Category: Miscellaneous

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Why Hand Expression is a Critical Skill

Why Every Breastfeeding Mother Should Know How to Hand Express Milk—Especially in Emergencies

This week, over 37 states in the US experienced a snow storm and snow emergency. It seems like a good time to talk about hand expression! Emergencies rarely arrive with warning. Power outages, natural disasters, hospital evacuations, sudden separations, equipment failure, or even something as simple as a forgotten pump can instantly disrupt a breastfeeding routine. In these moments, one low-tech, evidence-based skill can make an enormous difference for both parent and baby: hand expression of breast milk.

Despite being a foundational breastfeeding skill, hand expression is often under-taught, under-practiced, or framed as a “backup” rather than a core competency. In reality, knowing how to hand express milk is a form of preparedness—one that protects infant nutrition, maternal health, and breastfeeding continuation during emergencies.

Emergencies Don’t Stop Milk Production

Breast milk production continues regardless of circumstances. When milk is not removed effectively, several problems can arise quickly:

  • Breast engorgement and pain
  • Plugged ducts and mastitis
  • Reduced milk supply due to poor drainage
  • Increased stress, which can further interfere with milk ejection

In emergencies—such as hurricanes, wildfires, floods, or extended power outages—electric pumps may be unusable, and clean pumping supplies may be unavailable. Even in hospitals, emergencies can lead to separation between parent and infant, delayed feeding, or lack of immediate lactation support.

Hand expression requires no electricity, no equipment, and no special storage containers. It relies solely on the parent’s hands and knowledge, making it one of the most resilient breastfeeding tools available.

Hand Expression Is More Than a “Last Resort”

Hand expression is sometimes mistakenly portrayed as inferior to pumping. However, research and clinical experience consistently show that hand expression is highly effective—particularly in the early postpartum period and during times of stress.

Benefits of hand expression include:

  • Effective milk removal, especially for colostrum
  • Improved comfort and control compared to pumps
  • Reduced reliance on equipment that may fail or be unavailable
  • Lower risk of contamination when pump parts cannot be properly cleaned
  • Immediate relief from engorgement or pressure

For parents of newborns, hand expression can be especially critical when infants are sleepy, premature, ill, or temporarily unable to feed directly at the breast.

Emergency Scenarios Where Hand Expression Matters

Knowing how to hand express milk can be lifesaving—or at least breastfeeding-saving—in many real-world situations:

Natural disasters: Power loss, evacuation, and disrupted supply chains can eliminate access to pumps, replacement parts, or formula. Hand expression ensures continued milk availability.

Hospital emergencies: During emergency cesarean sections, NICU admissions, or maternal illness, hand expression may be the fastest way to initiate or maintain milk production.

Unexpected separation: If a parent and infant are separated due to medical care, transport delays, or sheltering situations, hand expression helps protect milk supply until reunification.

Pump failure or absence: Pumps break, batteries die, and equipment gets forgotten. Hands do not.

Pain or trauma: After breast surgery, nipple trauma, or significant engorgement, some parents find hand expression more comfortable and effective than pumping.

Supporting Infant Feeding When Resources Are Limited

In emergency settings, clean water, sterilization equipment, and safe formula preparation may be compromised. Breastfeeding and expressed human milk reduce the risk of infectious disease by eliminating exposure to contaminated water or feeding equipment.

Hand expression also allows milk to be:

  • Expressed directly into a clean cup, spoon, or syringe
  • Fed immediately without long-term storage
  • Shared safely with infants who cannot latch temporarily

This flexibility is particularly important in shelters, field hospitals, or low-resource emergency environments.

Emotional and Psychological Benefits

Emergencies are stressful, and stress can undermine confidence in breastfeeding. Hand expression offers parents a sense of control and agency during chaotic situations.

Many parents report that knowing how to hand express:

  • Reduces anxiety when plans fall apart
  • Reinforces trust in their body’s ability to nourish their baby
  • Helps them feel prepared rather than helpless

This psychological resilience is not trivial. Confidence and perceived self-efficacy are strongly linked to breastfeeding continuation.

Why This Skill Is Often Overlooked

Despite its importance, hand expression is frequently taught briefly—or not at all—in prenatal classes and postpartum care. Common barriers include:

  • Overemphasis on pump technology
  • Time constraints in clinical settings
  • Assumptions that pumping will always be available
  • Lack of hands-on teaching

As a result, many breastfeeding parents only learn hand expression after encountering a crisis—when stress is high and support may be limited.

A Call to Normalize Hand Expression Education

Hand expression should be taught:

  • Prenatally, as part of breastfeeding preparation
  • Postpartum, before discharge from birth facilities
  • By all lactation and maternity care providers
  • As an essential skill, not a backup option

Just as families are encouraged to prepare emergency kits with food, water, and medications, breastfeeding families deserve preparation that protects infant feeding during disruption.

Prepared Hands Save Breastfeeding

In an unpredictable world, breastfeeding resilience matters. Hand expression is simple, portable, free, and powerful. Teaching and normalizing this skill is not just good lactation care—it is emergency preparedness, maternal health protection, and infant feeding security rolled into one.

Every breastfeeding parent deserves to know that even when systems fail, their hands can still nourish their baby.

You can find an excellent video on how to hand express here.

 

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Marketing Hype or Good Health-You Decide

 

Donna Walls, RN, BSN, ANLC

I do love to watch commercials- they tell you so much about what is happening around us. At times, I have to voice my displeasure loudly, somehow believing the TV can hear me and will surely take the action I am strongly suggesting.

I have been a breastfeeding advocate for many years and have often wondered how an inferior product like formula (I really think NO ONE can dispute that breastmilk is superior), that costs money can even be competitive with a superior product that is free? I will assume it’s marketing and tactics that make formula appear to be equal or better.

What protections do we, as parents and professionals, have when it comes to information about products and services that affect our family’s health? Is there a clear line that states “this is hype or this is evidence-based information?” That line appears to be blurred so much of the time.

I will use infant formula as my first example. Several years ago there was a campaign to promote a formula that claimed to reduce infant crying by 50%. Can you imagine how many new parents were heading out the door in minutes to purchase this miracle, giving up on breastfeeding because of an  unsubstantiated claim. Preying on new parents’ vulnerability to bolster sales was the marketing plan. They eventually did have to remove the formula from the market, but how many infants were deprived of the benefits of breastfeeding before that happened?

Our food supply is another example of when marketing may be at odds with health goals. Marketing of foods usually focuses on ease and convenience, not the health promoting benefits of the foods. Companies producing foods have as the goal to make a profit while  optimum nutrition is not the bottom line. Preservative chemicals such as BHA (used in plastics), propylparaben (used in floor cleaners) or potassium bromate (used in bomb-making) have all been shown to have health-harming effects yet these and many other additives are commonly found in our foods.

Many foods are ultra-processed, making them more shelf stable, more convenient and more profitable but the processing often strips the foods of naturally occuring nutrients. Ultra-processed foods are either synthesized chemicals or dramatically altered foods with one or more additives that are not usually used in cooking. These additives include preservatives, flavorings, dyes,  artificial sweeteners or agricultural herbicides and pesticides, all substances that are never found in naturally occurring foods. Some of the health related concerns which have been shown to be related to eating and drinking these foods are increased risk of obesity, type 2 diabetes, heart disease, certain cancers, and even premature death. Some examples of ultra-processed foods are:

Sugary drinks (sodas, sweetened coffee/tea, energy drinks)

Deli meats including hot dogs and sliced meats

Frozen pizza and frozen meals

Snacks such as chips, cookies, crackers, baked goods

Many breakfast cereals

Canned soups

and

Infant formula

 

Now, let’s take a look at the personal the care products we use on ourselves and our families everyday. Commercials and social marketing promise to make us clean, soft, young and smelling like spring flowers.  We have been lulled into believing that a cream, lotion or spray can make our dreams come true. If only it were that easy and it came with no side effects. Everyday we are exposed to as many as 125 chemicals in personal care products, most with demonstrated health concerns. And it starts in pregnancy.

 

From creams to prevent stretch marks (they never work but the promise sells) to much needed pregnancy pampering including facials, massages and, of course the mani-pedi. These luxuries come with a steep price. Most of these contain additives which are categorized as endocrine disruptors that alter or block the functions of our natural hormones. Volumes of studies point to these chemicals causing increasing rates of reproductive cancers, falling fertility rates, increased risk of premature birth, early sexual maturation, fetal anomalies and damage to mammary cells causing concerns with milk production and supply.

Funny, we never hear about these concerns on glitzy ads. We are never encouraged to use simple coconut oil to moisturize, no-additives bar soaps and shampoos or essential oil based deodorants. Our actual health seems too often to take a back seat to profitable products promising  good- smelling babies and youthful moms.

 

So the next time you see a commercial promising easy, quick happiness- stop. Read the labels, do some research and make conscious purchasing your next step. Your health and the well-being of your family and friends will be your reward!!

 

References and Resources

https://www.who.int/news/item/28-04-2022-who-reveals-shocking-extent-of-exploitative-formula-milk-marketing

EWG.org/skindeep

Avoiding endocrine disruptors in toiletries, cosmetics and menstrual products

https://www.ewg.org/the-toxic-twelve-chemicals-and-contaminants-in-cosmetics

Nigel Rollins, MD, et al. Lancet.. Marketing of commercial milk formula: a system to capture parents, communities, science, and policy. Volume 401, Issue 10375p486-502February 11, 2023

UNICEF Examining the impact of formula milk marketing on infant feeding decisions and practices. 2022

https://communitycatalyst.org/work/building-power-with-communities/people-over-profit/

Bottom of Form

Chang, K, et al. Ultra-processed food consumption, cancer risk and cancer mortality: a large-scale prospective analysis within the UK Biobank The Lancet eClinical Medicine. Volume 56, February 2023

 

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The Problem with Plastics

Guest Blogger: Donna Walls

We love convenience. Anything to make our hectic lives easier is in our shopping carts. But, as we have learned over the decades, easier is not always better and plastics is a perfect example.

Plastics have crept into our lives over the past decades and become an ever-present part of our everyday lives. And until recently we assumed this modern convenience was just that, a convenience. But the evidence is piling up that this wonder of modern chemistry is actually harming the health of the environment and our families. Recent research has shown very small particles of plastics can be found in the human body. These tiny particles accumulate in our brain, lungs, blood, liver, reproductive organs and even in placentas. Recent research is also showing an alteration in the microbiome due to the presence of microplastics, which affects digestive functions and impacts the immune system.

How it happens:

Plastics break down into micro (<5 mm) and nano (<100 nm) plastics which are more easily absorbed into the human body. These plastics are a source of endocrine-disrupting chemicals, and include phthalates, bisphenols, alkylphenols, crude oil, dioxin and per- and polyfluoroalkyl substances, or PFAS, just to mention a few. These endocrine disrupting chemicals (EDCs) are associated with:

  • early sexual maturation
  • decreased fertility in men and women
  • preterm labor
  • thyroid and immune system dysfunction
  • neurodevelopmental delays in young children
  • abnormal mammary development and function
  • increased risk of reproductive cancer
  • central nervous system dysfunction including mood imbalances and ADHD

 

Maternal and Infant Health

Data from the US National Institutes of Health Environmental influences on Child Health Outcomes (ECHO) Program from 1998 to 2022 showed negative associations of phthalate metabolites with gestational age at birth, birthweight, birth length, birthweight for gestational age, and adverse birth outcomes. Studies in The Lancet Planetary Health show increased risk for pre-term birth after plastic chemicals exposures. Research at Mt. Sinai School of Medicine showed children were 2.5-times more likely to have attention problems that were “clinically significant” if their mothers were among those with the highest exposure to phthalates during pregnancy.

Plastic endocrine disruptors have also been implicated in breastfeeding insufficiencies. In 2024 an Environmental Health News study noted that “Women exposed to toxic PFAS chemicals before pregnancy are more likely to experience early cessation of breastfeeding”. We should also consider teaching parents about microplastics in bottles and milk storage bags.  “if infants were fed exclusively on pumped breastmilk stored in breastmilk storage bags, on average, an infant would ingest 0.61 to 0.89 mg of microplastics a day”. (Liu, 2023).

 

 

What can we do to reduce the use and exposures to plastics?

 

  • Switch to filtered water in stainless steel, bamboo, or glass water bottle. Avoid the use of plastic bottles for other drinks as well.

 

  • Use reusable shopping bags that can be washed and reused.
  • Do not use plastic cutting boards. The journal Ecotoxicology and Public Health found as many as 1,114 microplastic particles with each use. Scientists from the University of North Dakota also found that cutting carrots on a plastic board can generate as much as 15 milligrams of microplastics per cut, or about 50 grams per year – roughly equivalent to the weight of ten plastic credit cards.

 

  • Minimize the use of plastic or plastic-coated dishes, bowls and utensils.

 

 

  • Store food in glass, stainless steel, or paper containers. Purchase foods in glass jars whenever possible and reuse for storage.

 

  • If you’re a tea drinker look for plastic-free tea bags or use loose leaf tea.

 

 

  • Avoid plastic infant bottles, sippy cups, feeding bowls, food containers, and pouches.

 

  • Never microwave foods in plastic containers.

 

 

  • If using plastic bags for food, place an unbleached paper towel around the food to decrease contact with the plastic.

 

  • Purchase clothing make of natural fibers like cotton, bamboo, or hemp whenever possible.
  • Purchase and support companies that are ditching plastic bottles and containers like detergent strips and bar soap and shampoo that are packaged in paper.

 

  • Look for canned goods that state on the label that they are not lined with plastics or are BPA free.

 

 

  • Look for products that use newer “plant-based” plastics, sometimes referred to as bioplastics, with little or no plasticizing chemicals.

 

  • Avoid pliable plastic wrap, you can cover foods with beeswax cloths or other dishes.

We can do a lot by supporting companies that use less plastic in their products and packaging and talking to your friends, families, and community groups about these concerns and ways to protect our families from plastic exposures.

 

References and Resources

 

Zurub RE, et al. Microplastics exposure: implications for human fertility, pregnancy and child health.2024 Jan 4;14:1330396. doi: 10.3389/fendo.2023.1330396. eCollection 2023.PMID: 38239985

 

EWG.org   The Environmental Working Group

 

https://www.globalplasticlaws.org/un-global-plastics-treaty

 

Zhu L, et al. human. Total Environ. 2024 Mar 10;915:170004. doi: 10.1016/j.scitotenv.2024.170004. Epub 2024 Jan 12.PMID: 38220018

 

 

Hussain, K. Assessing the Release of Microplastics and Nanoplastics from Plastic Containers and Reusable Food Pouches: Implications for Human Health.  Environ. Sci. Technol. 2023, 57, 26, 9782–9792.Publication Date:June 21, 2023. https://doi.org/10.1021/acs.est.3c01942

www.endocrine.org/-/media/endocrine/files/topics/2020-dec-7-harmful-chemicals-backgrounder.pdf

Amboyne, A. Environmental Impacts of Microplastics and Nanoplastics: A Current Overview.Front. Microbiol., 15 December 2021. Sec. Microbiotechnology Volume 12 – 2021 | https://doi.org/10.3389/fmicb.2021.768297

EHN.org   The Environmental Health News

https://www.sciencedirect.com/science/article/pii/S0048969724055001

Liu, L. et al. (2023) “Release of microplastics from breastmilk storage bags and assessment of intake in infants: A preliminary study”, Environmental Pollution, p. 121197. doi: 10.1016/j.envpol.2023.121197.

https://www.sciencedirect.com/science/article/abs/pii/S0269749123001999

 

www.LifeWithoutPlastic.com

 

A Beginners Guide to Plastic-free Living  https://www.treehugger.com/beginners-guide-plastic-free-living-4858498

Impacts of Plastic Pollution  https://www.epa.gov/plastics/impacts-plastic-pollution#environmental

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Newest Research on Skin-to-Skin contact in the first hour

As you may know, here at The Healthy Children Project, Center for Breastfeeding, our focus has 4 main points;

  • Education: Offering lactation training programs for novices and professionals
  • Collaboration: Working together to create meaningful change in the field of maternal and child health care delivery
  • Research: Designing and implementing collaborative inquiry to solve practical dilemmas incorporating evidence-based protocols and solutions
  • Consulting: Developing and implementing community-specific strategies to promote, protect and support breastfeeding

Last year, several of our faculty and staff traveled to Uganda for a project that embodied all four of these focus points. Research based on the work they did was recently published in Scientific Reports. The impact of implementing and sustaining the international guidelines for skin-to-skin contact in the first hour after birth in Uganda.

I was able to sit down with one of the authors of the paper, Dr. Kajsa Brimdyr, to talk about the work and the experiences of the team while in Uganda.

Dr Brimdyr, can you tell us a little about the project?

While the project began in January 2023, planning began a year earlier. We’ve known Scovia Nalugo Mbalinda for many years. She and I worked together in Gulu, Uganda on a skin-to-skin project that resulted in several papers (you can find one here) and the beautiful video Kristin Svensson and I created to educate about skin-to-skin in Gulu. (You can watch it here). Mike was a member of the International Guideline Project workshop that we conducted in Iceland in 2023 (read the guideline here) and it was thrilling to work together again. Our team was interdisciplinary, from the US, Sweden and Uganda, consisting of PhD researchers, an MD, midwives, and breastfeeding specialists along with two Ugandan research assistants. We worked collaboratively with the leadership team at the hospital, including midwives, nursing students and physicians.

When we arrived at the hospital, our team started out by observing births and the newborn behavior. We video recorded newborn behavior starting from birth and continuing for the first hour. This was to get a baseline of what was happening at the facility.

Then, we began to implement the research methodology, PRECESS, which we have used and published about in the past in Egypt (read about it here) and Texas (and here). We began with a training program for staff based on the supplementary material in the International Guideline for Skin to Skin (you can find a copy of the supplementary material here).

True skin-to-skin contact begins immediately after birth and is uninterrupted and continuous, for at least an hour after birth. We also offered guidance for potential challenges. Then, the staff began implementing the guideline: immediate, continuous, uninterrupted skin-to-skin contact for at least an hour after birth for all of the deliveries – every staff member, every shift. It was a change in practice, not just a change for those who were part of the study. The hospital made the decision to change care for all. Then, our research team came back 6 weeks later. Not only were the staff continuing to implement the guideline, but they had also improved their skill with skin to skin.

When staff first see how capable newborns are, as they see the 9 stages for the first time, it’s just so special to me. They can see how much these new babies can do.

There are still challenges ahead. For example, the beds in the labor and delivery are narrow and don’t have side rails, and mothers are worried that the baby might fall off…. and it would be helpful if the unit had beds that are more conducive to skin to skin in the first hour.

 What do you think the key take-aways are from the project?

I love that this intervention is quick and easy to implement, and that it is sustainable. It’s possible to make significant change in a short period of time.

Was there anything that surprised you while you were there?

We were not surprised by this, but we were impressed by the collaborative spirit of the team at the hospital. Our research team was at the hospital 24 hours a day and we worked long shifts to cover the time. It was important for us not to just be there for births of only one shift of staff or another, but covering nights, days and weekends. The staff were so warm and welcoming, teaching us their process, and embracing the changes.

Do you have any favorite stories about your time there?

We loved so many parts of our experience doing this research. One thing that was extra fun was the storks. They have these enormous, 5-foot-tall storks, with a wing span of 12 feet! the storks live in that part of Uganda. The maternity hospital had a tree just outside of it filled with these storks. In many parts of the world, storks are a symbol for babies being born. Our team thought it was so special that the storks like to hang out at the maternity unit!

Is there anything else you’d like us to know about your work in Uganda?

There’s more to come! We’ll let you know when the other articles are published!

Let us know what you think or if you have any questions about the newest research paper. And as always, may all your ways be Milky Ways.

 

 

 

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Allow me to introduce myself

Have you ever noticed that parents always have stories about breastfeeding? When you introduce yourself and they learn that you work in the field of lactation, it seems to me that there is always a story. And parents really want to tell you theirs. Upon reflection, this makes sense to me. Giving birth and the subsequent feeding of an infant is a life changing event. It’s right up there with…well, I think if I’m being honest, it stands alone as a monumental moment in a person’s life.

I love to hear the stories. I love to hear about a parent’s journey through breastfeeding; the struggles, the triumphs, the frustration, the elation. All of it! Bring on the stories!

And that is part of what I hope to do here, at Our Milky Way. My name is Kristin and I am honored to be taking over the blog from Jess. Jess has shepherded this blog from infancy to this point. Her work is incredible, the stories she has shared are inspiring. I hope to do her work justice and continue writing interesting, inspiring, thought provoking work.

The first story I would like to share with you is my own. For those of you that have been around awhile, you have probably heard us say “all roads lead to breastfeeding”. And around here, that is certainly true, though some of our roads were a little windier than others. As with a lot of lactation care providers, my story starts with my own breastfeeding journey.

Imagine, if you will, a bright eyed young 29 year old woman; well educated, strong willed, and dare I say it, over confident. I took the birthing class because…birth seemed well outside my scope of experience. But a breastfeeding class? Nope. Didn’t take that because…breastfeeding, how hard could it be? You put the baby’s mouth on your nipple and they feed, right? Well, the big day arrives and we go through labor, lots of labor, we end up with an emergency C-section and my daughter is whisked away to the NICU for observation. After 4 agonizing hours, they bring her to me, checked, poked, prodded and cleared for action. And she is very, very hungry. And quite frankly, more than a little pissed-off. So I put her mouth next to my nipple and….she’ll have none of it. She is so mad, so frustrated that she will not stop crying. So of course, I start crying, which in turn leads my husband to start crying. I think the only one not crying at this point is the nurse. So, she makes a helpful suggestion that we give the baby “just one bottle” of formula to calm her down and then we can try again.

I know, I know…hindsight is 20-20.

Now, I need to clarify that I do think the nurse was trying to be helpful, but as you can probably guess, after that “one bottle” there was no going back for my stubborn, strong willed (like her mamma) little girl. To make this long story a bit shorter, we wound up pumping for 5 weeks to give her breastmilk from a bottle and then finally threw in the cloth diaper and switched to formula.

Fast forward 2 years and I am pregnant again and this time I am bound and determined to breastfeed. We end up with another C-section after trying for a VBAC and this time they bring my son to me in the recovery room! At which point, my husband turns to the nurse, who happens to be a lactation care provider, and says:

“If we don’t get this baby to breastfeed my life will never be the same!”

While a little self-serving, it worked. The nurse helped me to breastfeed in the recovery room. And we went on to successfully breastfeed for a year. There is more in that story, and I will share more as we get to know each other here. A little peek into the deeper story; cracked nipples, phone help with a CLC, circus (yes, you read that right), community support and a lot of learning.

Fast forward again about 5 years and I am back here on Cape Cod, where I grew up. I meet an old friend who tells me she works for the Healthy Children Project, Center for Breastfeeding. And of course, I tell her my story (see first paragraph above). About a year later I am working for Healthy Children, I’ve taken the Lactation Counselor Training Course, I know everything that went wrong with my own stories and I realize that this! This is what I want to do! I want to help other parents avoid the pitfalls, the mistakes, the misinformation. And well, the rest is history. I am proud to say I have been working with Healthy Children for over 15 years now. I learn constantly. I am inspired often. I am lucky lucky lucky to work with this amazing group of women.

But enough about me! I want to hear about you. For real! I find blogs so much more interesting if folks comment and participate in conversation. Maybe you have or know a good story? Reach out, I’d love to hear it and maybe share it. In the meantime, may all your ways be milky ways!

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