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Making It Work

Hand-Expression

From: NEW BEGINNINGS, Vol. 13 No. 2, March-April 1996, pp. 51-2

We provide articles from our publications from previous years for reference for our Leaders and members. Readers are cautioned to remember that research and medical information change over time.

"Making It Work" is a regular feature of the magazine NEW BEGINNINGS, published bimonthly by La Leche League International. In this column, suggestions are offered by readers of NEW BEGINNINGS to help mothers who wish to combine breastfeeding and working. Various points of view are presented. Not all of the information may be pertinent to your family's lifestyle. This information is general in nature, and not intended to be advice, medical or otherwise.

Situation

I am in a work situation that makes it especially inconvenient to use a pump. In addition, I prefer to avoid using "gadgets" of any kind whenever possible. I've heard that some mothers express their breast milk by hand. Can you tell me more about hand-expression?

Response

I never liked using a pump, so I decided to try to express milk by hand. I started simply by standing over the sink and experimenting with various hand positions until I figured out how to do it. I highly recommend hand expression: it's inexpensive, and you don't have to sterilize a pump, cart it around with you, or find an electrical outlet. All you need is a collection of milk storage bags, a place to wash your hands, and a private space.

I usually expressed milk directly into plastic storage bags, holding the bag with one hand and using the other to express milk. To help the milk begin flowing, I imagined my son nursing at my breast.

To maintain my milk supply, I expressed milk this way twice a day, once at work at the time that my son would have nursed if I had been at home, and again after he went to sleep. I was usually able to obtain four to six ounces of milk each time. I did this from the time my son was four months old until he turned one, and it was never necessary to supplement with formula. Although my son weaned himself last month, two months shy of his second birthday, I will always feel good about our nursing relationship and my ability to provide lots of my milk for my baby while I was at work.

Kathy Roach
Chicago IL USA

Response

I once got to see Chele Marmet demonstrate the Marmet Technique for hand-expressing breast milk. The nursing mother who volunteered didn't think she would be able to express much milk, because her baby had just "drained her dry." But the milk literally shot across the room. We were all quite impressed!

I think it's a good idea for every nursing mother to learn this technique. You'll always have your hands with you no matter where you go. It takes practice, but it's worth learning.

Mary DeCoste
Chapel Hill NC USA

Response

During discussions about breastfeeding and employment, most people are surprised when I mention that hand-expression turned out to be the most effective way for me to empty my breasts at work. I found it to be faster (no pump parts to wash), cheaper (no pump to buy), and more convenient (no pump to carry) than using a pump. I imagine they wonder "How could such a primitive method be better than a late-20th-century gadget?" Perhaps my story will help you decide if hand-expression is right for you.

With little success, I tried to express my milk with a hand-held battery pump a few weeks after my first baby, Alena, was born. I had read about the Marmet Technique of hand-expression in THE WOMANLY ART OF BREASTFEEDING. I followed the steps involved, but my efforts were equally unsuccessful. At an LLL meeting a few months later, I asked the Leaders for help. They suggested, among other things, that I talk to a woman in the Group who had had success with hand-expression. She showed me the rolling motion of the thumb and fingers (Marmet's Step 3) to compress the lactiferous sinuses right through her blouse! Since I wasn't scheduled to return to work until Alena was nine months old, I had some time to practice.

Armed with the live demonstration, Marmet's Technique made more sense to me and with some practice, I felt confident that hand-expression would work for me. I learned to express both breasts at the same time (right hand to right breast, left hand to left breast), and I expressed the milk directly into two containers the size of an eight-ounce coffee mug or plastic yogurt cup. The whole session, including the time to store the milk and clean up, took about 20 minutes. I expressed twice during my eight-hour work day, and I would collect a total of eight to twelve ounces. This I brought to the sitter's home for use the following day.

Here's how it worked. Using two screens, I set up a little cubicle in the corner of the ladies' room at work. I placed the two containers on a small, hip-height table, which was covered with a cloth that could be easily laundered (my aim was not always so good!). Undressing from the waist up was helpful because clothing inhibited my hand motions. I found that my milk would begin to let down by bending at the waist, gently brushing the tips of my nipples with my shirt, and breathing out as I completely relaxed the top half of my body. I first initiated very quick finger-thumb compressions, much like the initial rapid suckling of a baby. During the strongest part of the let down, I would stop the compressions and just gently push straight back into the chest wall (see Marmet's Step 2) while holding the breasts in the "C" hold. (I found that the compressions actually slowed my flow of milk during the initial let down.)

When the flow went from a spray to a trickle, I would begin the rhythmic method of position, push, roll, and compress (Marmet's step 4); milk would then intermittently spray out of the breasts during the finger-thumb compressions. Periodically, I would massage from the outer areas of the breasts toward the nipples and then again proceed with step 4. (I never used Marmet's Step 5 because it was uncomfortable for me and did not allow me to more effectively empty my breasts.) When the flow during the compressions slowed down to where only a few drops were released, I was finished.

I did try the hand-held pump several times again after I had become proficient at hand-expression. I found that I could pump only about half of what I could obtain manually. In fact, after the flow slowed down to drops with the pump, I could still obtain quite a lot of milk if I removed the pump and hand-expressed. Pumps do work well for many women, but hand-expression worked best for me.

Dawn Bernard
Troy MI USA

The Marmet Technique of Manual Expression*

This technique has been developed by Chele Marmet, a La Leche League Leader and lactation consultant who is the Director of the Lactation Institute in West Los Angeles, USA. As with any manual skill, practice is important.

  1. Position the thumb and first two fingers about 1 " to 1 1/2" behind the nipple. Use this measurement, which is not necessarily the outer edge of the areola, as a guide. The areola varies in size from one woman to another. Place the thumb pad above the nipple and the finger pads below to form a "C." Avoid cupping the breast.
  2. Push straight into the chest wall. Avoid spreading the fingers apart. For large breasts, first lift and then push into the chest wall.
  3. Roll thumb and fingers forward as if making thumb and fingerprints at the same time. The rolling motion of the thumb and fingers compresses and empties the milk reservoirs without hurting sensitive breast tissue.
  4. Repeat rhythmically to drain the reservoirs. Position, push, roll; position, push, roll.
  5. Rotate the thumb and finger position to milk the other reservoirs. Use both hands on each breast.

*1978, 1979, 1981,1988 Chele Marmet. Used with permission.

Editor's Note: For more information about hand-expression, please refer to the chapter on "Common Concerns" in THE WOMANLY ART OF BREASTFEEDING [Available from the LLLI Online Store.]

Last updated Thursday, October 19, 2006 by njb.
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