Thursday's Tip: Manual Expression & Breast Pumps, which works better?

By LLLC Blog, 14 January, 2016

Many of the lists of “things new parents need to have on hand when baby is born” include a breast pump if you are planning to breast feed. Some parents wonder if having a breast pump is a real need or a niche market that has been created by breast pump manufacturers.

The first question that should be asked when considering manual expression (also known as hand expression) vs using a breast pump is why is either option being considered? Depending on the reason removing milk from the breasts in a manner other than breastfeeding is being discussed may help define which type of milk removal will best meet the need. A mother who is separated from her hospitalized baby has very different needs than a mum who may want to occasionally miss a feeding.

Some studies have looked at the efficacy of manual expression and breast pumps and have drawn interesting conclusions. A 2011 study of mothers whose babies who were having difficulties with breastfeeding in the first three days randomly assigned them to 15 minutes of breast pumping or 15 minutes of manual expression. The mothers were followed at 1 week, 1 month and 2 months. The study found no difference in the amount of milk expressed, the mother’s pain levels or their confidence at the time of the intervention however the group who were taught manual expression were more likely to still be breastfeeding when their babies were 2 months old (97% vs 73%).

Morton et al in a 2009 study of mothers of premature babies found that when the mothers started using hand expression at each pumping session after using the electric pump their milk production increased from 500-600 ml average per day to 900-100 ml average per day after 8 days. The researchers determined that the expressed milk volume could be increased by 48% by combining manual expression with mechanical expression. They also found that mothers who were separated from their infants immediately after delivery could increase their production by 80% when they combined manual and mechanical expression at least six times per day starting in the first three days after delivery. They concluded that future milk production was influenced not only by the frequency of empting the breasts but also by the amount of milk that is removed.

Here are some of the advantages and drawbacks of both options:

Advantages of manual expression over a breast pump include

  • It is free and no special equipment or power source is needed. There is nothing to store or transport.
  • It is always available, even in an emergency
  • The skin-to-skin contact may more easily trigger the milk ejection reflex as many mothers say it feels more “natural”.
  • There is nothing, except mum’s hands, to wash up afterwards

Drawbacks of manual expression include

  • There is a learning curve and it involves physical effort that may become tiring on the hands and wrists
  • It may take more time to manually express both breasts than using a double breast pump to pump both sides at the same time
  • A hospital grade electric pump is better at establishing a milk supply if baby is not yet breastfeeding

Advantages of breast pumps over manual expression include

Many mothers are more familiar with breast pumps and more comfortable with the idea than with the thought of touching their own breasts

  • Electric powered breast pumps do the physical work and can be less tiring than manual expression or a hand powered breast pump
  • Double pumping set ups on some electric powered breast pumps allow mum to be hands free and pump both breasts at the same time thus saving her time and allowing her to do something else while pumping

Drawbacks of breast pumps include

  • There is a learning curve to mastering a breast pump and adjustments to the pumping routine may need to be made over time as the milk supply and milk ejection reflex changes
  • The most effective breast pumps are hospital grade electric powered models which can be very costly to rent or buy
  • Pump parts can break, get lost, or malfunction and then the pump is not functional
  • When pumping in public places the pump’s sound can draw unwanted attention and mum needs access to a place where she can wash her pump parts after pumping.

More information on expressing breastmilk manually or with a breast pump can be found in the The Womanly Art of Breastfeeding, 8th edition Chapter 15. To purchase a copy and support LLLC click HERE

La Leche League International hand out: Hand expression

LLLI Breastfeeding Today: The Power of Hand Expression

For breastfeeding support by phone or e-mail or to find a La Leche League Canada group meeting near you check out the website.