How can I pump more breastmilk?

Moms who need to express their milk exclusively or in addition to breastfeeding are often concerned about their milk production. Combining breast massage and hand expression with pumping can help moms remove more milk and drain the breast more fully. Put simply, hands-on pumping helps maximize the amount of milk removed now and maintain milk production in the future.

What is Hands-on Pumping?

Hands-on pumping is a milk expression technique in which moms use their hands to assist in milk removal. Breast massage and hand expression combined with pumping has been shown to maximize milk removal and subsequently, milk production. When using this technique, it is possible to effectively double the amount of milk expressed!

Why Hands-on?

• 85 percent of moms with babies between the ages of 1.5 and 4.5 months of age have used a breast pump  (Labiner-Wolfe 2008)
• The perception of not making enough milk is one of the top three reasons moms give for weaning (Li 2008)
• When a baby breastfeeds effectively, he uses a combination of vacuum and the action of the jaw and tongue to remove milk (Geddes 2007)
• The vacuum of a pump alone is less effective at removing milk that is thick and sticky like colostrum or fat-rich breastmilk (Steakly 2012)
• Hands-on pumping helps moms remove up to 48 percent more milk than expressing by pump alone (Morton 2009)
• Hands-on pumping increases the amount of fat-rich and calorie-dense milk moms are able to express (Morton 2012)

Hands-on Pumping How-To

1. Massage your breasts to help stimulate the milk ejection reflex. Use your fingers held flat against your breast and gently massage in a circular motion from the point where the breast meets the chest in a downward direction towards the nipple.
   

   Massage with hands while double pumping using a hands-free bustier
   Image copyright Beth Walldorf–All Rights Reserved

2. Double pump. Assure your breastshields fit well. Find a level of suction that is comfortable and effective for you. Consider using a “hands free” pumping bra, bustier, or sports bra with holes cut for the breastshields so that you can pump without having to hold them in place. This frees your hands so you can massage and compress your breasts while pumping.
3. When the sprays of milk slow to dribbles, stop pumping and repeat massage. Feel for areas of firmness. With gentle pressure, massage behind any area that still feels firm in a downwards direction towards the nipple.
   

   Use your hands to compress and massage while single pumping.
   Image copyright Beth Walldorf–All rights reserved

4. Single pump or hand express to complete your pumping session. Alternate breasts (right to left to right). Give each breast a short rest before expressing it again. Feel for areas of firmness and gently massage them out. Pay close attention to the outside of the breasts, as this will be the areas least likely to be well drained from pumping alone. Let the sprays of milk be your guide as to where your breast needs compression and massage. Experiment and develop your own technique. With practice, you will find what works best for you!

Hand express directly into the breastshield of your pump.
Image copyright Beth Walldorf–All rights reserved

Watch a video: Dr. Jane Morton explains her research, and mothers demonstrate the hands-on technique. Please click the link then click “proceed” in order to view the video.
Maximizing Milk Production With Hands on Pumping

Some additional ways to help maximize and maintain milk production:

• Spend as much time as possible holding your baby and/or  in skin to skin contact with your baby. Close contact with your baby encourages the “flow” of the breastfeeding hormones prolactin and oxytocin.
• Keep a flexible schedule for removing milk. Aim to breastfeed or express your milk at least 8 times in 24 hours.
• Music has been associated with increasing the amount of milk expressed in NICU settings. The music in the study cited in the link above is available as a free download.
• Consider warming your breastshields before pumping. One study found that using warm breastshields along with maximum comfortable vacuum decreased the time needed to remove 80 percent of the milk volume.
• If you have difficulty initiating letdown, Reverse Pressure Softening can help by stimulating the nerves that lie under the areola. These nerves control the release of the hormone oxytocin, which is responsible for milk release. Most moms can initiate letdown with RPS in 1-2 minutes. It is especially helpful when engorgement makes latching or pumping difficult.
• Choose a breastpump that is right for your pumping needs. Talk to an IBCLC to get personalized assistance finding a pump that works for you.

Hands-on pumping was developed by Dr. Jane Morton and studied at Lucile Packard Children’s Hospital and Stanford University School of Medicine.

References:

Geddes, D., Kent, J., Mitoulas, L., & Hartmann, P. (2007). Tongue movement and intra-oral vacuum in breastfeeding infants. Early Human Development, 84(7), 471-477.

Labiner-Wolfe, J., S. B. Fein, K. R. Shealy, and C. Wang. (2008) “Prevalence Of Breast Milk Expression And Associated Factors.” Pediatrics 122. Supplement: S63-S68. Print.

Li, R., S. B. Fein, J. Chen, and L. M. Grummer-Strawn. (2008) “Why Mothers Stop Breastfeeding: Mothers’ Self-reported Reasons For Stopping During The First Year.” Pediatrics 122.Supplement: S69-S76. Print.

Morton, J., Hall, J., Wong, R., Thairu, L., Benitz, W., & Rhine, W. (2009). Combining hand techniques with electric pumping increases milk production in mothers of preterm infants. Journal of Perinatology, 757-764.

Morton, J., Wong, R., Hall, J., Pang, W., Lai, C., Lui, J., Hartmann, PE., Rhine, W. (2012). Combining hand techniques with electric pumping increases the caloric content of milk in mothers of preterm infants. Journal of Perinatology, 32. 791-796.

Steakly, Lia. “Stanford expert discusses breastfeeding techniques.” SCOPE. Stanford School of Medicine. March 2012. Web. 5 Dec. 2013

Illustrations by Beth Whetstone Walldorf

Beth is an experienced and talented artist who works in a variety of mediums, most notably oils and acrylics. She holds a BA from Jacksonville State University and currently teaches art at Decatur High School. She and her husband live in Decatur, AL with their two girls who were both breastfed. Thank you, Beth, for sharing your time and talents for this project!