Hand expressing is a learned skill and with practice some mothers have found they do a better job than a hand held pump.
One vital factor in expressing milk is to get the milk to flow. Around each milk-making cell are tiny muscles that contract under the influence of oxytocin. Oxytocin is released in response to stimulus on the nipple/areola. When our babies directly feed at the breast the rapid sucking at the beginning of the feed causes oxytocin to be released. Your milk releasing, also known as Milk Ejection, fast becomes a conditioned reflex, so that often just thinking about your baby or getting ready to breastfeed gets the milk dripping.
When you first start expressing many mothers find it tricky and generally it’s because you need to condition the breasts to respond to another stimulus – the breastpump or your hands. So if your efforts are not being rewarded, be reassured, that, with time and practice things generally improve.
To help get the milk flowing you can warm the breast first, with a warm pack or in the shower. Follow this with some massage of the breast or stroking of the breast.
To hand express, place you fingers at the outer edges of the areola, or even a bit beyond (this ensures you are going to compress over the glandular tissue), push into the chest wall and then compress the fingers together. Avoid sliding down towards the nipple. You will discover there are “sweet spots” under you fingers that will reward you with more milk. Work your fingers around the breast, swap hands if your hand is getting tired, swap to the other breast if the milk flow is slowing. Thinking about your baby can help your milk to flow, having someone talk to you while you are expressing can take your mind off what you are doing and help you to relax and your milk to flow.
Here is a link to a terrific video about hand expressing, it’s by Jane Morton, a US Paediatrician who works with mums with hospitalized premature babies.
Jane demonstrates the steps to express milk by hand about 1½ minutes into the video. The hand expressing technique is the same regardless of the age of your baby.