How hands-on pumping increases milk production

The link between hands-on pumping (a combination of breast massage, hand expression, and pumping) and greater milk supply is well recognized. Studies conducted over the past decade have shown what some mothers discover instinctively—that they produce more milk when they massage their breasts while pumping than when they use only a breast pump. While most of the research has focused on mothers of preterm infants (who must express their milk for many weeks or months until their babies are able to breastfeed), hands-on techniques are likely to benefit all mothers and babies.

Dr. Jane Morton and her colleagues at Stanford University have spearheaded research on this topic, in their work with breastfeeding mothers of babies born prior to 30 weeks of gestation. In one study, they investigated the effects of breast massage and pumping versus pumping alone in mothers of preemies. In another study, they looked at milk composition in mothers of premature infants who used hands-on techniques versus those who did not. 

Because infants born prematurely are often unable to breastfeed for weeks or months, their mothers must rely on breast pumps to stimulate their milk production. Stanford researchers were guided by the theory that full milk production at two months requires frequent and effective milk removal in the first three days after birth. Participants were instructed to hand-express their milk (click here for how-to) during this critical 3-day period, then transition to hands-on pumping once their milk production increased. 

The researchers found that when mothers relied solely on breast pumping and stopped each pumping session when the flow of milk ended, they left available milk in the breast. Mothers who combined breast massage with breast pumping, and followed breast pumping with hand expression, removed more of the available milk. Mothers who used hand expression (five times or more each day) in addition to hands-on pumping were producing an average of 955 ml per day (approximately 32 ounces) at two months—an amount that would satisfy most healthy, full-term, exclusively breastfed 3-month-olds. Moreover, risk factors for low milk production—advance maternal age, obesity, cesarean birth, and preterm birth—had little or no impact on long-term milk production in the mothers participating in the study. 

Mothers, who stop breastfeeding earlier than planned, often cite “not enough milk” as the reason. Given that breast pumps are essential for many mothers, these results show that combining their use with other techniques is the best way to maximize milk production. 

Dr. Morton notes, “…all mothers already have a simple, safe, and free tool for assisting breast milk production: their own hands.” 

Perhaps the best strategy for helping all mothers make more milk is the no-cost, no-risk, hands-on solution. 

Illustration by Rick Powell © baby gooroo. May not be reproduced without permission.

Last updated August 15, 2020

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