expression.Once breastfeeding is well established, some new mothers choose to give their baby expressed breast milk by cup, spoon or bottle – but bottles can make it harder for a baby to breastfeed well. When a breast feeding is replaced with a bottle feeding, the mother’s breasts often are uncomfortable and she has to express her milk for comfort. Many mothers find it easier to just breastfeed.

When a baby gets several bottles a day on a regular basis, your milk supply often decreases. To build up your milk supply you will need to breastfeed frequently for a few days.

You may choose to express breast milk:

• If your baby cannot breastfeed well enough or is unable to breastfeed (is ill, or preterm, or you are away from your baby).
• If you are going to be away from your baby for longer than a few hours.
• To relieve full breasts so your baby can latch on better.
• If you are going back to work.
• So your partner can feed the baby when your milk supply is well established (usually after four to six weeks). 

Express breast milk:

• by hand
• with a hand pump
• with an electric pump - often used to express milk for babies not able to feed well enough at the breast
• by hand combined with an electric pump - combining the use of an electric pump with hand expression makes the most milk 

When using a breast pump, make sure you clean the pump pieces and bottles carefully.

If your baby is preterm and in the hospital, you may be asked to disinfect your pump parts once a day. 

Did You Know? When babies breastfeed they use suction to keep the breast in their mouth but they actually compress the breast to get milk. Pumps just use suction. You can make pumping work better by using hand expression as well as pumping and compressing your breasts while you pump.

Expressing by hand

Some women choose to express breast milk by hand – this can be done almost anywhere so it’s a convenient way to get some comfort and relief if your breasts are too full and your baby is having trouble latching on, or if you’re collecting milk to feed your baby later. Here are some tips:

• Wash your hands and get comfortable.
• Have a clean cup, bowl or jar ready to catch the milk.
• Gently massage your breast in a circular motion, working from shoulder to nipple.
• To start the let down reflex, roll your nipple between your thumb and finger.
• Put your hand in a C shape on your breast. Put fingers on the bottom and your thumb on the top at the outer edge of the areola.
• Gently push your thumb and fingers back towards your chest, then squeeze them together while you move them towards the nipple, but do not pinch your nipple.
• Catch the milk in a clean cup, bowl or jar.
• Move your fingers around the areola in a circle to express from different parts of your breast. Press and release, repeat the movement on your breast, and switch between breasts every few minutes. 

Hand expression with a preterm baby

If you have a preterm baby, using hand expression and a breast pump will help you make more milk:

• If your baby cannot feed well at the breast, you will need to express colostrum and milk.
• If you’re separated from your baby, it’s important to start hand expressing as soon as possible after birth or at least within the first six hours.
• Hand expression usually works better than a breast pump during the first 24 hours or so.
• After that, combine hand expression and pumping at least eight times in 24 hours if your baby still isn’t breastfeeding well.

Bisphenol A

Bisphenol A (BPA) is a chemical used to make hard, clear plastic known as polycarbonate. In 2008, Canada became the first country in the world to ban the sale of baby bottles containing bisphenol A. Choose glass baby bottles or look for hard plastic bottles made without bisphenol A (“BPA free”). Caution: Bisphenol A can also be found in the lining of cans of liquid infant formula.

Resources & Links:
Breastfeeding
Successful Breastfeeding

VIDEO: Admission to Postpartum - Keeping Your Baby Skin-to-Skin
VIDEO: Baby's Feeding Cues and Behaviours
VIDEO: Breastfeeding Positions
VIDEO: Hand Expressing Milk
VIDEO: Latching Your Baby