Hand Expression

Hand expression is just another tool like a pump. You are using your hand as if it were the pump, because the pump is unable to drain the breast efficiently, you are going to use your hand to try to drain the areas that the pump was not able to. You may have just pumped or nursed baby so it may take a little time to get the milk flowing again. The trick is to be patient and work with your body and let your body do most of the work. The goal is to stimulate your breasts enough to induce a let down which will eject the milk out naturally (you may even see some milk dripping from the other breast and you are simply using your hands to guide the milk out. 

1. Prep the breast by shifting the breast lightly. Next, find the outer boundary of your breast. Grab it with both hands and try to get under the glandular tissue and slowly and very gently walk your hands up toward the nipple as you knead the breast with your hands for about 5-10seconds. The purpose of this movement is to push the milk from the deeper layers to the surface.
2. Place fingers at the outer boundary of the aerola(this placement will vary individually, but usually best placement is about 2cm-4cm away from nipple area). The finger placement may be thumb on one end and middle and ring finger on the other end.
3. Push fingers into the chest wall.
4. Grab some of the tissue under the areola and bring the thumb and forefingers together at the base of the nipple as you gently pull up as the fingers come together at the base of the nipple. Visualize the baby’s nursing motion (the rolling motion) as you are pulling up.
5. At this point you may not see much milk flowing out, remember that you have just finished nursing or pumping. Most of the milk has been drained. The goal now is to induce let downs by stimulating the nipple with the movement described above.  This may take several minutes (possibly between 1-5min, it will also vary individually depending on how the body responds)
6. Once you begin to see more milk dripping out, you may also notice the other breast dripping milk, that is most likely your let down. At this point, you may push down a littler further into the chest wall with your fingers, bring them together as you did in step 4, and pull a little further out as to guide the milk out of your breast.
7. After the first let down ends (30sec or longer), feel the breast to see how they feel. Do they feel deflated, soft, jiggly, light? If you feel it feels good enough, then stop. If you are still feeling heaviness or firm areas begin repeat the whole process again. 
8. The goal is to try to get 1-3 additional let downs, if you are not seeing anything stop within 10 minutes and try again next time.
9. Try different finger placement around the areola as you express the milk to try to reach different ducts around the breast.
10. It may be helpful to trial the hand expression when the breasts are full to understand finger placement and the amount of force to apply as milk may flow more readily, while your breast are still full.
11. Be patient and it may take a while before you are comfortable, but stay encouraged and keep practicing.