HOW TO HAND EXPRESS
1.        MASSAGE – and stroke your breasts to help the milk to start to flow.

2.       SIT – comfortable leaning slightly forward so gravity works with you.

3.        POSITION – form a ‘C’ shape with your thumb and pointing finger either side of your areola, with an imaginary line from your finger through your nipple to your thumb.

4.       PRESS BACK – with steady pressure, keeping your fingers in the same place.

5.       COMPRESS TOGETHER – your fingers and thumb.  DO NOT squeeze, pull or slide.

6.       RELAX – your shoulders and your hand.

7.       REPEAT RHYTHMICALLY – from stage 3, change the location of your fingers.

8.       SWITCH - breasts as the flow slows to remove more milk.

Breast Massage and Hand Expression Video – https://vimeo.com/65196007

Stanford University Hand Expression Video - https://med.stanford.edu/newborns/professional-education/breastfeeding/hand-expressing-milk.html

If severe Engorgement is not relieved, the alveoli (milk producing cells at the end of the milk ducts) can become atrophied and may decrease milk production. If the engorgement continues it can lead to blocked ducts and mastitis.

Preventing & Relieving Engorgement:

+ Seek Help and support
+ BF frequently, aiming for least 10-12 times in 24 hours – with no more than a 3 hour stretch at night.
+ Have the baby actively BF
+ BF skin- to -skin to stimulate sucking
+ Vary BF positions to help promote drainage of the breast
+ Wear a supportive bra
+ Apply cold compresses to your breasts and under your arms.  A bag of frozen peas or a disposable diaper that you dampen and put in the freezer for 20 mins (15-20 minutes on, 15-20 minutes off, for 1-2 hours)

Before BF - Applying some heat immediately before BF can help the milk let-down. (A warm shower, soaking the breasts in a basin of warm water or warm bath, or applying warm compresses or a heating pad may help)
Gentle breast massage can help the milk flow

If the nipple and areola are swollen, don’t try to nurse without softening them up first.
– Hand express or pump a little milk from your breast to soften the nipple and areola before trying to nurse.
– Gently massage the breast before nursing.
– REVERSE PRESSURE SOFTENING
The aim is to soften the areola for better latching.
Fig. 1 or 2 - Press toward the chest wall and count slowly to 50.
Pressure should be steady and firm, and gentle enough to avoid pain.If breasts are quite large or very swollen, lye on your back and count very slowly.  This delays return of swelling to the areola, giving more time to latch.
Soften the areola just  before each BF until swelling goes away which could takes 2-4 days.
NB - hand expressing is preferable as pumping can draw the swelling towards the nipple.  Make any pumping sessions short, with only a medium/low vacuum and pauses to re-soften the areola if needed. Don’t try to increase the suction.

If the above suggestions don’t bring you enough relief.
Cabbage Leaf Compress
+ Green Savoy cabbage, put in the fridge to cool
+ Remove the hard stem of each leaf and gently pound leaves
+  Wrap the leaf around breast covering around the breast but leaving the nipple exposed
+ Change every 30 minutes or sooner if they warm/wilt
+ Check OFTEN, as over use can cause a decrease in your milk supply
+ Re-apply as needed (up to 3 times between feedings)

Pain medication - If the pain and swelling persists, using OTC (over the counter) medication may help.  Ibuprofen with it’s antinflamato properties and Paracetamol are safe to use together or alone.

Where does the law apply?
Anywhere that provides services (including food and drink), benefits, facilities and premises to the public and public bodies. This includes associations, like sports clubs.

What does discrimination mean in practice? 
Refusing to provide a service, providing a lower standard of service or providing a service on different terms to everyone else. For example, a cafe owner cannot ask you to stop breastfeeding or refuse to serve you.

What if you're asked to stop? 
First of all, make a complaint through the normal route. If that doesn't work, you can bring an action in a county court within six months of the incident.

What about Scotland?
The law goes even further: it is a criminal offence to try to stop or to prevent a woman from feeding a child under two in any public place.

Sources: Maternity Action, Made for Mums