Wednesday, July 18, 2012

Maximize Milk Removal: Breast Massage and Compression

Once baby is latching on well, the next most important strategy is to maximize breast drainage so that the signal to the breast to make more milk is amplified. One of the difficulties of low milk production is that the milk ejection reflex (let-down) is often less effective when it has less volume to work with. Thus, milk may not be completely drained by the baby or a pump.  An easy and effective way to maximize removal of milk is to massage the breasts, both before and during feeding (or pumping). One study looked at the effect of simultaneous massage with pumping and found that there was 40 to 50 percent more milk removed when pumping with massage than without it. This is a simple and very effective way to increase breast drainage.(1)

One popular version of breast massage is called breast compression and uses external pressure with the hand to pushing milk through the ducts, simulatulating milk ejection, so that more milk is expressed . The additional milk that is removed will be made, inceasing milk production.

Dr. Jack Newman developed the following breast compression technique, that many mothers have found results in faster flow and more milk expression.  Breast compression can be utilized at any time milk is being expressed, either while the baby is actively nursing or when the mother is pumping. You can view a video of breast compression on Dr. Newman’s website.

Breast Compression Technique

Hold the breast, cupping the breast from underneath with your thumb on one side of the breast and your fingers on the other.

Watch for the baby’s swallowing.  The milk flows more rapidly when baby is drinking with an open—pause—close type of suck. Open—pause—close is one suck; the pause is not a pause between sucks, but of milk flowing into his mouth before a swallow.  You may notice the same pause yourself when fluid flows in as you drink deeply and continuously.  If using compressions while pumping, watch for sprays of milk.

When baby is nibbling or no longer drinking with the open—pause—close type of suck, compress the breast gently but firmly (not so hard that it hurts) and try not to change the shape of the areola (the part of the breast near the baby’s mouth).  With the compression, baby should start drinking again briefly with the open—pause—close type of suck.

Keep the pressure up until the baby no longer drinks even with the compression, then release the pressure.  Often the baby will stop sucking altogether when the pressure is released, but will start again shortly as milk starts to flow.  If the baby does not stop sucking with the release of pressure, wait a short time before compressing again.

Releasing the pressure allows your hand to rest and milk to start flowing to the baby again.  If the baby stops sucking when you release the pressure, he will start again when he starts to taste milk.

When the baby starts sucking again, he may drink (open—pause—close).  If not, rotate your hand position and compress again as above.

Continue on the first side until the baby does not drink even with compression.  You should allow the baby to stay on that side for a short time longer, since you may occasionally get another milk ejection and the baby will start drinking again, on his own.  If the baby no longer drinks, however, allow him to come off or take him off the breast.

If the baby wants more, offer the other side and repeat the process.

You may wish to switch sides back and forth in this way a few times.
If you find a way that works better at keeping the baby sucking with an open—pause—close type of suck, use whatever works best for you and your baby.  As long as it does not hurt your breast to compress, and as long as the baby is "drinking" (open—pause—close type of suck), breast compression is working.(2) If you don’t find compressions helpful, try them again a few days or a week later.  Techniques that aren’t helpful at one stage of your production-building efforts may be helpful at another.

NOTE: Breast compressions for women with breastimplants is done differently. Use your hand from above the breast rather than below, compressing the sides.  This avoids compressing the implant, which could lead to rupture.


(1) Jones, E., Dimmock, P., Spencer, S. A randomized controlled trial to compare methods of milk expression after preterm delivery. Arch Dis Child Fetal Neonatal Ed 2001; 85:F91-F95.
(2) Newman, J.  Breast Compression. Handout #15: Jan 2003.

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