They're ONLY Hand Expressing? Well, that's not...

Hmmm, but is it?

Welcome to February! If you’re wondering where January went, you’re not alone. I traveled to Vancouver, Canada and snowshoed for the first time, celebrated my 30th wedding anniversary with my husband, Jon, and got both of my college daughters safely back to their respective schools on the East Coast for what will be their last semesters.

And now it’s Feb 1, and we should focus in on what we want to accomplish together!

I was recently reminded of just how much we STILL need to focus on the basics, the fundamentals, the keys to human lactation. To that end, and as part of my continuing work to write The Book, we’re focusing on early hand expression and early lactation in February.

Here’s what everyone needs to understand about Hand Expression: it is an essential part of breastfeeding and making milk. Think of it as equal to latching. Equal to positioning baby. Equal to watching the baby and counting the diapers.

If someone doesn’t know how to do it, they don’t know how to get milk out. They don’t know how to relieve engorgement. They don’t know how to give their baby extra milk if there’s a problem. They don’t know what to do when their baby is not with them.

Why are we teaching people how to breastfeed but failing to teach them how to hand express their milk? We’re setting them up for problems they won’t be able to manage on their own.

I think if we really get honest about this, it’s because there’s a lack of trust in hand expression.

When pumps are everywhere and everyone thinks they need one, are they really going to trust that something they can do on their own with their own hands is going to be “enough?”

Before there were pumps, ie for literally all of the time there were humans reproducing and feeding their young, breastfeeding mothers figured out how to get milk out of a fuller-feeling breast, how to get extra milk out to feed their skinny little baby (or their sister’s skinny little baby that didn’t seem to be able to nurse very well).

It’s what people (like me) did when they went back to work and had a terrible battery-operated pump made by a bottle company that (surprise!) didn’t work and we were engorged by lunchtime.

One colleague of mine recalls her first day back to work in the 1980’s as being punctuated by having to go to the bathroom to “squeeze milk out into the sink.” Really contributes to that feeling of being a “professional!”

Yes, people figured it out. They relied on it. They used hand expression to get milk out to feed their preterm baby in the NICU (and still do in many places where pumps and/or electricity are not available). I know a postpartum nurse who exclusively hand expressed when she went back to work after her baby (just about 5 years ago) because she said it was simpler, easier to arrange in between caring for her patients, and it just felt better than pumping for her. Her milk production was robust and remained so.

But I am finding that clients AND lactation care providers don’t trust hand expression.

(How can clients trust it if their lactation consultants don’t?)

This is one of those places where I find that having a really strong foundation of understanding about human lactation is vital.

Just like with breastfeeding itself, which we see that many medical professionals do not trust, hand expression is also treated as some kind of mysterious, invisible thing that isn’t to be trusted.

I am posing this question to you: do you believe that someone could maintain their milk production through hand expression alone?

Do you believe that exclusive breastfeeding is possible?

We really need to talk about this before we go any further.

If you have doubts about either of those things being possible, you may be operating under a bias that impacts how you practice.

If someone is NOT able to exclusively breastfeed, as a lactation care provider, you need to be able to explain why. It is the default. Not being able to exclusively breastfeed is NOT what is biologically expected of the human body, so when it happens, we need to be able to determine why. It is physiologically implausible that a human would not be able to nourish its own offspring, and where it happens, there is a reason that it happened.

Same goes for hand expression. (An argument can be made that this is nearly always going to be due to faulty or ineffective technique, which is a much simpler problem to resolve than with the exclusive breastfeeding question.)

We need to do a better job of teaching it, and we need to convey trust in it.

I have seen hand expression and faith in it as a technique literally save a mother’s milk production. The image of her naked upper body leaning over a large, wide, metal bowl, compressing her breasts rhythmically while collecting drops of milk in the bowl, smiling and cooing at her sweet baby beside her as she worked as hard as she could to get out the milk she had and teach her body that she needed more - this image will never leave me. For her, it is a badge. It redefined her sense of who she is. She did that with her hands.

We need to constantly check ourselves and how we practice to ensure that WE are not contributing to the over-reliance on products and tools that plagues new mothers and causes them to doubt themselves and their bodies at every step.

I’ve said it before, but it fits here as well: Breastfeeding is simple. Breastfeeding in our current society and culture is hard. How we support people who are trying to breastfeed and feed their own milk needs to reflect that and address the inherent inequities in a system that pushes reliance on commodities instead of self-reliance.

Here’s what we’ll be doing here at Evolve in February:

Paid members will meet for Group Coaching Calls every Friday in February at 10am Pacific.

On Sunday Feb 11 (or before), I’ll be writing a piece on early lactation techniques and the story of how they impact people. Then, on Monday, Feb 19 at 12pm, we’ll meet for Community Conversations, a new event here at Evolve. It’s open to anyone who reads the piece and is inspired to participate in the conversation. You can register here at this link.

Leaving off with this thought: Hand expression is not something we bring out only when there’s a problem or because we “have to” because of hospital policy. It’s an essential skill and part of the breastfeeding and milk production process.

Along with skin to skin, hand expression is a first-line, repeating part of breastfeeding, just like latching, positioning, and monitoring baby’s intake and output. They are all essential.