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.

 

Happy Asian American Pacific Islander (AANHPI) Breastfeeding Week 2024: Bridging the Gaps

National Breastfeeding Month is such a dynamic time of year on account of the weekly observances that honor unique cultures and voices within the wider realm of lactation and breastfeeding. 

This week, we celebrate Asian American Pacific Islander (AANHPI) Breastfeeding Week (August 15 to 21) with the theme Bridging the Gaps, in a call for advocacy around culturally tailored education and community-reflective lactation support. 

We’re revisiting a previous publication, as we did earlier this summer celebrating various national celebrations, in honor of AANHPI Breastfeeding Week. 

We hope you’ll enjoy this reworking of A collection of stories by and about those in the AANHPI community, which was originally published last summer. 

——

The 2023 Asian American Native Hawaiian Pacific Islander (AANHPI) Breastfeeding Week Telling our own stories. Elevating our voices was rich with opportunities to engage, learn and celebrate. 

Gorgeous content from Asian, Southeast Asian, Pacific Islander (ASAP!) Breastfeeding Taskforce’s Social Media Toolkit 2023

As part of the observance, the U.S. Breastfeeding Committee AANHPI Caucus presented the AANHPI Lactation Community Forum, an open panel discussion where AANHPI community members shared about their journeys to becoming lactation support professionals as well as provided guidance on how we can further build community capacity to support AANHPI families.

The Alameda County’s Asian, Southeast Asian, Pacific Islander (ASAP!) Breastfeeding Taskforce AANHPI Social Media Toolkit produced shareable social media content including messages and captions in the toolkit which have been translated into 11 different AANHPI languages: Chinese (both traditional and simplified), Farsi, Hindi, Hmong, Japanese, Korean, Native Hawaiian, Samoan, Tagalog, and Vietnamese.

It’s also become tradition to host the AANHPI Coloring Pages Contest. 

In an engaging discussion with Tonya Lang, MPH, CHES, IBCLC and Grace Yee in 2022, they described the diversity that exists under the AANHPI umbrella, shaking away the stereotypical idea that Asian culture is monolithic.

The Asian Pacific Institute on Gender-Based Violence begins to describe the complexity of AAPNHPI groupings and the forces that shape identity in Census Date & API Identities. AAPI DATA, which provides demographic data and policy research on Asian Americans and Pacific Islanders, compiled some wonderful visuals to help shape the numbers.

The overgeneralization of the API community has led to some misleading data about breastfeeding rates. On an aggregate level, initiation and duration rates are relatively high, but the statistics don’t account for stark disparities within these population groups. This piece covers this phenomenon in more depth and offers strategies for tailoring infant feeding support in the Chinese American population.

More gorgeous content from Asian, Southeast Asian, Pacific Islander (ASAP!) Breastfeeding Taskforce’s Social Media Toolkit 2023

As Dr. Magda Peck has pointed out, numbers and data are important because they drive decisions and policies, but they also have the potential to sanitize humanity. That’s where stories come in. Not only do they humanize the numbers, they can also help us make sense of the data.

In an effort to demonstrate the complexity and diversity of this population, we have collected several stories by and about those in the AANHPI community.

First up, is To-wen Tseng and her contributions to the San Diego County Breastfeeding Coalition’s blog. Tseng wrote most recently about her ‘why’ reflecting on National Breastfeeding Month. Read that piece here.

Joanne Datangel-Gallardo, MD, DPPS of the National Children’s Hospital, Philippines has worked extensively with relactation efforts. Read about Dr. Datangel-Gallardo’s work here.

Also out of the Philippines is a piece by Micaela Papa detailing how breastfeeding saved one baby’s  life and helped her mother recover from the stress of Typhoon Odette.

Not far south from this archipelago, is the island nation of Timor Leste. Here, emergency response efforts to protect breastfeeding have saved the lives of many. Community members manage and intercept artificial baby milk and other ultra-processed food product donations among other components of the nurturing care model. Read about these efforts here.

In Indonesia, efforts are also underway to combat commercial milk formula companies. Find a simple model for reporting Code violations here.

Jenny Lei Ravelo writes about the tangle of infant feeding complexities on Indonesia’s remote islands complete with stunning photos in partnership with the 1000 Days Fund.

In India, the Foundation for Mother & Child Health (FMCH) works to empower families from vulnerable communities with actionable information and services, resulting in health seeking behavior and nutritious food choices in order to tackle maternal child malnutrition, ultimately breaking the cycle of poverty. Read about the organization’s impact here.

And another beautiful collection from Asian, Southeast Asian, Pacific Islander (ASAP!) Breastfeeding Taskforce’s Social Media Toolkit 2023

In Spring 2023, the Asian Pacific Islander Breastfeeding Task Force(APIBTF) a part of Breastfeed LA, tailored the Dietary Guidelines for infants and toddlers for Chinese and Vietnamese communities, a project that augments APIBTF’s sister organization Alameda County’s Asian, Southeast Asian, Pacific Islander (ASAP!) Breastfeeding Taskforce’s Continuity of Care (CoC) Blueprint Project Prenatal Toolkit for AANHPI families. You can find out more about the efforts to center culture in health here.

Also exemplifying culture centered in health, is the Hmong Breastfeeding Initiative (HBI). With funding from Reducing Disparities in Breastfeeding through Continuity of Care Identifying Care Gaps grant from National Association of County and City Health Officials (NACCHO), the Hmong Breastfeeding Coalition (HBC) conducted an environmental scan of the Twin Cities (Minneapolis and Saint Paul, Minn.) on breastfeeding promotion and support for child-bearing age Hmong women and families. Read more here.

Tiffany Pao Yang has played a crucial role in this work. The daughter of Hmong refugees, she is especially invested in helping change the narrative around infant feeding in the Hmong population. Read part of her story here.

 

MORE TO EXPLORE

  • Professionals who identify as AANHPI or work PRIMARILY with AANHPI communities in birthing or lactation, are invited to complete a 10 minute nationwide survey and share it with colleagues.

The AANHPI Lactation Collaborative seeks to compile and create a resource directory to share publicly on their website. Your answers will also help inform future projects focused on increasing access to lactation support and resources for AANHPI birthing people.

If you have completed this survey in the past, please only retake it if you need to update your responses.

Responses are confidential other than information voluntarily provided for the AANHPI resource directory.

To take the survey, go to: https://tinyurl.com/AANHPICollabSurvey

Rambling about breasts

This week, I’m coming to you with some sort of ramble, an entry of things that have brought me joy over the last few weeks, all breast-related of course.

Wrought iron (assumed unintentional) breasts on Milwaukee building

To begin, a dear friend recently messaged me to share about a date she’d been on. She and the guy got on the topic of breastfeeding; she told him about how a mom’s body and baby’s saliva communicate to influence antibodies. 

“He shared [the info] with a friend who said she was going to switch to pumping her six month old because he got teeth,” she told me. “I was like wow, seriously, that is awesome. But then I also told him not to pump-shame!” 

Art positioned at the Henry Miller Memorial Library in Big Sur, Calif.

On another evening, I was at my kids’ grade school function in a circle with four other parents discussing Doomsday. What might it look like? we wondered. What’s the best approach to survival? What kind of supplies might we need? What will happen to currency? Isn’t it true that Hell is already here on Earth for so many? Breastfeeding and my milk were my answer to any distressing moment when I was lactating. Pink eye? Squirt some breastmilk on it. Kid scraped a knee? Breastfeed. Tumultuous bedtime? Breastfeed. And we know that breastfeeding is a lifeline in any true emergency situation. So I added to the Doomsday discussion, suggesting that I might work on relactation, mostly kidding but also reminiscing about how it used to fix all of my problems. One of my peers gasped, “Oh my god! Is that possible?!” I described how relactation could be possible for some. It was decided that this could be our savior in the event of an apocalypse.

El Niño advertisement at the Lincoln Center features breastfeeding Madonna

Then, last weekend, at an extended family gathering, we all oohed and aahed while the darling 10-month old at the table enjoyed his meal. My oldest daughter, 12, asked what her favorite food was when she was around his age. I thought about it, not remembering anything specific except, “The breast!” My kids liked nothing more than nursing. This embarrassed my daughter, but the rest of us had a good chuckle, and it was good to remember a time when my now preteen only wanted to be with me. 

The other sources of joy that I’d like to share with you come from the internet. 

I’ve been moved by and admiring these provoking, stunning pieces of art:

The Lactation Station 

Breastfeeding with Mother 

Workday Madonna with Child 

My Nurse and I 

Milky Way 

The Harvest

The Awakening Series 

Equally entertaining is an Instagram post by Dr. Katrina Mitchell: “​​The world’s most perfect dog toy: a burning bra, ‘Bite the Patriarchy’”.  

Pregnant belly formation at Crystal Caves on Grand Cayman Island

Then there’s Atlas Obscura which I frequent for oddball attractions in my area and across the globe. This week I came across the Mama Kannon Temple, a Buddhist temple in Japan dedicated to breasts. Somehow, this discovery led me to learn about the legend of Difunta Correa in Argentina. I’ve added both to my travel bucket list. 

And finally, I happened upon the Museum of Motherhood in St. Pete, Fla. It has a boob chair. This brings me immense joy, and I hope it’s a bright spot in your life too.