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Imagine, a Way to Collect Breast Milk Without a Pump

Feeding Time

“People in general think I’m totally nuts,” says Francie Webb, a doula, certified lactation consultant-in-training, and founder of The Milkin’ Mama, which is devoted to teaching hand-expression.

Hand expression, as Webb explains in her 2017 self-published book Go Milk Yourself: You Have Power. Express It!, “basically means getting milk out your boobs with your hands.” And Webb feels very strongly about it. The cover of the book, set against a solid red background, shows Webb, smirking with bright pink lipstick, gazing right at the reader through blue-framed glasses, pearls around her neck, cupping her breasts through her teal dress with both hands.

“When I say that hand expression changed my life, I mean it,” she told me over the phone, the slightest remnants of her Virginia roots audible in her otherwise northeastern accent. “When I write a book and put myself on the cover holding my boob … I’m not going to put myself out there in this way unless I truly believe so deeply in this work, and I believe in the depth of this work.”

No matter how new moms do it, feeding their babies can be a fraught topic. Though the majority of mothers now start out breastfeeding, by six months only about half have continued. If you look at exclusive breastfeeding rates the numbers are even lower — 13 percent by some estimates.

Even for those who manage to get a good latch and don’t have supply issues, there are a host of challenges to wanting to feed your baby with your body — especially if you have any hope of spending any time away from your child. What happens when you want a much-deserved night out, or want your partner to help out with feedings, or it’s time to go back to work? Health insurance plans must now cover the cost of a breast pump (for as long as the ACA lasts, anyway), but even an MIT Hackathon has yet to succeed in making them “not suck.”

Hand expression — in which a woman uses her hands to manually release milk — can help ease engorgement, aid letdown, and allow the collection of milk any time, anywhere. The WHO states in their breastfeeding counseling training manual that “the most useful way for mothers to express milk is by hand,” and a 2011 UCSF study showed that new moms who hand express in the first few days breastfeed longer. Yet it’s not something that has entered the motherhood mainstream.

“We’re very, very squeamish,” says Webb. “Because we don’t get milk out with our hands, the pumps do.”

But Webb doesn’t identify as a lactivist who thinks that breastfeeding is the only way. She’s supportive of parents who exclusively breastfeed, who pump, who formula feed, or who do a combination of any of those (and she’s careful to include all parents, not just those who identify as women). But she feels that there is a major tool missing from our tool box and wants to change that.

Before the birth of her first daughter in 2012, Webb had never heard of hand expression. First-time motherhood was full of confidence-knocking roadblocks for Webb: doctor-prescribed bed rest, not being able to deliver at the birthing center, fears about producing enough milk, and a difficult time pumping. When she returned to work as a middle-school learning specialist in Manhattan, her daughter was three and a half months old and she found that her pumped supply could barely keep up with her daughter’s needs.

The nanny asked her to send more. The pediatrician recommended formula. She tried everything to increase her supply: a hospital-grade pump, pumping more often, breastfeeding support meetings, lactation consultants, fenugreek, drinking gallons of water, massaging her breasts while pumping, and even looking at pictures of her baby while doing it. Sometimes, one tactic or another would work for a bit, but then her output would dwindle once again.

Slowly, Webb was able to build up sufficient supply to feed her baby, but she was stressed and feeling, as she talks about in her book, not enough.

Formula was not an option that Webb wanted to turn to. “I had a lot of anxiety about not having formula because I grew up on a lot of processed food and I have had digestive issues my entire life,” she said. “So I was kind of fixated on the idea that whatever my child is eating should be something her body would process instead of something that was preprocessed. So I mean, there was definitely some control and anxiety shit going on there.”

Desperate, Webb connected with a lactation consultant who ran through a list of questions before finally suggesting a video made by Dr. Jane Morton at Stanford University, which detailed how to maximize pumping output with the help of your hands.

Webb watched in awe as big bosomed women massaged milk out of their breasts. Tentatively, she gave it a go. She’d pumped herself dry, or so she thought. But as she worked her breast, a few more drops fell and she had a revelation:

There’s more where that came from.

Indeed, a study by Dr. Morton and others found that incorporating hand-expression techniques had a measurable impact on milk supply. “We have observed that pump suction alone often fails to remove a significant fraction of milk as more can be expressed using manual techniques,” the authors state in the study.

“In every study that’s been done, you get more milk or the same amount of milk as you do with a pump, but never less than you do with a pump,” Dr. Morton said in a recent phone interview, referring especially to milk expression in the first few days. “Volumewise you’re better off.”

Webb started hand expressing after pumping. At first she got a few drops, and then a whole extra ounce. She was able to build up her freezer stash. But as empowering as it was, she didn’t go whole hog on hand expression until she was out of options.

She was in California spending her first few nights away from her 5-month-old daughter when Webb realized that she had forgotten her pump parts across the country in her New York apartment. Panic set in.

Though Webb had yet to use hand expression as her sole method of milk removal, she had few other choices. In 24 hours she expressed 29 ounces by hand and never went back. “I remember thinking, I actually think that I’m at least as proud of this milk as I was of having our baby.”

She started spreading the good word to whoever would listen. She’d teach other parents in the pumping room at her school. Webb made an instructional hand-expression video for an online moms group and, as she says, “people went nuts.” She started taking clients little by little on the side. The lactation consultant who ran her breastfeeding support group commented that she’d never seen someone so excited about hand expression.

But it wasn’t until after her second daughter was born in 2014 in a whirlwind, faster-than-the-speed-of-light home birth attended by just herself and her husband (the photo of which went viral) that Webb dedicated herself to hand expression. She started doula training when her youngest was 6 weeks old, bringing her with her to the classes, and began The Milkin’ Mama — where she teaches her method of hand expression in person and via individual and group video conference —in 2015. She’s currently working toward becoming an International Board Certified Lactation Consultant (IBCLC) and should be done by 2020, even quitting her job as a learning specialist to focus on The Milkin’ Mama and being a doula.

After many hours spent practicing and teaching hand expression, Webb has developed what she calls the “Go Milk Yourself” method, which she describes in her book as “a menu of techniques.” She encourages lactating parents to experiment until they find the right approach that works for them. Webb says that massaging the breasts first for 30 to 60 seconds is usually a key step, and then the trick is learning how to alternate massage and compression.

The most common method of hand-expression massage is to form your hand into a C-shape and, starting at the base of the breast, gently glide it forward and down toward the nipple. Repeat. Other methods Webb suggests include using the heel of your hand to push down toward the nipple, “the spatula” (in which she says to imagine your hands come together to form a spatula and your breast is a bowl of brownie batter that you want to scrape clean), and “the milkshake, (which, just like it sounds, involves shaking your breasts “gently. But with fervor!”).

You can use one hand or two as long as you’re not too forceful with the compression (Webb learned this the hard way after bruising herself). The compression is the part where you actually express the milk and also can come in different forms. Most commonly, you once again make a C-shape with your hand but this time compress your fingers as you near the nipple, thus squeezing out the milk. Webb most commonly sees people hurting themselves when using what she calls the “slide your thumb” method of compression, in which you cup your breast and move your thumb toward the nipple in repetitive, short motions while compressing.

Even though she pulled the plug on her pump — eventually — Webb isn’t insistent that everyone go all hands on deck. “My goal is for people to know how to hand express and then use it in whatever way works best for them,” she says.

“The people who come to me, it’s not even necessarily they want to hand express,” says Webb of her client base. “They’re just looking for another option … It’s humans who are stressed about feeding their babies with their bodies or anticipate the possibility.”

That was the case for Mykkii Millott, who had her third child at the age of 40 but found it was the first time her body produced milk. “My first two kids had to be formula fed, so even though I was an older, experienced mother, I was new to the boob game,” she said. “My concern was even though I was able to start off being able to it wouldn’t last.” She was also nervous about lugging her pump back and forth on her long commute to work.

Millott first took an online workshop with Webb in April 2016, and later met with her in person. “Learning how to hand express was amazing. Absolutely amazing,” she recalls. “It’s freedom … Just the ease and availability of when I needed to be able to do it, I could just grab a bottle and get going.”

Millott did try pumping for a few weeks but, like Webb, didn’t respond as well as she would have liked. But when she hand expressed she could get a full bottle’s worth of milk. Soon enough, she ditched the pump. Her daughter just turned 2 and they are still nursing.

“I don’t want mothers to have to say if I had only known,” says Dr. Morton, who has spent the last few decades on a breastfeeding crusade of her own. “When I started it was in the early ’70s and there were no lactation consultants or pumps, or anything else. There was a minority of women leaving the hospital trying to breastfeed, about 20 percent.”

Things have changed a lot since the 1970s (“the only thing they called a pump looked like a bicycle horn,” recalls Dr. Morton), but when it comes to hand expression — and breastfeeding in general — there are still plenty of barriers.

Dr. Morton says that a majority of the women who don’t breastfeed as long as they would have liked is because they are concerned about insufficient milk supply. She sings the praises of hand expression — which her research has found to be particularly successful when initiated in the first few days of a baby’s life — both for its effectiveness and because “mothers find it more comfortable both physically and emotionally rather than having a huge machine.”

Obviously, not everyone feels so warmly about hand expression. Erin Zimmerman is committed to her electric pump. “I find hand expression time consuming and far less effective than pumping,” she says. “Also, I’d rather be able to use my hands for either work or time-wasting on my phone while hooked up to an electric pump.”

Others can’t get milk out via hand expression at all, or find it painful. Lactation consultants pushed Juliet Izon to hand express in the hospital after her daughter wouldn’t latch. “After doing that a few times, my boobs were bruised, my forearms were sore for days, and the whole process was extremely time consuming with very little result,” she says. “When I finally rented a hospital-grade pump a few days later, I was producing a ton, so I never hand expressed again. Good riddance.”

Besides the folks who love it or hate it, a lot of parents just don’t know anything about hand expression. Indeed, as Webb herself is quick to point out, it’s far from a trend. “People aren’t doing it, as a rule,” she says.

Rachel Levine, an IBCLC at NYU Langone Health’s Center for Perinatal Education and Lactation, says that, while hand expression is part of the pre- and postnatal breastfeeding education at the certified “baby friendly” hospital, most first-time parents come in never having heard of it. Instead, they tend to be “focused on getting ‘the best’ breast pump,” she said in an email. But she believes that “every breastfeeding parent should know how to hand express.”

When she does introduce hand expression, Levine says that often the initial response is embarrassed giggling, followed by surprise that it’s an effective way to express milk.

“We’ve created a culture where it is normal and common and encouraged, and — in some circles — a requirement to have a machine attached to a piece of a tissue on our body that is the exact same biological substance as the foreskin of a penis, and have a machine pull milk out from those breasts,” says Webb. “We’ve made that normal, so it’s not normal to use our hands.”

Plus, though it may not be rocket science, hand expression does take some instruction and practice to get the hang of it, and, as Dr. Morton points out, “it’s much, sadly, easier for a nurse to push in a machine and say here you go, then it is to go in and teach you how to hand express.”

Webb, Levine, and Dr. Morton all argue that the education should begin before breastfeeding even commences — Webb says that she can teach someone who’s not yet lactating how to hand express. But as Dr. Morton points out, it can be tricky to get folks to pay attention before they need it. “Many times they’re more interested in the color of the nursery than breastfeeding before then,” she has observed.

Though Webb admits that she used to be anti-pump, after teaching hand expression to hundreds of people around the world, she now believes that it’s all about options and choice.

“I’m a privileged white woman, and it’s very easy for me to say all of those things, and I want to help people through the process of hand expression and all of the topics it touches on. I want to help people have some of those things, be respected, be heard, and be empowered,” says Webb. “We deserve that, every single one of us.”