In our recent podcast interview, Maya Bolman, RN, IBCLC, and Ann Witt, M.D., make the distinction between hand expression, breast massage, and therapeutic breast massage in lactation. Although these are all related, they are different.
Using a rolling motion, with one hand on the bottom and one hand on the top, the breast can be rolled in a top-to-bottom movement. The rolling motion should continue in an effort to move the milk and elicit an effective milk ejection reflex (MER, or let-down.)
3. Side to side
Not only do Maya and Ann recommend a rolling motion from top to bottom, they also suggest rolling the breast from side to side. Again, this rolling motion should be continuous while performing the therapeutic breast massage in lactation.
Honestly, you must see the video that these two experts have created. They show the mother’s fists gently kneading the breast while rolling the breast from side to side. This is an interesting technique, and I admit, I have never tried it before!
5. Fingers, and fingertips
Usually, we think of using our entire hand to do massage or to do hand expression. Maya and Ann don’t object to that—they are quick to say that techniques vary from culture to culture. A native of Russia, Maya comes to us with techniques that may be different than those that we’re used to here in the United States.
However, hand expression of milk can be accomplished by using the fingertips only. Similarly, Ann and Maya advocate using the fingertips-only approach for gentle massage.
“Opposing” is Kittie Frantz’s term, but it nicely conjures up an image of the technique Maya and Ann teach for therapeutic breast massage in lactation. I always explain this to mothers by equating it to the numbers on the clock. By “opposing,” I mean that the fingers are at opposite places on the face of a clock, for example 12 and 6; 1 and 7; 3 and 9.
I frequently encourage women to use tapping if their nipples are a little reluctant to protrude. But Maya and Ann also use tapping on the corpus of the breast, in order to help move the milk and/or create an MER.
This is one of my favorite points to make. Women do not immediately gain rhythmicity. But after a little practice, their movements become more regular and rhythmic. Sometimes, while they are hand expressing, I’ll hum or tap my foot. It helps them get into that rhythm.
9. Olive oil
If you’ve spent any amount of time in one of my courses, you know I’m a big fan of olive oil for relieving white blebs, lubricating flanges, healing sore nipples, and more. And if you’ve ever used my hotel room to pump your milk during the course, you’ve probably noticed that I bring my own olive oil soap from home. If you’ve ever gone to lunch with me, you’ve seen me put olive oil and Bragg’s Cider Vinegar on my salad. I qualify as a big fan of olive oil!
However, I admit, I would have never thought of suggesting olive oil for therapeutic breast massage in lactation until I heard Maya and Ann mention it. Wow, score another one for olive oil!
10. Sweet spot
I use this term to mean the place where the milk congregates. Any woman who has ever used hand expression or therapeutic breast massage in lactation will quickly agree that there’s a spot where the milk seems to congregate, and they will see lots of dripping or spraying (and feel lots of relief!) if they hit this “sweet spot.” (I also say it feels like a little string of pearls below the skin.)
Yes, I saved the best for last. Usually, we tell mothers who are engorged to massage and hand express toward the nipple. Not entirely true. If the milk is “stuck,” there are times when hand expression, warm packs, cold packs, and a bunch of other techniques just don’t work. The best thing to do is try to move the fluid and swelling by massaging towards the axilla – the armpit – rather than toward the nipple.
After that, hand expression is likely to be successful. Wonder why? Maya and Ann explain on this week’s podcast.
Have you tried therapeutic breast massage in lactation?
Yes I used massage (didn’t know how) and I think most breastfeeding mothers do. I wish I had known to use olive oil. I always felt like I was pulling my skin a little, but I worried about what I dare use as a lubricant, so I used water but of course it dried almost instantly. Thanks for sharing!
Quick question regarding massaging towards the armpit….
What about the women who may have glandular tissue and engorgement there? I’m wondering about backflow or statement milk and set up for mastitis?
Thanks for the help!
I’m not sure I can answer your question. I can say, however, that some women do become engorged into their armpits, I’ve seen it; it’s not necessarily going to cause mastitis.