Hand Expressing Breast Milk vs. Pumping - Essential Facts You Need To Know

By Andrea Tran RN, BSN, MA, IBCLC

Breastfeeding mothers have been hand expressing breast milk since the beginning of time.

With the proliferation of fancy electric breast pumps, some mamas may consider hand expressing a technique that is no longer needed. That couldn't be further than the truth.

In this article, we will take a look at hand expressing breast milk vs. pumping. This comparison will demonstrate how valuable it can be to use hand expression.

WHAT IS HAND EXPRESSING?

You are expressing milk any time you remove milk from your breast without breastfeeding your baby. When you use your hands to get the milk out, it is called hand expression.

The alternative way of breast milk expression is by using a breast pump. There are manual pumps, electric breast pumps, and battery-powered pumps.

HAND EXPRESSING VS ELECTRIC PUMP

It can be tempting to believe that a breast pump with the latest technology will be superior to hand expression. However, there are times when hand expression will be the better choice.

When expressing colostrum
Breast engorgement - hand expressing can provide targeted relief from engorged breasts.

The swelling of the tissue around the milk ducts that happens with engorgement can interfere with milk flow and result in a breast pump being ineffective to get much milk out.
A study of 60 moms who experienced engorgement concluded that hand expression was more effective at relieving engorgement than using a manual breast pump (Source).
Another study showed that mothers appreciated being taught hand expression techniques as a tool to manage engorgement (Source).

Hand expressing can help you breastfeed for longer. A research study comparing hand expressing breast milk vs. pumping in 68 mothers whose babies were feeding poorly showed that the moms who hand expressed were more likely to be still breastfeeding at two months (Source).
You can use it to target a clogged duct.
Some moms find that breast pumps are not effective in stimulating a let-down and this results in the pump not being effective in expressing milk. Hand expression can prove much more effective for these women.
Not every mama can afford and maintain a high-quality breast pump.

A poor-quality electric breast pump can be worse than no pump at all.
Bad pumps often result in low milk output and can make expressing a painful ordeal.
To keep a pump in good working order certain parts need to be replaced on a regular basis.

Knowing how to hand express can be useful in emergencies.

Electricity goes out
Pump quits working
You are stuck in traffic, and you don't know when you are going to get home.
You get stuck in a blizzard and have to spend the night at a hotel, and you don't have a pump. This actually happened to a lactation client of mine.

HAND EXPRESSING COLOSTRUM

Colostrum tends to be thick and sticky. When pumping this liquid gold, much of this precious early milk clings to the pump parts and bottles, and very little can be fed to the baby.

Hand expressing before your milk comes in allows you to collect more colostrum that can then be fed to your baby. Expressing onto a spoon or kindestCup is ideal. The colostrum can immediately be given to your baby.

If you want to save what you hand express, you can draw it up into a syringe for use later.

You can also express your colostrum directly into the baby's mouth.

IS HAND EXPRESSION BETTER THAN A PUMP?

There are several benefits when comparing hand expressing breast milk vs. pumping.

You always have the 'equipment' you need to hand express your milk.

Using an electric pump requires access to electricity.

Cleaning involves washing your hands with soap and water. You can use hand sanitizer if you don't have access to running water.

Soap and running water are needed to clean all the individual breast pump parts adequately.

The CDC recommends sanitizing pump parts once a day for extra germ protection. These are some situations when sanitizing is prudent:

Baby is younger than 3 months
Baby was born prematurely
Baby who has a weakened immune system

Daily sanitizing is not necessary when pump parts are cleaned thoroughly after each use for a baby older than 3 months who is healthy (Source).

Important: All breast pumps have parts that need to be replaced on a regular basis. If this is not done, it can compromise your milk production. Obviously, this is not an issue when you express milk with your hands. Your hands are always ready when you need them.

SIDE NOTE: HOW OFTEN TO REPLACE BREAST PUMP PARTS?

Many pump users are not aware that various pump parts are considered 'consumables' that need to be replaced regularly in order to maintain proper function. Below is a quick reference guide to when to replace which pump parts, assuming daily use (thanks to Exclusive Pumping):

Valve Membrane: every 2 weeks - 2 months
Duckbill valve: every 1-3 months
Backflow protectors: every 3-6 months
Flanges: every 6 months
Tubing: when it becomes damaged

how often to replace breast pump parts

DIRECT COMPRARISSON BETWEEN HAND EXPRESSION AND PUMPING

See video below. Obviously, this is just one person (me) but these findings (more milk in the same amount of with hand expression) are consistent with recent research on hand expression (i.e. Dr. Jane Morton's work at Stanford University).

WHEN TO START HAND EXPRESSING

You can start hand expressing during the last month of pregnancy. Women who want to avoid formula have collected colostrum while pregnant to have on hand in case their baby needs to be supplemented.

HOW TO COLLECT YOUR MILK WHEN HAND EXPRESSING

As previously mentioned, you can hand express onto a spoon when expressing colostrum. You will need something that can hold more volume once your milk comes in. kindestCup is an excellent device to collect both, colostrum or mature milk. It was designed with hand expression in mind, regardless of milk volume.

A bottle is not the best choice for hand expression. Milk typically sprays in different directions, which can make trying to hand express into a bottle an exercise in frustration. A bottle's narrow opening makes it hard to aim correctly consistently.

Expressing into a bowl is another option. However, some people find that leaning over a bowl is not comfortable.

HAND EXPRESSION WHILE PUMPING

Mothers of premature babies who used hand expression techniques before, during, or after using an electric pump were found to have more milk (Source) and milk that was higher in calories (Source).

Using hand expression during pumping is referred to as hands-on pumping.