There’s been a lot of discussion recently about whether parents should be using breast pumps right from day zero. For years, the message from UK services was simple: hand expression is best in the early days. But in neonatal and some maternity units, parents are now encouraged to start using pumps immediately after birth, often in combination with hand expression.
Is this a gimic encouraged by the pump manufacturers, or is it grounded in research?
And what is the most up-to-date advice under the Baby Friendly Initiative (BFI)?
Let’s look at what the evidence and guidance actually say.
Hand Expression Still Matters
The UNICEF UK Baby Friendly Initiative (BFI) still requires that all breastfeeding parents are shown how to hand express. This remains a core skill, because:
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Colostrum volumes are tiny. In the first 72 hours, pumps can lose small amounts of milk in the tubing or collection sets, while hand expression allows parents to collect every drop.
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It helps build supply. Early, frequent hand expression (around eight times in 24 hours) mimics normal newborn feeding patterns and stimulates milk production.
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It is always available. Hands don’t rely on equipment, power or flange sizing, making hand expression a skill that can be used anytime and anywhere.
Most BFI-accredited Trusts still recommend hand expression as the first step after birth, particularly for collecting colostrum.
Pump Use from Day Zero
BFI standards and NHS practice have evolved. The BFI Assessment of Breastmilk Expression Checklist highlights the importance of early, frequent and effective expressing, combining hand and pump expression where appropriate. It recommends that parents are supported to use both methods and that expression begins as soon as possible after birth, ideally within two hours.
Some hospitals, such as Guy’s and St Thomas’s NHS Foundation Trust, advise parents whose babies are in neonatal care or not feeding effectively to begin expressing within the first two hours. Parents are encouraged to start with hand expression and introduce a pump once milk begins to flow more freely.
This shift reflects a more flexible and evidence-based approach. Pumps are no longer seen as unsuitable in the first days. Instead, the combination of hand and pump use is recognised as the most effective way to establish supply when direct breastfeeding is delayed or limited.
Why Combining Hand and Pump Expression Works
Evidence and practice guidelines show that using both methods together can:
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Improve total milk yield
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Increase fat and calorie content
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Support more consistent long-term supply
BFI and NHS guidance both focus on effectiveness. Whether using hands, a pump, or both, milk removal needs to be comfortable and efficient. Poor flange fit, incorrect suction, or pain can reduce milk flow and risk nipple trauma. Early review of technique and equipment fit is essential, ideally within the first 12 hours.
Typical UK Practice in 2025
Stage
Recommended Approach
Reason
First 72 hours
Prioritise hand expression, collecting colostrum with a syringe or small sterile pot.
Colostrum volumes are very small; hand expression is more effective and waste-free.
If baby is not feeding or is separated
Begin expressing (by hand and/or pump) within two hours of birth.
Early stimulation helps protect long-term milk supply.
When milk increases
Combine with or transition to an electric or hospital-grade pump.
Pumps help maintain supply once milk flow increases.
Longer term
Use whichever combination feels comfortable and effective.
Consistent, efficient milk removal is the goal.
So yes, using a pump from day zero is now accepted and often encouraged, particularly in neonatal or high-risk circumstances. But hand expression remains an essential part of that early care.
Antenatal Expressing
Antenatal expressing is a different situation. Here the guidance is clear: only hand expression should be used, from around 36–37 weeks onwards, and only if it is safe to do so.
That means no vaginal bleeding, no uterine contractions, and no known risk of preterm labour. Breast pumps are not recommended antenatally because of the theoretical risk of triggering contractions, and because hand expression is perfectly adequate for collecting small amounts of colostrum.
Current NHS and BFI-aligned sources are consistent on this point. Parents should hand express small volumes into sterile syringes or containers, store the colostrum appropriately, and bring it to hospital if needed after birth.
What Do I Think?
I am all for parents learning to use both hand and pump expression — but only when it is done properly. That means ensuring parents understand how to use a pump correctly, with the right flange fit, timing and settings, and only after they have been shown and supported to hand express.
They also need to understand that colostrum in the first few days is likely to be in very small quantities. My concern is that a mother might be handed a pump without proper fitting or explanation, and then feel disheartened when she collects nothing. Too often, this reinforces the idea that she has somehow failed or that lactation is not going to work for her.
I would rather see someone proudly holding a full 1 ml syringe of colostrum than an empty pump bottle.
If parents are told that it is fine to use a pump before their milk comes in, it is imperative that this is done with care, context, and individualised support. Anything less risks undermining confidence rather than building it.
Safety and Professional Support
Whether antenatally or postnatally, technique and comfort are key. Expressing should not cause pain. If it does, the method, pressure or pump settings should be reviewed. Early input from skilled professionals makes a significant difference in confidence and milk outcomes.
The Bottom Line
UK BFI-aligned care in 2025 is not about hand versus pump. It is about ensuring every breastfeeding parent:
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Learns how to hand express
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Has timely access to a suitable pump when needed
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Receives practical, compassionate support to express early, frequently and effectively
Hand expression remains vital, especially in the first days, but early pump use is now recognised as a useful tool to support and protect milk supply when babies cannot feed directly. The best approach combines both, guided by good technique and sensitive, individualised care.
References
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UNICEF UK Baby Friendly Initiative. Guide to the UNICEF UK Baby Friendly Initiative Standards. 2014. https://www.unicef.org.uk/
babyfriendly/wp-content/ uploads/sites/2/2014/02/Guide- to-the-Unicef-UK-Baby- Friendly-Initiative-Standards. pdf -
UNICEF UK Baby Friendly Initiative. Assessment of Breastmilk Expression Checklist. 2017. https://www.unicef.org.uk/
babyfriendly/baby-friendly- resources/implementing- standards-resources/ assessment-of-breastmilk- expression-checklist/ -
Guy’s and St Thomas’s NHS Foundation Trust. Expressing Your Breast Milk. https://www.guysandstthomas.
nhs.uk/health-information/ expressing-your-breast-milk -
NHS Cambridge University Hospitals. Antenatal Hand Expression of Breast Milk Guidance. https://www.cuh.nhs.uk/
patient-information/antenatal- hand-expression-of-breast- milk-guidance/ -
NHS Greater Glasgow & Clyde (Right Decisions). Antenatal Colostrum Harvesting Guideline. https://rightdecisions.scot.
nhs.uk/shared-content/ggc- clinical-guidelines/maternity/ antenatal-general/antenatal- colostrum-harvesting-1154/ -
NHS Lothian. Antenatal Hand Expressing Guideline for Pregnant Women with Diabetes. https://www.anchb.scot.nhs.uk/
media/4hidrcsn/nhs-lothian- antenatal-hand-expressing- guideline-for-pregnant-women- with-diabetes.pdf -
The Breastfeeding Network. Expressing and Storing Breastmilk. https://www.
breastfeedingnetwork.org.uk/ breastfeeding-information/ continuing-the-breastfeeding- journey/expressing-and- storing-breastmilk/ -
Kent Community Health NHS Foundation Trust. Baby Friendly Re-accreditation Success. 2024. https://www.kentcht.nhs.uk/
community-health-online/baby- friendly-re-accreditation- success/
