Dear Friends:
    These are not the only ways of hand expression, but  the ones I have 
distilled from videos and workshops. I demonstrate on myself or  ask permission 
from the mother to express from her breast. If I take milk  out from her, I ask 
her to close her eyes and focus on the feelings she has in  her breast from my 
finger placement and the milk coming out.
    It is best to do some nipple stimulation first, or  warm compresses, or 
do it when she is leaking already.
    One way is to use both hands, holding the  breast and moving the hands 
towards the nipple with some force.I heard someone  call this the 'double 
diamond' technique.  
Another way is to put a thumb and middle finger at  12-6 positions on the 
edge of the areola with the nipple in the middle and  squeeze, hold, and release 
in rhythm. When that lobe stops giving milk,  move fingers to 3-9 and 10-4 and 
11-5 positions to get other lobes.
    Another way is to put the thumb and middle finger  at 12-6 positions on 
the  edge of the areola and push straight back into  the chest wall. Hold the 
fingers in that position and squeeze, hold and  release, squeeze, hold and 
release in a rhythm that copies a baby's sucking  rhythm.
    warmly,

Nikki Lee RN, MS, Mother of 2, IBCLC, CCE
Maternal-Child Adjunct  Faculty Union Institute and University
Film Reviews Editor, Journal of Human  Lactation
Support the WHO Code and the Mother-Friendly Childbirth  Initiative

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