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. 

Massaging out clogs

-The goal again is to mimic baby at the breast, the baby is efficient by pulling the clog out not pushing the clog out.

  1. Soak the breast in epsom salt 5-10. Epsom salt has magnesium sulfate in it which supports muscles to relax. This may support ductal relaxation which may allow the milk that is stuck to flow. Using the haaka during this soak may be helpful for some. If you do not have time to soak, apply warm compress soaked in epsom salt may also be supportive.
  2. Find the clog (it may be small tender lump or wedge)
  3. Follow the clog toward the nipple and find the area in front of the clog where it is soft.
  4. Gently manipulate the area in front of the clog, to break apart what may be clogged. You can try gently rubbing fingers back and forth to break apart the clog or apply the massager in the area.
  5. Get under the clog usually near the peripheral of the breast and try to push up toward the nipple.
  6. Hand express and express the milk, repeat the expression motion at least 2-3mins to keep pulling the clog out. You may even try dangling and expressing. The shower may be a great place to try. You can also try dangle pumping as well.
  7. Repeat the process for about 5 -10min. If the clog has not cleared, stop and try again later. 
  8. The trick to removing clogs is gentle but frequent. Avoid aggressively working on the clog for long duration as it may lead to increased inflammation. Gentle and frequent attempts are usually more efficient. 
  9. When nursing, try to use your thumb in that area when compressing and push your thumb toward the nipple as long as it does not disturb the baby.
  10. Apply cool compress to support managing inflammation.

Daily Massaging in Shower

  1. 1 Take this time to look for any clogs
  2. Warm water may help to relax and improve flow
  3. Gently massage like hand expressing(instructions above)
  4. Express the milk 
  5. Dangling may help if there is a clog present