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 Waldorf--All Rights Reserved

    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 Waldorf--All rights reserved

    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 Waldorf--All rights reserved

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.


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!



Posted in Breastfeeding | Tagged , , , , , , , , , | 1 Comment

Guest Post: A mother’s birth and breastfeeding story

(c) 2014 E. Gomez

(c) 2014 E. Gomez

I decided when I found out I was pregnant, to do all that I could for my child from the start. I changed my household and beauty products. I began to strictly buy the best food available. Thankfully, it is not hard to achieve this on the SF peninsula. I contacted a doula in my area who also became my Yogi & guide to meditation, which I have always struggled with. Early on I decided that my birth would be natural and my children would be breastfed.

Being born in late 70’s to a Mexican immigrant I was not breastfed. It just, “wasn’t done”, was my mothers only explanation. Her mother did not breastfed her children either. Back then they had wet nurses that did the breast feeding. I can not imagine missing out on the connection breastfeeding gave me with my children. But that was part of the culture at the time and I am not willing to judge their choices. Especially since my family was understanding & very supportive of mine.

My sons birth was wonderful and peaceful. Lasting only 3 hours from start to finish. With my Abuela, my Mothers, and husband present. They prayed they even sang, it was wonderful. My doula was an amazing advocate for my choices in the labor & delivery room and after. My son latched on without a problem in the hospital and we were sent home on schedule.

Our first night home was another story completely. It was near 100 degrees and I became so engorged that he could not latch. We cried together most of the night. I called the lactation nurse in a panic she gave me some advice that I did not execute well. After another desperate call full of tears we made an appointment for a at home visit the next day. She came over bright and early and changed our lives. Diego was able to latch and ate with gusto. I decided to join her lactation support group at the local hospital which met once a week. It was pretty much a huge meeting room with chairs lined along the walls women of all ages and races with our brand new to 2 year old babies. That group was my lifesaver throughout the first six months of my son’s life. Whatever questions or thoughts we had we voiced them there. It was a safe space to talk amongst supportive women going through the same things. I learned so very much from them all, and made some forever friends.

At that point my son was a happy very chubby baby that no one could believe I only breastfed. People often commented on the fact that they, “knew”, breastfed babies were skinny, less healthy looking, and never slept through the night. We changed their minds about that quickly. I had decided that I would breastfeed my children for a year. It seemed like a substantial enough amount of time but I was not opposed to breastfeeding for longer if they needed.

When my son was 7 months old I found out I was pregnant with my daughter. Being that my son was such a healthy eater, breastfeeding began to drain me. I was exhausted, I began to try to pump to freeze a reserve for him in case I could not longer continue. Since I am in this country alone without my family I had never been separated from my son at all. I had never had to pump or give him a bottle. This was challenging, he detested the bottle. I bought every brand available no matter the price with no success. I began to donate my stored milk to mothers with low supply or mothers who had adopted infants so that it would not go to waste. Finally we found a nipple he would take. I began to give him one bottle a day just to get him used to the idea. He turned a year old and I began to wean him off my breast, more bottle than mama; I also continued to pump. By the time he was a year and 3 months he was only being bottle fed and had 3 months of stored supply. I was too tired to continue.

When my daughter was born I obviously began the whole process again. He showed some interest, so I fed him from time to time. But he lost interest within a couple months. The world was his oyster now that he was mobile. With my daughter I introduced the bottle a little earlier. I stayed most of that year in Mexico with my family and had help with my daughter so that I could take my son out for some bonding time just he and I. I did not want him to feel jealousy of his baby sister. She was another happy chubby breastfed baby that slept and ate very well. I began to wean her at a year and a month old. And by a year and 4 months she was drinking the 3 months of stores milk I had for her. Breastfeeding was a wonderful experience for me and my children. It took some of my family members some getting used to me feeding in public. But I made sure to do my best to be open to their questions or comments.

I wore my children for the first year of their lives which is “not done” in Mexico any longer either. The classes are less defined today but still exist and the lower classes are the only people you will see feed their children in public or wear their children. Our friends and neighbors became used to seeing me wearing my babies and stopped staring. I am happy to see a change in this generation of a larger middle class. Hopefully soon there will be more education and support for breastfeeding there as well. I have spoken to all my nieces of my experience and a few have even followed my lead. Becoming a mother has made my life so much more meaningful. And I am blessed to have been able to give my children the best start in life possible. I wish that for us all.

(c) 2014 E. Gomez

Posted in Breastfeeding | Leave a comment

¿Qué tiene la leche materna?

Traducción: Laura Nafissi, Vanina Schoeijett, Verónica Garea, IBCLC.
Revisión: Delfina Medeot
babybluependleton.jpgPuede ser que hayas escuchado a las mujeres de tu comunidad, quizá tu madre o tu abuela, hablando de amamantar a sus bebés. Mucha gente dice que amamantar es la “mejor” opción para todas las madres y que todas las madres deberían amamantar a sus bebés. ¿Te preguntaste alguna vez qué tiene la leche humana que la hace tan diferente de la fórmula? A diferencia de la fórmula tu leche es específica de la especie (hecha para los humanos) y brinda todos los nutrientes necesarios para que tu bebé crezca sana y fuerte.
La leche está compuesta de muchas partes. Están los elementos no-nutritivos, algunos tan pequeños que ni el mejor laboratorio los puede replicar. Estos componentes bioactivos ofrecen más que alimento: se ocupan de proteger el tracto urinario de tu bebé de infecciones y de mantener el intestino libre de bacterias nocivas y virus. Se especula que la razón por la que la leche de las madres tiene tantos anticuerpos y componente inmunológicos es que al nacer el sistema de defensa del bebé está muy inmaduro. El sistema inmunológico de tu hijo no madurará por completo hasta aproximadamente los cuatro años de edad, así que tu bebé nace relativamente indefenso y muy vulnerable a la enfermedad. Cuando amamantas proteges a tu bebé recubriendo sus intestinos y otras partes de su sistema digestivo inmaduro con proteínas protectoras, especializadas, y los factores inmunológicos de la leche materna hacen su trabajo también en el torrente sanguíneo. Tu leche es una barrera sólida contra gérmenes indeseables.
De acuerdo con el trabajo esclarecedor de la Dra Ann  Prentice en 1996, la lista de factores no-nutritivos incluye los siguientes elementos:
“Factores antimicrobiales: IgA  secretora, IgM, IgG, lactoferrina, lisozima, componente C#, leucócitos, factor Bifidus, lípidos y ácidos grasos, mucinas antivirales, GAGs, oligosacáridos.”
• La lactoferrina funciona como un transporte de hierro que también actúa como antimicrobiano, en particular contra la bacteria E.coli.
• La lisozima es bactericida (mata bacterias) y anti inflamatoria, y a medida que sigues amamantando, sus niveles aumentan paulatinamente y alcanzan su máximo  aproximadamente a los 6 meses. Amamanta a tu bebé durante el tiempo que quieras, tu leche lo protegerá de enfermedades mientras dure la lactancia
• sIgA, IgG e IgM trabajan brindando una extensión del sistema inmunológico de la madre hacia el bebé. Los anticuerpos de la madre se expresan en la leche para dar inmunidad (protección) a enfermedades específicas (antígenos) en el ambiente. Mantener a la madre y la bebé juntos después del nacimiento le da a la madre más oportunidades de desarrollar anticuerpos a cualquier bacteria en su entorno común. Si este tema te interesa especialmente, aquí tienen otro artículo sobre el sistema inmune entero-mamario (N de T: en inglés)
• Los ácidos grasos poliinsaturados de cadena larga, en particular DHA y AA, están asociados a la visión y al proceso cognitivo (pensamiento). El contenido de estos dos factores en la leche materna está vinculado con la dieta de la madre.
Otros ejemplos de componentes no-nutricionales de la leche materna en el artículo de Ann Prentice:
“Citokinas/antiinflamatorios: factor de necrosis tumoral, interleukinas, interferón-gama, prostaglandinas, antioxidantes, antitripsina α-1, antiquimotripsina α-1.
Hormonas: Inhibidor por realimentación (FIL), insulina, cortisol, prolactina, hormona tiroidea, corticoesteroides, ACTH, ocitocina, calcitonina, PHrP, eritropoyetina.
Enzimas digestivas/otros: esterasa BSS, lipasa BSS, amilasa, lipasa-lipoporteína, casomorfina, péptidos β, nucleótidos, ADN, ARN.”
Notarás que algunos de los componentes que hemos listado en este artículo están repetidos en más de una categoría: éstos sirven para más de un propósito. De hecho, algunos de estos factores tienen propósitos nutricionales luego de que han cumplido su trabajo antimicrobiano y han sido digeridos y absorbidos. Se relacionan unos con otros y con el cuerpo del bebé. En tanto la leche es digerida, más factores bioactivos son producidos y van teniendo nuevos efectos en el bebé. Puedes verlo como un círculo conectado entre la madre, el bebé y la leche.
Aquí van algunos detalles más sobre los principales componentes de la leche:
• La amilasa es una enzima necesaria para que el cuerpo descomponga los almidones que contienen los alimentos. Hace la digestión de la leche materna mucho más fácil para tu bebé.
• La lipasa es una enzima que el cuerpo necesita para descomponer las grasas y es también beneficiosa para tu bebé.
• El factor activador de plaquetas ayuda a acelerar cualquier necesidad de curar los pezones de la madre y también los intestinos del infante.
• La caseína dificulta que los microbios se peguen a las paredes mucosas del cuerpo de tu bebé. Esas paredes recubren la parte interna de los pulmones, del tracto digestivo, de la nariz. Todas las puertas de entrada están cubiertas por mucosa.
• Los oligosacáridos trabajan como los principales protectores contra los gérmenes. Poseen partes llamadas “ligadores” que engañan a las bacterias y virus haciéndoles creer que son partes del bebé; las bacterias y virus se adhieren a los oligosacáridos en su lugar y luego son eliminados del cuerpo del bebé.
Existen ciertas proteínas en la leche que ofrecen funciones de protección:
• -caseína
• Proteínas del suero: -lactoalbúmina: Alfa-lactoalbúmina Humana Hecha Letal para las Células Tumorales (HAMLET por sus siglas en Inglés), lactoferrina, inmunoglobulinas, lisozima y seroalbúmina.
Existen carbohidratos que proveen las calorías necesarias para el crecimiento de tu bebé:
• Lactosa
• Lacto-N-tetraosa
Existen grasas que sostienen el almacenamiento de calorías  para los picos de crecimiento y son esenciales para el desarrollo del cerebro y de la visión:
• Triglicéridos (la grasa primaria en la leche materna)
• Ácido oleico
• Ácido palmítico
• Ácido araquidónico (AA)
• Ácido docosahexaenoicoExisten células que hacen un trabajo especial manteniendo a tu bebé sano:
• Leucocitos (glóbulos blancos): fagocitos, basófilos, neutrófilos, eosinófilos y macrófagos
• Linfocitos: células T y B
• Células  madre
Hay  factores de crecimiento:
 Cortisol
 Insulínico
 Tiroxina
 Colecistoquinina
 Epidérmico
 Nervioso
 Transformante
 Taurina
 Poliaminas
* Las siguientes secciones de hormonas (vitaminas, minerales, transportadores, y citoquinas) estarían incompletas si no fuera por el trabajo de Cecily Hedberg, Sherri Hedberg, y Haley Rumble. Nos basamos en gran medida en su trabajo, y el crédito de esta sección es de ellas con adiciones nuestras de poca importancia.
Hay hormonas:
 Oxitocina
 Prolactina
 Factor inhibidor (FIL)
 Insulina
 Cortisol
 Corticoesteroides
 Hormona adrenocorticotrópica (ACTH)
 Calcitonina
 Hormona Paratiroidea (PHrP)
 Eritropoyetina
 Triyodotironina (T3)
 Hormona tiroidea estimulante (TSH)
 Hormona liberadora de tirotropina (TRH)
 Trombopoyetina
 Hormona liberadora de gonadotropina (GnRH)
 Hormona liberadora de la hormona de crecimiento (GRH)
 Leptina
 Grelina
Hay vitaminas:
 Vitamina A
 Vitamina C
 Vitamina B1
 Vitamina B2
 Vitamina D
 Vitamina E
 Vitamina K
 Betacarotenos
 Tocoferoles
 Tiamina
 Riboflavina
 Niacina
 Ácido Fólico
 Ácido pantoténico
 Biotina
Los minerales:
 Calcio
 Fósforo
 Sodio
 Potasio
 Cloro
 Zinc
 Magnesio
 Hierro
 Selenio
 Colina
 Azufre
 Cromo
 Cobalto
 Flúor
Hay citocinas / elementos antiinflamatorios
 Antioxidantes
 α -1 antitripsina
 α -1 antiquimotripsina
 Interleukina-1β (IL-1β)
 IL-2
 IL-4
 IL-6
 IL-8
 IL-10
 Factor estimulante de colonias de granulocitos (G-CSF)
 Factor estimulante de colonias de macrófagos (M-CSF)
 Factor de crecimiento derivado de las plaquetas (PDGF)
 Factor de crecimiento endotelial vascular (VEGF)
 Factor de crecimiento de los hepatocitos -α (HGF-α)
 HGF-β
 Factor de necrosis tumoral-α
 Interferón-γ
 Factor de crecimiento epitelial (EGF)
 Factor de crecimiento transformante-α (TGF-α)
 TGF β1
 TGF-β2
 Factor de crecimiento insulínico-I (IGF-I)
 Factor de crecimiento insulínico- II
 Factor de crecimiento nervioso (NGF)
 Eritropoyetina
También hay transportadores:
 Lactoferrina
 Aglutinante de folato
 Aglutinante de cobalamina
 Aglutinante de IGF
 Aglutinante de tiroxina
 Aglutinante de corticosteroide
Hay muchas cosas buenas en la leche materna que aún se desconocen, y el tema sigue siendo explorado. Los efectos de la lactancia materna en tu bebé durarán hasta su vida adulta, y pueden influir en la salud de sus hijos, nietos y las generaciones posteriores. Incluso si estás fumando o bebes de vez en cuando, tu bebé todavía necesita tu leche. La próxima vez que alguien te diga que la fórmula es más fácil, puedes mostrarles este artículo, y podrán comparar los ingredientes en la parte posterior de una lata fórmula con esta lista. La lactancia materna es la opción natural, y amamantar a tu bebé resulta mejor para la salud de ambos.Referencias:
Prentice, A. (1996) Constituents of human milk,. Food and Nutrition Bulletin, (The United Nations University Press), 17(4)
Heslett, c., Hedberg, S. & Rumble, H. Breastmilk poster. Douglas College, new Westminster, BC, Canada
Riordan, J. & Wombach, K. (2010), Breastfeeding and Human Lactation, 4th edition. Jones and Barlett Publishers
Lucas, A., Gibbs, J. & Baum, J.D. (1977), What´s in breastmilk. Lancet, 8019:1011-2
Garofalo, R. (2010), Cytokines in human milk. Journal of Pediatrics. 152 (2 suppl): s36-40
Walker, a. (2010) Breastmilk as the gold standard of protective nutrients. Journal of Pediatrics, 152 (2 suppl): s3-7
Cregan, M.D. et al. (2007), Identification of nestin- positive putative mammary stem cells in human breastmilk. Cell Tissue Res. 329 (1): 129- 36
Lehti, K.K. (1989), Iron, folic acid and zinc intakes and status of low socio- economic pregnant and lactation amazonian women. Europian Journal of clinical Nutrition. 43 (8); 505 -13.
(c) 2011. Serena Meyer, IBCLC
Actualizado 16/07/2012

Posted in Articles for Breastfeeding Support Workers, Breastfeeding | Leave a comment

We’re still here!

april-2011-238We apologize for our lack of posts these last few months. Our writing team is busy, busy, busy with family, school, and work. There never seem to be enough hours in the day to do all we would like and writing has unfortunately hit the bottom of the collective “to do” pile. Expect more posts from us near the holiday season (aka winter break). We have many exciting posts in the works, including some just for moms who need to express their milk. There will be guest posts, too!

In the meanwhile, please tell us what topics YOU would like to read about. We welcome your ideas (and perhaps even your guest post). Don’t forget to check us out on Twitter and Facebook. Use the quick navigation buttons on the right hand side of the page to take you there.

Thank you for your continued support of Native Mothering. We couldn’t do it without you!

Posted in Resources for Parents | Leave a comment

10 Ways Families Can Support Breastfeeding

You are welcoming a new baby to the family. Congratulations! Breastfeeding is one of the healthiest, most rewarding things a mom can do for her baby. It is only natural that you want to support the new mother in breastfeeding and to make it as easy as possible for her to succeed. Here are a few tips that you may find helpful along the way.


1. Learn more about breastfeeding before the baby arrives. Reading books and articles from respected, evidence-based resources can help you gain a better understanding of how breastfeeding works and what to expect. Talking to other mothers about their breastfeeding experiences can also be a valuable way to learn.
2. Support her choice to breastfeed. Let her know you’ll do what you can to help her breastfeed as long as she desires. Don’t try to persuade her to offer bottles of breastmilk or formula when not medically indicated. Remember that there are many ways for family members to bond with the baby besides feeding.
3. Bring her water or her favorite beverage and a snack. Breastfeeding can make moms feel thirsty and hungry. New moms tend to care for their babies before themselves, and their own needs may go temporarily unmet without a little help. A refreshing drink of water in the middle of a marathon feeding can really make a new mom’s day!
4. Give her a break. After she breastfeeds her baby, offer to hold, rock, or carry the baby in a sling or front carrier while she rests (or showers, or goes for a walk around the block, or…). Assure Mom you will let her know when baby shows early signs of hunger.
5. Help her with baby care. Offer to change the baby’s diaper or bathe the baby while she takes care of her own personal needs.
6. Help with the chores. Ask Mom what she needs you to do or ask her to leave a list on the refrigerator. Laundry, vacuuming, sweeping, cooking, dishes, and grocery shopping are chores that most often top the “to do” list.
7. If there are older children, read to them, play with them, or take them out for the afternoon. The one-on-one time will be special for them, and Mom will appreciate the time to bond with her new baby.
8. Entertain house guests and enable Mom to have a quiet space alone with the new baby. During the early weeks it is common for babies to spend a lot of time breastfeeding. Mom will still be healing after birth, and entertaining for long periods of time may be tiresome. She may even feel uncomfortable breastfeeding in front of certain people. Entertaining guests can help take the pressure off of Mom to be sociable and allow her time and space to rest and bond with her baby.
9. Help her deal with criticism about breastfeeding. Remind her of all things she is doing right. Provide her with unbiased, evidence-based information that will help her overcome the criticism (for example, if she is being criticized for not supplementing remind her of how to tell her baby is getting enough milk). If necessary, step in and speak for Mom in a good way.
10. Tell her you’re proud of her for breastfeeding. Your encouragement and support could be the difference between her continuing with breastfeeding as long as she plans to or stopping before she is ready. You are an important part of her success!

Posted in Uncategorized | Leave a comment

Emily and Zora

Emily and Zora_breastfeeding

Posted in Breastfeeding | Tagged , , | Leave a comment