Hand Expression

Hi There!

I am hand expressing after I pump to be sure to empty my breasts (I am an EP'er and loathe every minute of it but its what I have to do).

Anyway, I know to pump until I don't see "streams" or "sprays" of milk but is this true with hand expression as well? I feel like I could hand express forever and still have streams of milk. Will it ever just go to droplets indicating that I have emptied the breast pretty well or do those streams mean I still have milk to get out.

Thanks!

Heather

Hi Heather! I hope a fellow ep-er will chime in, but my here is my basic understanding about milk expression in general.

There are two reasons to express milk if baby cannot nurse or cannot nurse well. To establish and maintain production and to express enough milk to feed baby (if possible.)

The former is usually accomplished quite well if milk is removed from the breasts frequently and effectively-the way a healthy normal infant would feed. This does not necessarily mean the breasts must be "emptied." Lactating breasts are never truly empty, and an infant does not typically 'empty' the breast during a feeding. People talk about 'emptying' the breasts all the time without really understanding what that would mean. A living lactating mother is ALWAYS making milk. If mom is alive, she cannot be "emptied."

Of course a mom can reach a point where she stops having letdowns during a session, or the flow of milk is very slow. The breasts may appear empty to mom. But in other cases, a mother will still see milk coming for a very long time-an hour or more! These very long expressing sessions can become counter productive, as of course that is exhausting. And according to the book Making More Milk, it is maintaining a good frequency of milk expression as opposed to duration each time, that is most beneficial to milk production.

I also think that when you (gently) squeeze down the breast during hand expression, it's a bit like squeezing toothpaste out of the tube. Maybe the motion itself may cause the milk to look like it is "spraying?"

As for the latter, how is that going? Are you able to express enough for baby?

Also, about how frequently do you pump/hand express each day?

I am able to express about 600ml/day. I am pumping as much as I can as I am alone during the day with him. I get in at least 8 pumps a day sometimes 9 but 8 is the norm. On the weekends I can get in more as my husband is here to help me. I am getting up in the middle of the night to pump when he gets up to eat.

When you mention the motion of squeezing, that is what I am wondering about.

We are working on getting him back to the breast fulltime but it's a slow process- this morning he was at the breast for 4 full minutes before getting upset. We are working with tongue tie issues and with a speech language pathologist.

600 ml- So that is about 20 ounces, right? How old is baby and how much does baby eat daily?

So 8 times a day as a typical day is good frequency for pumping, which is much more exhausting to mom than only nursing. An infant might well nurse more often than that, but when also pumping and feeding it can all get ridiculously draining for mom. SO it is important to maintain some balance.

Basically I am suggesting that if you are still seeing milk express from the breast and need that additional milk in order to meet (or get closer to) baby's daily needs, there is no harm in continuing to keep expressing, as long as it is not so long that it becomes exhausting or counterproductive. If you are making as much as baby needs, no need to express more. Does that make sense?

It is often very helpful to hand express after pumping, but if you are still seeing lots of milk, that makes me wonder if the pump is doing the job it should be doing.

That is interesting you are working with a speech pathologist. Does he or she have experience helping mothers bring baby to the breast? If not, are you also consulting with a lactation specialist? (IBCLC?)

So baby was treated for the tongue tie-had a frenotomy?

Quote:

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this morning he was at the breast for 4 full minutes before getting upset

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This is great! Yes it can be a very slow process but every additional second baby latches and nurses is progress. Why do you think baby gets upset? Slow flow? I assume you have tried some instant reward to keep baby nursing longer? dribbling expressed milk, Breast compressions?

Hi there, I am not an EP-er, but I do follow up my workday pump sessions with hand expression, and this is what I have observed. To echo Meg's thoughts, I feel like my breasts are never really "empty" -- I could hand express for a looong time and still get SOMETHING out. Although I've never tried to keep going till there is NOTHING because frankly I think my hands would cramp up before that point. I think the hand expression stimulates further letdown so it might just be cyclical. So I just hand express until (1) I used both hands on each side and rotated fully around the face of the clock, so to speak, to ensure I've hit all the milk ducts, (2) the volume and speed of the milk ejection has decreased, and (3) my breasts feel pretty soft. At that point I surrender to the law of diminishing returns ;)

Thanks for the help!

I am going to continue to hand express after I pump.

Meg- The baby did have a frenotomy and I am doing breast compressions, etc. I am not sure why he gets upset still trying to figure that one out :(