•As the milk begins to flow, you may feel a distinct feeling of heaviness or tingling as the milk begins to spray or drip out. Some mothers never feel a distinct sensation when their milk lets down, while for others it is strong enough to be almost painful. Some mothers don’t feel the sensation in the early days of nursing, but will feel it later on. As long as your baby is getting milk, you know it is letting down. You will also experience milk leaking from the other breast as it lets down on one side. This is normal, as your milk always lets down on both sides at once (your body doesn't know you’re not nursing twins!) Another sign that your milk is letting down is "afterpains", which are abdominal pains similar to menstrual cramps. These cramps are caused by the release of the hormone oxytocin. The same hormone that makes your milk let down also causes your uterus to contract. The afterpains may be mild or severe, and are usually stronger in women who have had children before than in first time mothers. The uterine cramping, while not pleasant, is a sign that your uterus is contracting and returning to its pre-pregnant state. This occurs faster in nursing mothers than in formula feeding mothers - another advantage of breastfeeding. Your uterus will continue to shrink for about six weeks, but the afterpains are usually only uncomfortable for the first few days after birth. Don't be surprised if the cramping is much stronger while your baby nurses - that's a sign that your milk is letting down effectively. You may also experience increased blood flow during the first few days after birth while your uterus is contracting, especially during nursing when your milk lets down.
•Place the container under the breast and lean over it. Grasp the areola by putting your thumb on the top and your forefinger on the bottom. Press the breast tissue back toward your chest and squeeze your thumb and finger together, rotating forward, just behind the areola. Do this a few times, then move the fingers half an inch to the left or right and compress again. Continue rotating around the areola until you reach all around the breast. You may want to use your other hand to alternate massaging and compressing.
•Another method is to hold the breast with your thumb on the top of the areola, and the other four fingers cupping the breast from underneath, with your little finger touching your ribcage. To start expressing, begin a wave-like motion by pushing your little finger gently into the breast, followed by the fourth, third, then index finger while you compress the tissue with your thumb from above. Rotate until all areas of the breast are compressed.
•With both these techniques, repeat the procedure on the other breast once you have rotated all around the first breast. You may want to alternate breasts more than once, which encourages multiple let downs.
While there is always some milk in your breasts, it is easiest to hand express when your breasts are full, especially in the morning.
The techniques described above may sound complicated, but they really aren't once you practice a little. Some mothers are very successful at manual expression, but others find it frustrating and tiring. It is not a good method to use on a regular basis, or to use after feedings when the breast is relatively empty. It usually takes at least 20-30 minutes to empty the breast with hand expression or manual pumping.
I often talk to mothers who are trying to use hand expression or manual pumps and they say things like, "I sat there for half an hour, and only got one ounce of milk. What's wrong with me?" The answer is "nothing". The problem is that they are only getting out the small amount of foremilk that collects between feedings, but aren't getting their milk to let down. If the milk is not letting down, you will see drops of milk slowly dripping out, but not spraying or spurting out. If you are pumping and only getting drops (and this applies no matter what type of pump you are using), stop and go back to the suggestions above to get your milk to let down. Continuing to pump or express while only getting drops will just frustrate you and make you tense, making it less likely that your milk will let down and flow freely.