You may think you will never express milk by hand. Kind of third world, isn't it? Well, you'd be surprised. I know my friend Beth was surprised when I had to walk her through it over the phone when she'd left her pump at home and couldn't leave the office...

Hand expression brings you back to my favorite recommendation - a hot shower. That's right, the shower is the best place to learn this art, so read carefully (or print out the page and laminate it) and then off to the showers with you.

Mastering hand expression involves mastering a certain knowledge of your own breasts. Of course, since you do your breast exam every single month (don't tell me that you don't, I refuse to hear it), you're already familiar with your breasts, but now you need to learn about where the milk collects.

One-minute anatomy lesson: Your breast has a number of milk-producing glands, all connected to ducts that exit the breast at the nipple. Behind your nipple is a region of the duct that swells with milk prior to a milk ejection (this used to be called the "milk sinus" until they realized it disappeared when there was no milk in it). Once you find these swellings, you've found the key to getting the milk out. You don't actually have to feel the swellings, you just have to figure out how to get behind them, because pressing behind these swellings causes the milk to come out. This is why your baby needs a large mouthful of breast for a good latch - he uses his tongue to press the milk out of where it collects behind your nipple.

The basic technique (described beautifully by Chele Marmet in 1978 and elaborated in detail here) is to hold your breast with your thumb and fingers about an inch to inch and a half behind your areola. If your breast were to miraculously turn into a clock, you would find your thumb and fingers at the numbers 12 and 6. Gently press back towards your chest wall, roll your thumb and fingers gently together and towards the space behind your nipple, and that's it! Now - off to the shower. Run some warm water over your breasts to stimulate the milk flow and get you relaxed. Move your hands around and varying the positioning. When you find the right spot, you'll know. The milk will spray everywhere. Once you've mastered this in the shower, you can practice hitting a container. It's not really that hard, once you get the hang of it. Once you've finished one location, rotate your hands around your breast to drain all of the ducts. Breast compressions can help as well.

Below is a picture from the Medela website, illustrating the Marmet technique for manual expression:

The little circles are your thumb and fingers

Some pictures (particularly the photos on breastfeeding.com) make it look like you're pinching your nipple. Do not pinch your nipple. Remember, you're pressing milk that is behind your nipple out of  your nipple. Pinching your nipple not only hurts, it blocks this flow.