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  3. Hand-Expression Steps and Common Mistakes
Course Content
Why Breastfeeding Matters (10 minutes)
Health and developmental benefits for infants Maternal benefits (physical and mental) Economic and community-level advantages Common myths and culturally specific misconceptions
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Health & Developmental Benefits for Infants from Breastfeeding
Maternal Benefits of Breastfeeding (Physical and Mental)
Economic and Community-Level Advantages of Breastfeeding
Common Myths and Culturally Specific Misconceptions about Breastfeeding
Newborn Feeding Cues & Anatomy (20 minutes)
Early vs. late hunger cues and what they mean Normal newborn feeding patterns and stomach capacity Brief breast anatomy (lobes, ducts, nipple, areola) in plain language Signs of effective feeding (swallowing, contentment, diaper output)
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Early vs. Late Hunger Cues in Infants
Normal Newborn Feeding Patterns and Stomach Capacity
Breast Anatomy (in Plain Language)
Signs of Effective Feeding in Breastfed Babies
Positions & Achieving a Good Latch (40 minutes)
Position options: cradle, cross-cradle, football/clutch, side-lying Stepwise approach to help baby latch (prepare — attach — assess) Signs of a good vs. poor latch (comfort, nipple shape, audible swallowing) Small-person adaptations (premature, small mouth, tongue-tie considerations) Safe positioning for mothers with C-section recovery
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Position Options for Breastfeeding
Stepwise Approach to Help Baby Latch
Signs of a Good vs. Poor Latch
Small-Person Adaptations in Breastfeeding
Safe Positioning for Mothers with C-Section Recovery
Protecting & Building Milk Supply (25 minutes)
Establishing supply in the first days and weeks (frequency, skin-to-skin) Night feeds and cluster feeding explained Lifestyle and medical factors that reduce supply (e.g., certain medications, stress) Relactation and increasing milk supply safely Nutrition and hydration myths vs. evidence
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Establishing Milk Supply in the First Days and Weeks
Night Feeds and Cluster Feeding
Lifestyle and Medical Factors That Reduce Supply
Relactation and Increasing Milk Supply Safely
Nutrition and Hydration Myths vs. Evidence in Breastfeeding
Expressing & Storing Breastmilk (20 minutes)
Hand-expression steps and common mistakes Choosing and using pumps (manual vs. electric) — practical tips Safe collection, labeling, storage, thawing and warming guidelines (low-resource options included) Cleaning and hygiene for bottles and storage containers Feeding expressed milk to infant (cup, spoon, paladai, bottle considerations)
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Hand-Expression Steps and Common Mistakes
Choosing and Using Breast Pumps (Manual vs. Electric)
Safe Breast Milk Handling
Cleaning and Hygiene for Bottles and Storage Containers
Feeding Expressed Milk to Infants
Common Problems & Practical Solutions (25 minutes)
Causes of sore nipples and immediate relief techniques Managing engorgement and preventing blocked ducts Recognising mastitis vs. normal engorgement and when antibiotics may be needed Low weight gain: assessment steps and feeding plan adjustments Non-judgmental approach to supplementation and safe short-term options
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Causes of Sore Nipples and Immediate Relief
Managing Engorgement and Preventing Blocked Ducts
Recognising Mastitis vs. Normal Engorgement
Low Weight Gain — Assessment and Feeding Plan Adjustments
Non-Judgmental Approach to Supplementation
Returning to Work or School; Feeding Outside the Home (15 minutes)
Creating an express-and-feed routine (timing, containers, transport) Practical storage and transport tips for different commute types Rights and workplace basics (general guidance; encourage local legal verification) Communicating with caregivers and preparing safe feeder notes Emotional coping and practical fallback plans
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Creating an Express-and-Feed Routine
Practical Storage & Transport Tips for Expressed Breast Milk by Commute Type
Rights and Workplace Basics for Breastfeeding Mothers
Communicating with Caregivers and Preparing Safe Feeder Notes
Emotional Coping and Practical Fallback Plans
Special Situations (20 minutes)
Feeding preterm or low-birthweight infants: kangaroo care, cup or tube feeding basics Managing twins/multiples: tandem feeding tips and time-saving routines Mothers on medication or with infectious illness: how to check drug safety and local guidelines (HIV, TB, etc.) Using donor milk or milk banks (where available) — safety basics
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Feeding Preterm or Low-Birthweight Infants
Managing Twins/Multiples — Tandem Feeding Tips and Time-Saving Routines
Mothers on Medication or with Infectious Illness — Drug Safety & Guidelines
Using Donor Milk or Milk Banks — Safety Basics
When to Seek Help & Building a Support Network (15 minutes)
Red flags for baby and mother (e.g., poor weight gain, fever, severe pain) Where to seek help: clinic, CHW, lactation consultant, emergency care Building a support network: partners, family, peer counsellors, community groups Using telephone/text supports, community groups, and referral pathways
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Red Flags for Baby and Mother
Where to Seek Help for Breastfeeding Challenges
Building a Support Network for Breastfeeding Mothers
Using Telephone/Text Supports, Community Groups, and Referral Pathways
Wrap-up, Resources & Final Assessment (15 minutes)
Key takeaways and common pitfalls to avoid Next steps: seeking local support, advanced training options How to use course materials beyond the course (groups, sharing, peer support) Final 20-question multiple-choice quiz (80% pass mark)
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Key Takeaways and Common Pitfalls to Avoid
Next Steps — Seeking Local Support & Advanced Training Options
How to Use Course Materials Beyond the Course
Final 20-question multiple-choice quiz (80% pass mark)
How to Breastfeed — Self-Paced, Evidence-Based Course for African Moms

Introduction

Hand-expression is a simple, free, and effective skill every mother can learn. It helps relieve fullness, collect milk when away from baby, and maintain supply. Unlike pumps, it requires no equipment — only clean hands and a container.

1. Why Learn Hand-Expression?

  • Relieves engorgement or blocked ducts.

  • Collects colostrum in the early days (small amounts are precious).

  • Useful where pumps are unavailable or electricity is unreliable.

  • Helps stimulate supply in the first days after birth.

2. Steps for Hand-Expression

  1. Preparation

    • Wash hands with soap and water.

    • Have a clean container ready.

    • Find a comfortable, private space.

  2. Stimulate Let-Down

    • Gently massage breasts in circles, or place a warm cloth for relaxation.

    • Gentle nipple rolling or skin-to-skin with baby can help.

  3. Hand Positioning (C-hold)

    • Place thumb above and fingers below the areola (not on the nipple).

    • Form a “C” shape around the breast.

  4. Compress and Release

    • Press back toward the chest wall.

    • Gently compress thumb and fingers together.

    • Release — repeat rhythmically (press, compress, release).

  5. Rotate Around the Breast

    • Move fingers around the areola to express from different ducts.

    • Alternate breasts every few minutes.

  6. Collect and Store Milk

    • Collect drops or streams into a clean cup, spoon, or container.

    • Store milk safely according to guidelines.

3. Common Mistakes to Avoid

  • Squeezing or pulling the nipple only → causes pain and little milk.

  • Pressing too hard → bruises tissue, reduces flow.

  • Rubbing skin roughly → irritates skin and can cause cracks.

  • Expecting large amounts immediately → especially in early days, colostrum comes in drops.

  • Stopping too soon → let-down may take 1–2 minutes before milk flows well.

4. Practical Tips

  • Relax, breathe deeply — tension reduces milk flow.

  • Use hand-expression after feeds to boost supply if needed.

  • Practice makes it easier over time.

End of Lecture Quiz

Q1. Where should the fingers be placed during hand-expression?
A. Directly on the nipple
B. Far away from the breast
C. Around the areola in a “C” shape
D. On the upper chest

Answer: C. Around the areola in a “C” shape
Rationale: Milk is expressed from ducts beneath the areola, not the nipple itself.

Q2. What is a common mistake mothers make during hand-expression?
A. Using a clean container
B. Massaging before expression
C. Pulling or squeezing only the nipple
D. Rotating hand position around the areola

Answer: C. Pulling or squeezing only the nipple
Rationale: This causes pain and yields little milk.

Q3. True or False: Colostrum usually comes in small drops, not large amounts, in the early days.
Answer: True
Rationale: Small drops of colostrum are normal and highly nutritious for newborns.

Curated Online Resources

Key Takeaways

  • Hand-expression is a vital skill every mother can use — no equipment required.

  • Use a C-hold, press back, compress, and release — not nipple pulling.

  • Colostrum comes in drops, not ounces — and that’s enough.

  • Relaxation and patience improve results.

Call to Action

  • Mothers: Practice hand-expression early, even before leaving the birth facility.

  • Health workers: Teach hand-expression routinely to every mother.

  • Communities: Normalize hand-expression as a free, practical tool for all families.

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