By Dr. Kathleen F. McCue, FNP, IBCLC and Katie Ralls
As the customer service rep for Simple Wishes and Pumping Essentials, I wanted to share my
story, in hopes of helping other mothers out there who might face similar challenges.
My story begins with being diagnosed with Vasa-Previa (overlapping blood vessels next to the
inside of the cervix) when I was 22 weeks pregnant, I was placed on hospital-based bedrest for
the rest of my pregnancy.
This story, however, has a happy ending. Baby Harper was born at 33-weeks gestation via C-
Section when my liver function tests sky-rocked and I felt really sick. I intrinsically knew there
was something wrong and am thankful my nurse listened to me and acted quickly. We have a
voice within us that tells us what to do, but listening to that voice can be an art form, especially
when we’re pregnant and everything is new.
While on bedrest, I was given non-stress-tests twice a day with the plan of an eventual C-
section. All in all, I spent a total of nine weeks in bed and was only able to get up twice a day for
walks and brief trips to the bathroom. This was one of the most difficult times I ever could have
Thankfully, with enough advanced planning, I had been given two rounds of injected steroids at
24 and 32 weeks; this helped mature my baby’s lungs in anticipation of her early delivery. I had
no “Golden Hour,” where I could breastfeed my baby and be skin-to-skin, as she was whisked
away to the Neonatal Intensive Care Unit so she could be given the best chance possible of
survival outside of my womb.
Harper was born weighting 3 lbs., 2oz. and was only 15.25 inches long. She spent her days in a
NICU isolette being monitored 24 hours a day. My husband and I spent our days watching and
On day three post-partum, I literally thought my breasts were going to explode. I woke up with
breasts that were twice their normal size, tender and rock hard. Thanks to a class I had taken
prior to delivering, I learned and remembered the method of hand-expression to relieve
engorgement. Although I had access to a hospital grade pump, at this moment in time, this is
what felt right to me.
Hand expression. How could a hand be better than this super expensive breast pump? Am I a
cow? I feel like I could fill a swimming pool but I only have little drops my first day.
I think hand expression is the best thing to use, second only to the baby itself. Breast massage.
Pull back, compress, release, repeat. You can use it anywhere at any time. You do not need a
plug, battery, clean flanges. You always have your hands with you.
It’s really interesting to know that my first experience performing hand expression involved two
breasts that were NOT my own. Yep, I milked another woman. I had learned all about it in my
classes with Evergreen Perinatal and at WIC where I worked for five years. How hard could it
be? I had all the confidence on the outside and all the nervous shakes on the inside. My friend
was in pain. She had forgotten her pump at home and we had just walked out of the Raider’s
Stadium in Oakland, CA. We were making our way to the parking lot when she looked like she
might cry. Can I help her?!?! Ok what did they say to do again? Massage around. Feel for lumps.
Made a “C” hold. Why weren’t my hands bigger?! Ok now push back….. And compress. And
again…. Push back and compress. Oh my gosh it is working! After spraying milk everywhere
there was a sigh of relief. I had done it!
Again, not too long after the previous incident another friend had forgotten her pump at a
family party. Welp… looks like I am going to attempt this again. This time in a bathroom sink.
Once again, It worked! Having said that, learning to hand express, hand expressing your friend
and hand expressing yourself are not the same.
When my own daughter was born at 34 weeks, I knew I needed to get my milk flowing right
away. I was so hopped up on Magnesium, pain meds and morphine… … I was all thumbs…. So
this is what it supposed to feel like? I was amazed that it worked. 2, maybe 3 droplets came out.
Breakfast, lunch and dinner! Haha! I am joking. It didn’t feel great, to be honest as I had bruises
all over my breasts which my husband got the stink eye for from a nurse later that day. Sorry
I knew the facts about hand expression. When using hand expression correctly you could
express more milk than you could with any pump. You did not need a magic bra or a magic
breast pump to express milk. My baby was too small and premature to latch and have milk
transferred. It was up to me to get it going.
The lactation staff at the hospital where I was admitted for observation had a video about what
to expect in the first few weeks. How you could potentially go from syringe feeding (another
technique rather than a bottle) to possibly breastfeeding directly when the baby was “ready”.
Unfortunately, my baby was not cleared to breastfeed until she was 6 months old due to silent
reflux (a danger for aspiration). Her epiglottis was under-developed which caused her to inhale
thinner liquids. This was heartbreaking.
As the months went on I used hand expression in many different circumstances. If I forgot my
pump, if an outlet was not available, in the shower for comfort, to release plugged ducts, to
express milk into my baby’s eye if it had discharge (it happens). I will be forever grateful for the
knowledge I had and the confidence that was built by my experiences and training. I believe
every mother should learn how to hand express for these very reasons.
I remember using a video clip that was on the Standford.edu website to encourage many moms
to use this technique over the breast pump.
The method is to start with clean hands and sit down in a place where you can relax and get
comfortable. By the way, this should be the case whether you’re nursing, pumping, hand-
expressing, or simply holding your baby. You need to build a nest of sorts. Gather a container to
catch your milk, then gently massage the breast your expressing in a circular motion from chest
wall down to the nipple. Heat can also be an added benefit. In order to stimulate your let-down
(a reflex that starts the milk squirting out of the nipples), you’re going to need some rolling of
the nipple between your thumb and index finger. You will then place your thumb on the top of
the areola (the edge where the darker color ends and your breast begins) and your index finger
at the bottom (same placement). Spread the skin back toward the chest wall, squeeze in and
gently but firmly pull, aiming the nipple into the collection container. There is a sweet spot that
you will have to find. Some moms find that the area needing compression is either closer to the
nipple or further back on the areola. It will take practice. Remember, they’re not faucets! You
will get faster with practice and yield more milk as you gain confidence.