The purpose of breast compression is to continue the flow of milk to
the baby when the baby is only sucking without
drinking. Drinking (“open mouth wide—pause—then close mouth” type of
suck—see also the video clips at the website www.drjacknewman.com)
means baby got a mouthful of milk. If baby is no longer drinking on his
own, mother may use compressions to “turn sucks or nibbling into
drinks”, and keep baby receiving milk. Compressions simulate a letdown
or milk ejection reflex (the sudden rushing down of milk that mothers
experience during the feeding or when they hear a baby cry—though many
women will not “feel” their let down). The technique may be useful for:
Compression is not necessary if everything is going well. When all is
going well, the mother should allow the baby to “finish” feeding on the
first side and offer the other
side. How do you know the baby is finished the first side? When he is
just sucking (rapid sucks without pause) and no longer drinking at the
breast (“open mouth wide — pause — then close mouth”
type of suck). Compressions help baby to get the milk.
- Poor weight gain in the baby
- Colic in the breastfed baby
- Frequent feedings and/or long feedings
- Sore nipples in the mother
- Recurrent blocked ducts and/or mastitis
- Encouraging the baby who falls asleep quickly to
continue drinking not just sucking
- A “lazy” baby, or baby who seems to want to just
“pacify”. Incidentally babies are not lazy, they respond to milk flow.
Breast compression works particularly well in
the first few days to help the baby get more colostrum.
Babies do not need much colostrum, but they need some. A good latch and
compression help them get it.
It may be useful to know that:
Breast compression—How to do it (Use with Protocol
to Manage Breastmilk Intake)
- A baby who is well latched on gets milk
more easily than one who is not. A baby who is poorly latched on can
get milk only when the flow of milk is rapid. Thus, many mothers and
babies do well with breastfeeding in spite of a
poor latch, because most mothers produce an abundance of milk. However,
the mother may pay a price for baby’s poor latching—for example: sore
nipples, a baby who is colicky, and/or a baby who is constantly on the
breast (but drinking only a small part of the
- In the first 3-6 weeks of life, many babies tend to fall
asleep at the breast when the flow of milk is slow, not
necessarily when they have had enough to eat and not because
they are lazy or want
to pacify. After this age, they may
start to pull away at the breast when the flow of milk slows down.
However, some pull at the breast even when they are much younger,
sometimes even in the first days and some babies fall asleep even at 3
or 4 months when the milk flow is slow.
In our experience, the above works best, but if you find a way which
works better at keeping the baby drinking with an “open mouth wide—pause—then
close mouth” type of suck, use whatever works best for you and your
baby. As long as it does not hurt your breast to compress, and as long
as the baby is “drinking” (“open mouth wide—pause—then
close mouth type” of suck), breast compression is working.
- Hold the baby with one arm.
- Support your breast with the other hand, encircling it by
placing your thumb on one side of the breast (thumb on the upper side
of the breast is easiest), your other fingers on the other, close to
the chest wall.
- Watch for the baby’s drinking, (see
videos at nbci.ca ) though there is no need to be obsessive
about catching every suck. The baby gets substantial amounts of milk
when he is drinking with an “open mouth wide—pause—then
close mouth” type of suck.
- When the baby is nibbling at the breast and no longer
drinking with the “open mouth wide—pause—then close
mouth” type of suck, compress the breast to increase the internal
pressure of the whole breast. Do not roll your fingers along
the breast toward the baby, just squeeze and hold. Not so
hard that it hurts and try not to change the shape of the areola (the
darker part of the breast near the baby’s mouth). With the compression,
the baby should start drinking again with the “open mouth wide—pause—then
close mouth” type of suck. Use compression while the baby is
sucking but not drinking!
- Keep the pressure up until the baby is just
sucking without drinking even with the compression, and then release
the pressure. Release the pressure if baby stops sucking or
if the baby goes back to sucking without drinking. Often the baby will
stop sucking altogether when the pressure is released, but will start
again shortly as milk starts to flow again. If the baby does not stop
sucking with the release of pressure, wait a short time before
- The reason for releasing the pressure is to allow your hand
to rest, and to allow milk to start flowing to the baby again. The
baby, if he stops sucking when you release the pressure, will start
sucking again when he starts to taste milk.
- When the baby starts sucking again, he may drink (“open
mouth wide—pause—then close mouth” type of suck). If
not, compress again as above.
- Continue on the first side until the baby does not drink
even with the compression. You should allow the baby to stay on the
side for a short time longer, as you may occasionally get another
letdown reflex (milk ejection reflex) and the baby will start drinking
again, on his own. If the baby no longer drinks, however, allow him to
come off or take him off the breast.
- If the baby wants more, offer the other side and repeat the
- You may wish, unless you have sore nipples, to switch sides
back and forth in this way several times.
- Work on improving the baby’s latch.
- Remember, compress as the baby sucks but does not
drink. Wait for baby to initiate the sucking; it is best not to
compress while baby has stopped sucking altogether.
You will not always need to do this. As breastfeeding improves, you
will be able to let things happen naturally. See the videos of how to
latch a baby on, how to know a baby is getting milk, how to use
compression at ncbionline.org
Questions? First look at the website nbci.ca or drjacknewman.com. If the information you need is not there, go to Contact Us and give us the information listed there in your email. Information is also available in Dr. Jack Newman’s Guide to Breastfeeding (called The Ultimate Breastfeeding Book of Answers in the USA); and/or our DVD, Dr. Jack Newman’s Visual Guide to Breastfeeding (available in French or with subtitles in Spanish, Portuguese and Italian); and/or The Latch Book and Other Keys to Breastfeeding Success; and/or L-eat Latch and Transfer Tool; and/or the GamePlan for Protecting and Supporting Breastfeeding in the First 24 Hours of Life and Beyond.
To make an appointment online with our clinic please visit www.nbci.ca. If you do not have easy access to email or internet, you may phone (416) 498-0002.
Breast Compression, February 2009©
Written and revised (under other names) by Jack Newman, MD, FRCPC, 1995-2005©
Revised by Jack Newman MD, FRCPC, IBCLC and Edith Kernerman, IBCLC, 2008, 2009©