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00:00 Welcome to the Spoken Tutorial on Hand expression of breastmilk.
00:06 In this tutorial, we will learn- benefits of expressing breastmilk,
00:12 how to express breastmilk by hand and
00:15 how often should a mother express breastmilk.
00:20 Breastmilk expression is useful- to relieve breast engorgement,
00:25 to treat nipple soreness and dry skin on the dark area around the nipple,
00:31 to feed a baby if mother’s sore nipple is extremely painful while latching,
00:38 to increase or maintain mother’s breastmilk supply,
00:42 to keep breastmilk available for a baby when the mother goes out or to work,
00:49 to help a baby to attach to a full breast by softening the dark area around the nipple;
00:57 to check whether the baby has fed from one breast completely before offering the other breast,
01:05 to make nutritious complementary food for a baby by using breastmilk instead of water or cow’s milk,
01:14 and, to help in feeding milk to - premature babies,
01:18 sick babies,
01:20 babies with poor muscle tone,
01:22 babies with cleft lip and/or palate and
01:27 babies who have difficulty in latching deeply to the breast.
01:32 Now, let’s learn how to express breastmilk.
01:37 The most recommended way for a mother to express breastmilk is by using her hand.
01:44 Because this method causes less discomfort to the dark area around the nipple.
01:51 Also, this method needs no appliance. So the mother can do it anywhere and at any time.
02:00 Expressing breastmilk by hand is a learned skill and will improve with practice.
02:08 It is easy to hand express breast milk when the breasts are soft.
02:13 Therefore, a mother should learn this skill on the first or second day after delivery.
02:21 Before expressing breastmilk, mother should have a steel or glass container ready to collect the expressed milk.
02:29 She should choose a cup, glass, jug or jar with a wide mouth.
02:36 She should wash the chosen container in soap and water.
02:41 After that, she should either keep the container in boiling water or pour boiling water into the container and leave it for a few minutes.
02:52 Then, she should either air dry the container completely or wipe it dry with an unused clean cloth.
03:01 The container should never be dried with a used cloth such as a used kitchen cloth.
03:10 After the clean container is dried completely, next step is to release breastmilk from the breast.
03:17 To help her milk flow, the mother should feel relaxed and emotionally connected to her baby.
03:26 Mother can try the following:

She can sit quietly and privately or with a supportive friend.

03:34 Some mothers can express easily in a group of other mothers who are also expressing breastmilk.
03:41 She can hold her baby on her lap with skin-to-skin contact.
03:46 Or she can look at her baby or hear her baby’s voice.
03:53 Sometimes even looking at a photograph of her baby or smelling her baby’s clothing helps.
04:00 She can take a warm soothing drink, but the drink should not be coffee, strong tea, alcohol or any stimulant.
04:12 She can also warm her breasts to help her milk flow.
04:17 To warm her breasts, she can apply a cloth soaked in hot water to her breasts or have a warm water bath.
04:28 She can stimulate her nipples and the dark area around them by-

gently pulling

or rolling them with her fingers.

04:38 She can massage her breasts lightly using circular movements.
04:44 Mother can ask a helper to rub her back.
04:47 For the back rub, the mother should-

sit down,

lean forward,

04:53 fold her arms on a table in front of her and

rest her head on her arms.

05:01 Her breasts should be unclothed and hanging loose.
05:07 The helper should rub down both sides of the mother's spine.
05:12 She should use her closed fist with her thumbs pointing forward.
05:17 She should press firmly, making small circular movements with her thumbs.
05:24 She should work down both sides of the spine at the same time from the neck to the shoulder blades.
05:34 She should do this for two or three minutes.
05:38 All these steps will help in releasing the breastmilk.
05:43 This release of breastmilk is called Oxytocin reflex or let down reflex.
05:51 After the Oxytocin reflex begins, the mother must wash and dry her hands thoroughly.
05:59 Then, the mother should sit comfortably.
06:04 She should lean forward slightly.
06:07 She should hold the container near her breast.
06:11 Now, she should place her thumb and fingers on the breast in a C shape hold from the side.
06:20 She can use either hand for holding either breast. And, she can switch to the other hand when the first one tires.
06:29 While holding the breast, her thumb should be on the upper part of the breast.
06:35 And her fingers should be placed opposite to the thumb on the lower part of the breast.
06:42 Her thumb, nipple and fingers should always be in a straight line.
06:48 And, the nipple should be in the middle of the thumb and the index finger.
06:54 There should be a distance of 2 fingers between-

the nipple and her thumb and

the nipple and her fingers.

07:04 If the fingers are too close to the nipple, the milk may not flow for long.
07:10 Mother will release more milk when she compresses the milk ducts beneath the dark area around the nipple.
07:19 In this picture, the mother is holding her right breast correctly with her right hand.
07:27 Now, she should press the breast slightly inwards towards the chest wall by applying steady pressure.
07:36 Then, without moving the hand gently compress the breast between the thumb and the fingers.
07:44 And then release the pressure on the breast.
07:48 The mother should repeat these 3 steps-

Press back, Compress, And release.

07:56 The first step of pressing back towards the chest wall is an important step.
08:02 Pressing only towards the nipple will give very little milk.
08:07 But when the breast is pressed back, milk from the dense breast tissue is released.
08:15 But, avoid pressing too far back because that can block the milk-ducts.
08:23 When the mother starts expressing breastmilk by hand, very few drops of milk may come out at first.
08:30 As the let down reflex starts, milk starts to drip out.
08:36 In the first few attempts, it is common for the milk to drip out or come slowly.
08:42 Later, breastmilk may flow in streams. As with breastfeeding, expressing breastmilk is a skill that comes with practice.
08:53 Colostrum, the first milk after birth, may only come in drops but is enough for the newborn.
09:01 The thick, often yellow, milk has enormous protective benefits for the baby.
09:08 The mother should repeat the 3 steps until the flow of milk slows down to a drip again.
09:15 Then she should re-position her fingers to express milk from other parts of the breast.
09:23 She can feel for where the breast seems fuller and compress those areas.
09:30 She should express milk from one breast for at least 3 to 5 minutes until the milk flow slows down.
09:38 Then she should express milk from the other breast in the same way from all the areas.
09:45 And then, again express milk from both breasts a second time.
09:51 Expressing breastmilk from both breasts adequately takes 20 to 30 minutes.
09:57 It may take more time, especially in the first few days. As in those days, only a little milk may be produced.
10:07 It is important not to try to express in a shorter time.
10:12 Remember, expressing breastmilk by hand should not hurt. If it hurts, the technique is wrong.
10:21 Breast tissue is delicate.
10:24 Avoid rubbing, sliding or pulling the fingers along the skin, towards the nipple.

This can cause breast soreness.

10:36 Avoid tightening or stretching the skin over the dark area around the nipple.
10:42 Also, avoid squeezing or pulling the nipple.
10:46 Pressing or pulling the nipple cannot express enough milk.
10:51 It is the same as the baby sucking only the nipple.
10:57 After expressing breastmilk, the mother should cover the container with a clean cloth or plate.
11:04 Then, she should store her breast milk safely for later use.
11:09 Safe storage of breastmilk and feeding stored breastmilk to the baby are explained in another tutorial.
11:19 Let’s now discuss how often a mother should express milk.
11:24 If the purpose is to initiate and maintain breast milk production

Or to feed a low birth weight baby or sick newborn baby, then-

11:35 she should express milk as soon as possible after delivery.
11:40 She may only express a few drops of Colostrum at first.
11:45 This helps breastmilk production to begin.
11:48 It acts similar to a baby suckling soon after delivery.
11:54 The mother should express as much as she can and as often as her baby would breastfeed.
12:02 This should be at least every 2 to 3 hours, including during the night.
12:08 If there are long intervals between expressions, she may not be able to produce enough milk.
12:16 Next, if the purpose is to build up mother’s milk supply and if it seems to be decreasing after a few weeks:
12:25 she should express breastmilk every 1 to 2 hours immediately after breastfeeding the baby and
12:33 if the baby is expected to sleep for more than 3 hours, then she can express in between feeds.
12:42 If the purpose is to relieve symptoms such as engorgement or leaking of breastmilk at work:

the mother should express only as much as is necessary.

12:53 If the purpose is to keep nipple skin healthy:

the mother should express a small drop of breastmilk to rub on her nipple.

13:02 She should do this after a bath and after breastfeeding.
13:07 If the purpose is to keep milk for her baby while the mother is out at work:
13:14 the mother should express milk while at work to help keep up the supply.
13:20 And, the mother should express breastmilk before going to work and leave it for the carer to give to the baby.
13:29 For doing this - mother can plan few weeks ahead if she has a fridge.
13:34 She can express extra milk and store it for later use.
13:39 Mother can express even after the baby has breastfed.
13:44 Mother should leave about 60 to 90 milliliters of milk for each feed.
13:51 More breastmilk can be given as per baby’s need while mother is away.
13:57 Remember- the more frequent hand expression is used, the easier it becomes to express milk, the faster the milk releases.
14:07 And, the more milk mother will make.
14:11 This brings us to the end of this tutorial.

Thank you for joining.

Contributors and Content Editors

Debosmita, PoojaMoolya, Sandhya.np14