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Ep. 67- Hand Expression

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Happy birthday to us. Happy birthday to us. Happy birthday dear Milk Minute Podcast! Happy birthday to us. Boop a dupe. We’re a year old. Guys, we gestated it. We birthed it. It’s a year old. Thank you so much for hanging with us throughout the Milk Minute’s awesome journey over this past year. We made it through a pandemic.

Yeah. We made it through all kinds of, we made it through pregnancy. Yeah. A birth. A birth postpartum which you’re still in, but you’re crushing it, so good job. I am also weirdly, officially having my one-year anniversary at my job. Woohoo! New jobs good stuff, man. I teach at West Virginia University. I teach at the school of nursing and I teach all of the students how to do OB on the floor.

So I’m like the real in life person and I absolutely love it. So if you know me, you know, I love to teach. That’s what we do here at The Milk Minute. That’s what we do in the Facebook group. And that’s what I do at work work. So we’ve had a big year. We’ve had a huge year, lots of changes, new, new life, new jobs, new podcasts, all kinds of stuff, yep.

And we are over 30,000 downloads. Yeah. Woo. Oh, yeah. And we’re only growing. So if you want to give us a birthday present, what you can do is recommend the podcast to a friend. Yes, please recommend us to a friend or share us on Facebook and you can always become a patron so we can actually hang out with you because as much as we love doing this, we actually really love getting to know you and watching you grow a baby and have a baby and breastfeed your baby over zoom.

So we do that once a month. We get together with our top tier patrons and we would love it to be you. So come get us at And Lyra would love to meet you too. She comes on the Zoom sometimes. And Heidi will definitely be on the zoom and every time, every time she’s pretty obsessed with, she’ll mostly be looking at herself, but she’ll be excited that you’re there too.

She’s like that’s Heidi. Oh gosh. Well thank you guys again for being our biggest support and we love you and couldn’t appreciate you more. All right. Well, we’ll see you. Hopefully you’ll stick around for another year and we’ll be two next time. Who knows how much we’ll grow? How much are you going to grow, Lyra? All right. Thank you everybody.

This is Maureen Farrell and Heather O’Neal and this is The Milk Minute. We’re midwives and lactation professionals bringing you the most up-to-date evidence for all things lactation. So you can feel more confident about feeding your baby, body positivity, relationships, and mental health. Plus, we laugh a little or a lot along the way.

So join us for another episode. Hello, everybody. Welcome to The Milk Minute Podcast. We are going to talk about hand expression today because I don’t think a lot of people understand what it is, how to do it or why you would do it. And we want to give you all of those tips today. But first we’re going to start with a listener question from Amanda K.

She says, “I have a massively clogged duct, and I cannot for the life of me get it out. I’m afraid it will turn to mastitis. My son is refusing to nurse from that side, I guess, because it’s so clogged. So far, I’ve tried pumping, dangle pumping, massage, hot compress, nursing, dangle nursing hand expression, haakaa with Epsom salt and vibration. Any other ideas so I don’t have to resort to asking my husband to get it out?”

Yeah. I mean, first we’re going to say keep going, because those are all excellent ways to resolve a clog. But let’s just, you know, we have a couple other ideas and maybe let’s talk about like the order of operations here. You know, we’re going to do massage and hot compresses first.

You know, and maybe that’s also a warm Epsom salt bath before we do pumping or feeding. Right. And you’re going to want to feed on that side first because that’s when baby is going to be the hungriest and the most vigorous and we’re going to need, it sounds like, a lot of suction to get that thing out.

And a baby is a much better pump than a pump. So you’re always going to want a hot compress to loosen things up, massage to further loosen things up, baby directly to that boob at the hungriest time. If you can have someone help you by applying vibration to the clog while your pumping or nursing, that’s super helpful too.

And then I’m going to add in start taking a pretty hefty dose of sunflower lecithin. Yeah. I usually recommend when you have an active clog, 1200 milligrams three times a day and then actually maintain, after you get rid of the clog, maintain on just 1200 milligrams, one time a day maybe even for the rest of the time that you are nursing.

Yeah. And then add in some ibuprofen because sometimes just the swelling from, from all that you know, massaging and vibration and you know, whatever’s happening does not help you make room to pass that clog. So Ibuprofen to reduce some of that swelling and pain, frankly, cause this isn’t fun.

And you know, you can take 600 milligrams of ibuprofen every six hours. So if you want to take it 30 minutes prior to nursing that should decrease the swelling and the pain during this whole process and give you a little bit more stamina as you’re trying to get that clog out. And then we’re going to finish with a cool compress.

Never start with a cold compress because cold makes things shrink up. We want everything open, open, open, open, but then when you’re done, after you vibrated and massaged and sucked and all of these things, we’re going to need to cool it back down and not leave you hot like that. And yes, you are a setup for mastitis.

So please be aware of that. It can happen very quickly. And if you’re taking ibuprofen every six hours, it might mask a fever. So if you’re starting to feel general malaise, like my whole body, just, Ugh, I don’t feel good. Lay off the ibuprofen for a little bit and see if you develop a fever. If you do, you need antibiotics.

Right. And that’s part of the reason I don’t recommend Tylenol in this case. I mean, one, ibuprofen does a better job being an anti-inflammatory, but it is not as good at reducing a fever as Tylenol is. So, you know, if you have a fever, we want to know that that’s happening. Is it really not as good? It’s I think it’s genetic.

I mean, for, for the most part Acetaminophen seems to be. It’s like the first go to, right? Because it’s easier on your body. Yeah. But I swear Tylenol for me is like spitting into the ocean. You know, it does nothing. I have, but I think that’s genetic. I’ve never had ibuprofen reduce a fever for me. Really? We are different. We’re different.

Anyway, there you have it folks. Pay attention to your body. You know, know yourself and call a doctor if you need to. There you go. I hope that helps, Amanda. Get that clog out and don’t tell your husband to suck on it cause he lost his sucking reflex when he was about two years old, he will not be helpful.

Let’s take a quick break to thank our sponsor, Aeroflow. Aeroflow is your one-stop shop to get the most popular breast pumps and accessories through your insurance. So don’t let your insurance go to waste. Why don’t you let Aeroflow do all the dirty work for you? You never have to call your insurance when you use Aeroflow and they remind you when you’re eligible for free replacement parts.

Yep. So when you’re tired in your postpartum period, and you’re wondering why your pump isn’t working as well, you might get a text that says, did you know you need replacement parts? And you say, I did not know that. Right? You push a button and boom; they show up at your door. Thanks Aeroflow. Thank you so much. Go ahead and check out the link to Aeroflow in our show notes and order your pump through them.

So, hand expression. I feel like I talk about this literally every day. I think that all lactation consultants talk about hand expression and then the patients smile and nod and then they say, okay, how do I do that?

Or, and like, you know, they just don’t really get why they would do it, or when they would do it. Right. There’s that too. It can feel complicated, but really it’s only complicated because we live in a culture where we don’t grab our boobs in any way, other than sexually, most of the time. We’re kind of trained to ignore our bodies in general, growing up here.

So, first I want to recommend it just as a way to get to know your lactating glands here. To understand how your body works. Right? Like, you know, you’re feeding a baby, maybe you’re pumping, get hands-on. Because it’s a good, first of all, it’s a good emergency skill. If you are ever stuck without a working pump or baby.

It is a good problem-solving skill in a lot of different kind of breastfeeding troubleshooting scenarios. But also like this is your body. This is a process that’s happening. And it’s really good to be able to understand how it works, what you can do to encourage it to work better, how it feels, you know, it’s something everybody should try at least once.

If you are not even pregnant yet and you are listening to this podcast to prepare, first of all, congrats. That’s amazing. Way to be taking the initiative. Grab your breasts right now, hashtag grab your glands and feel what normal is, you know, what your normal is before you even get to the point where you’re pregnant and lactating, because then you’ll be able to feel what’s not normal.

Like if the first time you grab your own self is the time that something is wrong, you’re going to have no context for how bad it is or what you really need to do about it. So get a baseline on yourself when you can. Start, start that at any point in time. And that way you’ll know if something’s up.

And that goes for breast cancer too. Like we, I don’t really push a lot of self-breast exams, but I think it is a good idea for people to get a general feel for what they feel like. Yeah, absolutely. But let’s, let’s just talk about the mechanics of this first, do you think, and then we can talk about where we might use it.

Yeah. Good. Okay. So every, let me just say that everybody does this differently. Everybody’s boobs are different. Everybody’s hands are different. And if you YouTube hand expression, you’re going to find 20 different videos of people doing this differently, which I love. I do too. It’s great, Heather and I do it differently.

I dunno why. We need to do a hand expression mashup. Yeah. Squirt, squirt, squirt, squirt. But essentially at least the way I do it, maybe you tell me if you do it differently, Heather, is I recommend that you hold your breast just behind the areola in kind of a C hold, whichever kind of C feels comfortable to your hand and wrist.

A lot of us get tendonitis while breastfeeding. So be careful about that. And you’re going to put a little bit of pressure back toward your body and squeeze and then kind of gently like holding that squeeze, like bring your fingers toward your nipple. So you’re going to slide them along the areola to the nipple and stretch it a little bit.

And you’re going to then go back behind your areola, squeeze, push back and glide forward again. So the amount of like pushback, compression, nipple pulling, whatever that you need to effectively hand express is going to be different for every single person. Personally, I like to do more of the like stretching first to kind of stimulate a letdown.

And then I do more of the like real compression once I get milk flowing. You should not be hurting yourself. No, whatever you’re doing, if it hurts, try something different. Yeah, I do it pretty similar. I think the only thing that I would add, you know, I would say I definitely start with some gentle nipple stretching or nipple rolling to stimulate a letdown.

And then I kind of watch the pattern of the flow and I kind of match that. You know, you’re, anytime you’re expressing milk, you’re mimicking breastfeeding. And when you breastfeed, it’s typically short, quick, lots of nipple stretching in the beginning and then it moves into deeper, longer, slower. And then I will sometimes stop for a second and I will massage like all the way back towards the chest wall, just to kind of like loosen everything up, get it back down into the milk ducts and then start again. And kind of stretch out my wrist. Cause you want to make sure that you’re comfortable and that it should feel like you’re massaging your own hand.

Like, oh, this is my hand. It feels good. Maybe it hurts and it’s cramping, but I’m going to take a minute and I’m going to reposition and I’m going to do it when it feels good again. Yeah. And you know, this kind of intimacy with your own body might be hard for some people, you know, whether you have some history of trauma with your body or you’re experiencing some body dysphoria.

You know, it’s, it can be really difficult, so take baby steps. If this is something you know that you struggle with or say, you start because you’re listening to this episode and you’re like, whoa, something happened. I don’t feel good. That’s okay. Take a step back and start from where you’re comfortable.

If you’re comfortable just to massage like the upper area of your chest as a baby step, that’s fine. Or just to kind of practice these movements a little bit while baby’s feeding, that’s fine too. But it, it is a really good skill to have. And let’s talk about why, Heather? Yes. How would we use this?

So I use it first of all. So let’s take it back to the beginning. So say you just had your baby maybe yesterday and now your milk is starting to come in and you’re feeling a little bit engorged and maybe your nipple is flattened a little bit because your breast is engorged and the baby’s having a hard time latching on because your breast is a little bit harder and your nipple’s too flat.

That is not a flat nipple. That is an engorged breast. So if someone says, oh, you have really flat nipples and your milk just came in, you can tell them to, you know, suck it. You know what? And even if you do have flat nipples or inverted nipples, that doesn’t mean you can’t breastfeed, so also tell them to suck it.

Right. A podcast episode called special nipples. We’ll put it in the show notes. Just go find it. Yeah. So I would use hand expression in this scenario to loosen up some of that swelling. I’d probably start with some reverse pressure softening where you take your hands almost in a claw like position. Like you’re going to pick a strawberry and you’re going to push back on your areola toward your chest wall for just a few seconds.

Sometimes that alone will stimulate a letdown, which is great. It’s great if that happens, you can just catch it in a little medicine cup or whatever you’re using to catch the milk. And you’re going to just push directly back to move some of that swelling out and create more of a nipple tip for the baby to latch on to. If it’s, if that is still not enough for the baby to latch, I will hand express some of that milk off and soften the breast.

So there’s actually more space for compression around the areola with the baby’s mouth. And then the more milk they remove. Well, I should say the more frequently they remove milk, the less engorged you’ll be. The best way to prevent engagement in the first place is small, frequent removal of milk. Yeah, absolutely.

And if you’re doing hand expression at that point too, you can express right into a syringe. You just take off the plunge. And kind of put that back right near you. You have to plug the tip, so it doesn’t come out the front. Take off the plunger, have one hand to hold that right at the nipple tip while you express with the other.

Yeah. So a lot of the time, the first couple of days, we’re doing hand expression to deal with engorgement or to stimulate a letdown for a baby who’s not patient enough to wait for one, right. Those babies who fuss right away at the breast. But, you know, I am, my mind always goes to emergency situations with this, Heather, because that’s kind of where I got my start into medicine was doing like an emergency wilderness, first responder, and all these things.

So. You know, if your baby has a medical emergency and has to go into the NICU or something and you don’t have a pump right away, hand expression is a good way to start to get milk for your baby because milk is medicine. Or, I mean, freak things happen all the time. You could get stuck in an elevator at work for six hours.

You know, your pump’s upstairs in your office, your baby’s at home. Like what are you going to do? You should definitely do your best to express milk with your hands. Yeah, battery malfunctions happen with your pump and you sometimes I would actually argue that hand expression is easier than using a manual pump.

It’s different for everybody, but me personally, I can feel where the milk is in the ducts because it’s kind of, it fills up like spokes on a wheel. So as you’re hand expressing, you can either do it overhand or underhand or whatever hand you want. And then just move your hand around the spokes on the wheel and empty what you can empty.

That’s a really good way to think about it. I know it’s hard for us to sometimes explain a physical action on a podcast. So I’m hoping that you can get a picture in your head of how to do this. But again, there’s so many instructional videos that you can watch while you’re listening to this while you’re trying. And I think the best way to figure it out is just experimentation.

Like, have you ever grabbed your breasts to feed your baby and you accidentally squirt them in the face? You know, slash I do that like literally every day. That is a good way to start. You’re like, oh, I squeezed right there. Cool. Let me start squeezing there. And then you can do it to your partner. Yeah. I, my son thinks it’s funny when I squirt him.

You find that one, that one milk duct, that’s like really active. That’s so funny. But yeah, you might also need hand expression to troubleshoot clogs. Yep. Like we answered in the question, which I argue is an emergency. If you have a clog, do not ignore that thing. That thing is not here for you. That thing is going to turn into a little mastitis beast, if you don’t take care of it.

And it’s usually Saturday night at 11 o’clock. Yep. And there’s no lactation consultant around. There’s, you know, nobody’s picking up the phone that knows what to do and by morning you could have full-blown mastitis. So yeah. Like we said, when we answered the question, hot compress, massage, and hand expression. And really using that thumb to kind of work that clog towards the nipple.

Yeah. And I know plenty of people who have been so frustrated trying to pump that when they suddenly, when they start hand expressing, they’re like, oh, I can do this. And they just hand express instead. Can we really quickly chat about that? Yeah. I have had several clients now who quote unquote, do not respond to the pump.

Now I am, I don’t have like a brain scanner. I don’t have a way to test people’s hormones and I’m not sure that it really matters. What matters is what works for you. So if you’re not responding to a pump, you aren’t broken. No, it’s not your fault. And you’re not a machine, right? You’re not a machine. We’re not actually meant to be able to respond to anything other than a baby.

And it’s kind of a miracle that we have anyway. We didn’t evolve to do this like, you know, hundreds of thousands of years ago. Pumps have really only been available for us to use at home since the nineties. Think about that for a second. Like, it has not been that long that we’ve been pumping at home and we all put so much pressure on ourselves like we’re supposed to be pros at this.

First of all, you’re learning how to do this for the first time ever in your life. Whether you’re 21 years old, or you have your PhD and you’re 45 as a first-time parent, you are the same. Neither one of you has pumped before, and it’s an even playing field when you’re, when you’re learning how to do something like this that you’re not evolved to do.

So if you do not respond to the pump, try hand expression. And yeah, that’s what people did before pumps. Yeah. I mean, seriously, it’s, it’s also how we have milked dairy animals for quite a long time too. I’m sure cows respond better to hand milking than a machine. Yeah. I don’t know if you watch Outlander. Do you watch Outlander? Do you remember? That hand expression scene, Heather, was the most hilarious. Like the sound effect on it was hilarious. I know. So for those of you that don’t watch Outlander, Claire decides to go find Jamie. It’s been awhile, but she rides off with her sister-in-law, with Jenny, the day she had a baby. Her breech delivery. So Claire delivers her breech, baby. They get on horses. Jenny’s like, cool, my vagina’s fine. No big deal. And she rides off and they’re on the trail for like a day. And she’s like, oh, me breasts are hurting or whatever in her Scottish accent.

And she hand expresses into a little silver cup and aggressively throws the milk into the woods because the baby isn’t there with her. And I was like, yeah, I guess, what are you going to do? Dude, I would have drank that. First of all, she threw that in the woods and I was like, what the fuck? Yeah. What are you doing?

That’s your resource? Delicious. Anyway, it’s fine. So we wanted to keep this one short and sweet for you guys. And mostly, I just wanted to encourage you to try it. And don’t be afraid to really elongate that nipple. Your nipple has the ability to stretch up to 300%. So don’t hurt yourself, but also don’t be shy, stretch that nip, see what happens. You know, like be a bad ass like Jenny Fraser. Fraser. Hop on your horse, express milk into a little metal cup.

Yeah. And then aggressively throw it into the woods and be like, I touch my own glands. Yeah. But really like your body’s amazing. It deserves love from you, you know, get to know your body and appreciate its amazing functionality. Right. And if you’re not ready to do a full hand expression for like a replacement for a pumping session, try hand expressing after you pump and see what happens.

See if you get a little bit of extra, see what your pump wasn’t able to remove and what you could remove. Start small and build up if you want to, your choice.

Hey guys, it’s Maureen here and I wanted to let you know about my Etsy shop. I am an artist and a designer, and I have a shop where I make educational breastfeeding posters, shirts for birth workers, like for your favorite nurse or midwife, shirts for people who are lactating, mugs, stickers, all kinds of stuff.

Some of my birth paintings are on there. It’s an eclectic collection and it’s really beautiful. So if you want to find that you’re going to go to, except instead of a B it’s a six. So that’s the wandering womb with a six instead of a B.

Today’s award in the alcove goes to Lupita S and she is right now working on weaning her nine-month-old from the breast because she’s pregnant. So congratulations on your pregnancy. And also I’m going to say congratulations on knowing when you need to stop and making it nine months. Like this is a complex thing.

It’s some things people really struggle with knowing when to ween and you know, what their goals are and what to, how long to breastfeed. So, you know, I’m just really impressed that you, you know yourself, you know when you need to stop. So actually Lupita, I have to tell you this. Lin-Manuel Miranda had an improv group called We Are Freestyle Love Supreme.

And I actually purchased one of the episodes for $3 and they asked the audience to give a random name and they were going to rap about it. And someone said Lupita. And they were like, all right. And they have a whole rap song improv. And it goes, what y’all know about Lupita, Lupita. Lupita.. You got to go check it out.

It’s so good. So if you’re a Lin-Manuel Miranda fan, and you really love hearing the sound of your own name, you’re going to love it. All right. What award are we getting today? How about the Know Thy Self Award? I like that. Yeah, because you don’t need to explain yourself to anybody when you’re done breastfeeding.

You’re done and that’s great. You’ve done a great job. Nine months as amazing. Thank you Lupita for being a listener and a member of our group, and we’ll see you next time on the Milk Minute. Ta Ta. Bye. Thanks for listening to The Milk Minute. If you haven’t already please like, subscribe and review our podcast wherever you listen.

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