Health-and-Nutrition/C2/Hand-expression-of-breastmilk/English

Visual Cue	Narration
Slide Number 1 Title Slide	Welcome to the Spoken Tutorial on hand expression of breastmilk.
Image: Woman feeding breastmilk to a baby from a cup GIF: Mother expressing breastmilk with her hand. Image: Multiple pictures of mother expressing breastmilk	In this tutorial we will learn, Benefits of expressing breastmilk How to express breastmilk by hand and How often should a mother express breastmilk
Image: Mother is expressing her breastmilk by hand. GIF: Mother expressing breastmilk Image: Mother with engorged breasts.	Breastmilk expression is useful to: Relieve breast engorgement;
Image: Dry, sore and cracked nipples. Image: Sore and cracked nipple	To treat nipple soreness and dry skin on the dark area around the nipple;
Image: Mother in pain Image: sore nipple	To feed a baby if mother’s sore nipple is extremely painful while latching
GIF: Mother’s breastmilk supply increasing	To increase or maintain mother’s breastmilk supply;
Image: Working mother	To keep breastmilk available for a baby when the mother goes out or to work;
Image: Full breast Image: Baby trying to attach to a full breast	To help a baby to attach to a full breast by softening the dark area around the nipple;
Image: Foremilk. Image: Hindmilk. Image: Mother breastfeeding from right breast Image: Mother offering left breast to the baby. Image: Empty breast and breast full of milk.	To check whether the baby has fed from one breast completely before offering the other breast.
Image: Bowl of complementary food with water added to it. Image: Bowl of complementary food with breastmilk added to it. Image: More than sign. (>)	To make nutritious complementary food for a baby by using breastmilk instead of water or cow’s milk
Image: Premature baby Image: Sick baby Image: Baby with poor muscle tone Image: Baby with cleft lip Image: Baby with cleft palate Image: Baby is unable to latch deeply to the breast	And to help in feeding milk to - Premature babies Sick babies Babies with poor muscle tone Babies with cleft lip and/or palate and Babies who have difficulty in latching deeply to the breast
GIF: Mother expressing breastmilk	Now, let’s learn how to express breastmilk.
Image: Mother expressing breastmilk by hand	The most recommended way for a mother to express breastmilk is by using her hand.
Image: Red nipple and areola after expressing breastmilk	Because this method causes less discomfort to the dark area around the nipple.
Image: breast pump	Also, this method needs no appliance. So the mother can do it anywhere and at any time.
Image: Mother is practising expression of breastmilk.	Expressing breastmilk by hand is a learned skill and will improve with practice.
Image: Soft breasts.	It is easy to hand express breast milk when the breasts are soft.
Image: 1st and 2nd day after delivery. Image: Calendar	Therefore, a mother should learn this skill on the first or second day after delivery.
Image: Wide mouth steel container Image: Wide mouth glass container	Before expressing breastmilk, Mother should have a steel or glass container ready to collect the expressed milk.
Image: Wide mouth cup Image: Wide mouth glass Image: Wide mouth jug Image: Wide mouth jar	She should choose a cup, glass, jug or jar with a wide mouth.
Image: Mother is washing a wide mouth cup with soap and water	She should wash the chosen container with soap and water.
Image: Cup is kept in boiling water Image: Mother is pouring boiling water in the container Image: Clock showing 10 minutes	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.
Image: Cup is air-dried completely	Then, she should either air dry the container completely Or wipe it dry with an unused clean cloth The container should never be dried with a used cloth such as a used kitchen cloth.
Image: Inside of the breast showing breastmilk release from the tissues in the ducts	After the clean container is dried completely, next step is to release breastmilk from the breast.
Image: Mother is relaxing with the baby	To help her milk flow, the mother should feel relaxed and emotionally connected to her baby.
Image: Mother is sitting quietly and privately Image: Mother is sitting with a supportive friend	Mother can try the following: She can sit quietly and privately or with a supportive friend.
Image: Mother is sitting with other mothers.	Some mothers can express easily in a group of other mothers who are also expressing breastmilk.
Image: Skin-to-skin contact between mother and child	She can hold her baby on her lap with skin-to-skin contact.
Image: Mother is looking at the baby Image: Mother is listening to the baby’s voice. Image: Mother is listening to her baby’s voice on phone.	Or she can look at her baby or hear her baby’s voice.
Image: Mother is looking at baby’s photograph Image: Mother is smelling baby’s blanket and clothing	Sometimes- even looking at a photograph of her baby or smelling her baby’s clothing helps.
Image: Mother is drinking a hot drink from a cup Image: Tea Image: coffee Image: alcohol	She can take a warm soothing drink. But, the drink should not be coffee, strong tea, alcohol or any stimulant.
Image: Mother is applying warm compress on breasts Image: Mother is taking a warm water bath	She can also warm her breasts to help her milk flow. To warm her breasts, she can- apply a cloth soaked in hot water to her breasts, or have a warm water bath.
Image: Mother is gently pulling or rolling her nipple and areola	She can stimulate her nipples and the dark area around them by- gently pulling or rolling them with her fingers.
Image: Mother is massaging her breasts using circular movements	She can massage her breasts lightly using circular movements.
Image: Helper is rubbing mother’s back	Mother can ask a helper to rub her back.
Image: Mother is sitting. Helper is standing close to her. Image: Mother is leaning forward. Helper is standing close to her. Image: Mother has folded her arms on a table in front of her. Her head is on her arms.	For the back rub, the mother should- sit down, lean forward, fold her arms on a table in front of her and rest her head on her arms.
Image: Mother’s breasts are unclothed and hanging loose	Her breasts should be unclothed and hanging loose.
Image: Helper is rubbing down both sides of mother’s spine.	The helper should rub down both sides of the mother's spine.
Image: Helper’s fist is closed with thumbs pointing forward.	She should use her closed fist with her thumbs pointing forward.
GIF: Helper massaging mother’s back	She should press firmly making small circular movements with her thumbs.
GIF: Helper is massaging mother’s back. Image: 2-3 minutes clock	She should work down both sides of the spine at the same time from the neck to the shoulder blades. She should do this for two or three minutes.
Image: Oxytocin reflex	All these steps will help in releasing the breastmilk. This release of breastmilk is called Oxytocin reflex or let down reflex.
Image: Mother washing her hands. Image: Mother showing her dry and clean hands.	After the oxytocin reflex begins, the mother must wash and dry her hands thoroughly.
Image: Mother is sitting comfortably	Then, the mother should sit comfortably.
Image: Mother is leaning forward slightly	She should lean forward slightly.
Image: Mother is holding the container with her left hand near her right breast	She should hold the container near her breast.
Image: Mother has placed her right thumb and fingers on her right breast in a C shape hold from the side. Image: C shape hold	Now, she should place her thumb and fingers on the breast in a C shape hold from the side.
Image: Mother is using left hand to hold her right breast in C shape hold. Image: Mother is using her right hand to hold her left breast in C shape hold Image: Mother switches from her right to her left for holding her right breast in C shape hold.	She can use either hand for holding either breast. And she can switch to the other hand when the first one tires.
Image: Highlight mother’s right thumb on the upper part of the right breast	While holding the breast, her thumb should be on the upper part of the breast.
Image: Highlight mother’s fingers on the lower part of the breast	And her fingers should be placed opposite to the thumb on the lower part of the breast.
Image: Mother’s right thumb, nipple and fingers are in a straight line. Nipple is in the centre.	Her thumb, nipple and fingers should always be in a straight line.
Image: Nipple is in the middle of the thumb and the index finger	And the nipple should be in the middle of the thumb and the index finger.
Image: Distance of 2 fingers between the nipple and her thumb Image: Distance of 2 fingers between nipple and mother’s fingers	There should be a distance of 2 fingers between- the nipple and her thumb and the nipple and her fingers.
Image: Mother’s thumb and fingers very close to the nipple and pinching it. Very less milk is coming out.	If the fingers are too close to the nipple, the milk may not flow for long.
Image: Mother’s thumb and fingers are at a distance of 2 fingers from the nipple. Image: More milk is coming out from the milk ducts beneath the areola. Image: Milk flowing inside the breast.	Mother will release more milk when- she compresses the milk ducts beneath the dark area around the nipple.
Image: Mother is holding her right breast in a C shape hold with her right hand	In this picture, the mother is holding her right breast correctly with her right hand.
Image: Mother is pressing the breast slightly inwards towards her chest wall by applying steady pressure.	Now, she should - Press the breast slightly inwards towards the chest wall by applying steady pressure.
Image: In that pressed position, without moving the hand, mother is gently compressing the breast between the thumb and fingers.	Then, without moving the hand - gently compress the breast between the thumb and the fingers.
Image: Mother releases the pressure on the breast and comes to the starting position.	And then, release the pressure on the breast.
Image: All 3 steps together GIF: Mother is expressing breastmilk in these 3 steps	The mother should repeat these 3 steps- Press back Compress And release.
GIF: Mother is pressing the breast slightly inwards towards the chest wall	The first step of pressing back towards the chest wall is an important step.
GIF: Mother is pressing towards the nipple and very little milk is released.	Pressing only towards the nipple will give very little milk.
GIF: Correct expression technique and more milk is released.	But when the breast is pressed back, milk from the dense breast tissue is released.
GIF: Mother is pressing too far back and too hard Image: Blocked milk ducts	But, avoid pressing too far back, because that can block the milk ducts.
GIF: Mother is expressing milk the right way but only a few drops come out.	When the mother starts expressing breastmilk by hand, very few drops of milk may come out at first.
Image: Let down reflex Image: Mother is still expressing breast milk and milk is dripping out.	As the let down reflex starts, milk starts to drip out.
GIF: Mother is expressing breastmilk and milk is dripping out slowly GIF: Mother is expressing milk and milk flows in streams Image: Mother’s confidence increases when she breastfeeds for a long time. Image: Mother’s confident increases when she expresses breastmilk for a few days.	In the first few attempts, it is common for the milk to drip out or come slowly. Later, breastmilk may flow in streams. As with breastfeeding, expressing breastmilk is a skill that comes with practice.
Image: Few drops of colostrum coming out of mother’s breast when she is expressing breastmilk Image: Colostrum protects the baby from diseases	Colostrum, the first milk after birth, may only come in drops but is enough for the newborn. The thick, often yellow milk, has enormous protective benefits for the baby.
Image: Step 1 of hand expression. Mother is pushing her breast back towards the chest. Image: Step 2 of hand expression. Mother is pressing the breast. Image: Step 3 of hand expression. Mother has released the pressure. Image: Breastmilk flows in a drip	The mother should repeat the 3 steps until the flow of milk slows down to a drip again.
Image: Mother is holding the breast in U shape hold	Then, she should reposition her fingers to express milk from other parts of the breast.
Image: Mother checking the breast for fullness and compressing.	She can feel for where the breast seems fuller, and compress those areas.
Image: Clock 3-5 minutes Image: Milk flow slows down	She should express milk from one breast for at least 3 to 5 minutes until the milk flow slows down.
Image: Mother is expressing milk from the other breast	Then, she should express milk from the other breast in the same way from all the areas.
Image: Mother is expressing milk from both breasts again	And then again express milk from both breasts a second time.
Image: clock showing 20-30 minutes Image: clock showing 45 mins Image: Expression in first few days Image: 5-10 minutes clock	Expressing breastmilk from both breasts adequately takes 20 to 30 minutes. It may take more time, especially in the first few days As in those days, only a little milk may be produced. It is important not to try to express in a shorter time.
Image: Mother is feeling the pain while expressing milk Image: Cross mark	Remember, Expressing breastmilk by hand should not hurt. If it hurts, the technique is wrong.
Image: Breast tissue Image: Mother is rubbing fingers towards nipple. Image: Sliding Image: Pulling Image: Breast soreness	Breast tissue is delicate. Avoid rubbing, sliding or pulling the fingers along the skin, towards the nipple. This can cause breast soreness.
Image: Tightening or stretching the skin over areola	Avoid tightening or stretching the skin over the dark area around the nipple.
Image: Pulling the nipple Image: Less milk comes out when mother presses the nipple Image: Baby is nipple-feeding	Also, avoid squeezing or pulling the nipple. Pressing or pulling the nipple cannot express enough milk. It is the same as the baby sucking only the nipple.
Image: Container covered with cloth Image: Container covered with plate	After expressing breastmilk, the mother should cover the container with a clean cloth or plate.
Image: Container is stored safely in fridge Image: Container is stored safely in the room	Then, she should store her breastmilk safely for later use. Safe storage of breastmilk and feeding stored breastmilk to the baby are explained in another tutorial.
Image: Mother expressing breastmilk multiple times in a day Image: Initiating and maintaining breastmilk production Image: Milk supply in a container Image: Low birth weight baby Image: Sick newborn baby Image: Mother is expressing breastmilk within 6 hours after delivery	Let’s now discuss how often a mother should express milk. If the purpose is to initiate and maintain breastmilk production Or to feed a low birth weight baby or sick newborn baby, then- She should express milk as soon as possible after delivery.
Image: Mother is expressing few drops of colostrum Image: Breastmilk production begins Image: Baby breastfeeding in the delivery room in laid back hold.	She may only express a few drops of colostrum at first. This helps breastmilk production to begin It acts similar to a baby suckling soon after delivery.
Image: Mother is expressing breastmilk as often as baby breastfeeds Image: Mother is expressing breastmilk every 3 hours for 24 hours Image: Mother is expressing breastmilk after 3 hours. Breastmilk output is low.	The mother should express as much as she can And as often as her baby would breastfeed. This should be at least every 2 to 3 hours, including during the night. If there are long intervals between expressions, she may not be able to produce enough milk.
Image: Mother’s milk supply is increasing from 350ml to 850ml. Mother is happy. Image: Mother’s milk supply is low 350ml. She is sad. Image: Mother is breastfeeding the baby every 1-2 hours. Image: Immediately after breastfeeding, mother is expressing breastmilk. Image: Baby is sleeping for more than 3 hours. Image: Mother is expressing milk between 2 breastfeeding sessions.	Next, if the purpose is to build up mother’s milk supply - And if it seems to be decreasing after a few weeks: She should express breastmilk every 1 to 2 hours immediately after breastfeeding the baby and If the baby is expected to sleep for more than 3 hours, then she can express in between feeds.
Image: Breast engorgement Image: Leaking of breastmilk at work Image: Mother expressing breastmilk Image: Mother gets relief from breast engorgement Image: Leaking of breastmilk at work stops	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.
Image: Mother is expressing a small drop of breastmilk. Image: Mother is rubbing the small drop of breastmilk on her nipple. Image: Mother is bathing. Image: Mother is breastfeeding.	If the purpose is to keep nipple skin healthy: The mother should express a small drop of breastmilk to rub on her nipple. She should do this after a bath and after breastfeeding.
Image: Mother is working Image: Father is feeding milk to the baby from a small cup Image: Mother is expressing milk at work Image: Mother is expressing milk at home Image: Mother gives the expressed milk to father who is holding the baby	If the purpose is to keep milk for her baby while the mother is out at work: The mother should express milk while at work to help keep up the supply. And the mother should express breastmilk before going to work and leave it for the carer to give to the baby.
Image: Refrigerator Image: Expressed breastmilk stored in fridge Image: Mother is expressing breastmilk after feeding the baby Image: 60-90 ml expressed breastmilk Image: Father is adding more milk than 90 ml to the container for feeding the baby Image: Mother is at work	For doing this - Mother can plan few weeks ahead if she has a fridge. She can express extra milk and store it for later use. Mother can express even after the baby has breastfed. Mother should leave about 60 to 90 milliliters of milk for each feed More breastmilk can be given as per baby’s need while mother is away.
Image: Mother is expressing breastmilk more often Image: Mother is comfortable while expressing Image: Milk is flowing from the tissues to the milk ducts beneath areola Image: Mother is producing more milk 750 ml	Remember, The more frequent hand expression is used- the easier it becomes to express milk, the faster the milk releases And the more milk mother will make.
Slide Number 2 Acknowledgement	This brings us to the end of this tutorial. Thank you for joining.

Contributors and Content Editors

Bellatony911, Tasneemiitb