Hand expressing before birth: when is it useful and when not?

Desiree Bobby
Jan 16
5 min read

This article covers everything you need to know about hand pumping before birth. When to do it, and when not to. We'll discuss the potential benefits and drawbacks . We'll also address myths like the idea that prenatal pumping will speed up labor.

First of all, we need to talk about this.

You may have heard it before: "If you hand pump prenatally, it can induce labor." The idea that nipple stimulation can induce labor has long been around. And that's why many pregnant women wonder if hand pumping is safe towards the end of their pregnancy.

This reluctance isn't unfounded. Older, small studies suggested that prenatal pumping might be associated with earlier deliveries or more neonatal unit admissions. This made healthcare providers understandably cautious.

But small studies don't tell the whole story. That's why this topic was later investigated much more thoroughly.

To really get clarity on this, the DAME study was conducted.

The DAME is a large, well-designed study that followed 635 pregnant women with diabetes. Half of the women began hand pumping at 36 weeks of pregnancy, while the other half did not.

The results were clear and reassuring. Women who used prenatal hand pumping did not give birth earlier than women who did not. Their babies were also not admitted to the neonatal unit more often, and no additional risks for mother or child were found.

The conclusion: prenatal hand pumping does not speed up labor.

But what about nipple stimulation and contractions?

This requires an important distinction. There is research showing that intense nipple stimulation can influence labor initiation.

A Cochrane review of six studies showed that prolonged and active nipple stimulation, such as intensive breast massage, reduced the number of women who had not given birth after 72 hours. Other studies also show that intensive breast massage around the due date can increase the chance of spontaneous labor.

That might sound daunting, but there's a nuance to it. These studies involved women who consciously tried to induce labor with prolonged and intense stimulation . This is quite different from the gentle, brief, and gentle hand pumping sometimes done in the final weeks of pregnancy in preparation for breastfeeding.

You may find that healthcare providers have different views on prenatal hand pumping.

This is because it's not a standard part of care and is always considered individually. Factors such as your pregnancy, medical history, and personal resilience play a role.

Therefore, it's normal for one hospital or healthcare provider to be more cautious than another. This doesn't mean either one is wrong, but that a tailored approach is key.

In some situations, prenatal hand pumping is actually seen as a useful preparation.

By gently practicing hand pumping before birth, some women can become comfortable with their breasts, hand pumping, and collecting colostrum. This can significantly contribute to a sense of calm and confidence, especially if pumping becomes necessary (temporarily) after delivery.

There are several situations in which pumping is used more often after birth, for example when:

there is diabetes, such as gestational diabetes
low milk production was experienced during a previous pregnancy
if the baby is known to be larger or heavier than average (macrosomia)
the baby is expected to be small or light, for example in the case of an early induction or growth retardation (dysmaturity)
the baby has a congenital condition, such as a cleft palate, which can make breastfeeding more difficult
multiple births are expected
there is a planned caesarean section
the mother is overweight
there has been breast surgery in the past
there is polycystic ovary syndrome (PCOS)

In these situations, a small supply of colostrum in the first few days after birth can be helpful. To do this safely, read the instructions here.

At the same time, it is important to keep expectations realistic.

Prenatal hand pumping doesn't guarantee an easy start to breastfeeding and says nothing about how much milk you'll produce later. It also says nothing about your body, your commitment, or how well you'll care for your baby later. Some babies need supplements after birth, regardless of whether they were pumped prenatally, and that's part of the normal process.

Prenatal hand pumping is therefore primarily a possibility, not a benchmark or a test. What feels comfortable for one person may not be beneficial for another.

Furthermore, manual pumping isn't suitable for everyone. It's not recommended for those with an increased risk of preterm birth (such as a previous preterm birth, placenta praevia, high blood pressure, or other pregnancy complications).

If you are unsure whether it is suitable for you, it is always wise to discuss this with your healthcare provider, so that you can determine together what is helpful and safe in your situation.

While prenatal hand pumping can be helpful in some situations, it is also important to recognize the downsides.

Prenatal hand pumping isn't a standard recommendation, nor is it a fixed step in preparing for breastfeeding. If you choose not to start, you're not missing out on anything and you're not doing anything wrong.

For some (expectant) mothers, pumping can actually cause uncertainty, especially when little or no colostrum is visible. This feeling is perfectly understandable, but it can sometimes unintentionally add tension at a time when rest would be helpful.

Prenatal manual pumping usually involves very small amounts. Most women express a few drops to about 1 milliliter per session before birth. Sometimes they manage to express a little more, sometimes nothing at all. This is all within what's normal for this phase.

For comparison, newborns consume an average of between 7 and 30 ml per feeding in the first one to two days after birth, approximately 8 to 12 times a day. This demonstrates how small the amounts collected prenatally often are compared to what a baby ultimately needs.

Therefore, prenatal hand pumping is usually not a way to build up a 'stock', but mainly a way to become familiar with the process.

For some women, waiting until after the birth actually provides more peace, and that peace is at least as valuable.

For some women, prenatal hand pumping brings peace of mind. For others, it can be stressful. You might find yourself starting each session with expectations, or feeling disappointed when you see little. Sometimes comparisons creep in, with stories or images from others.

If you find that hand pumping is causing you more stress than confidence, stopping isn't a failure, it's self-care. Listening to what it's doing to you is just as important as following advice. And trust that your body doesn't need a manual to become a mother.

Love,

Bobby