I have had great success with the following: Massage each breast for about 30 seconds. Lots of skin of mother's palm and fingers on the breasts.  massage top and bottom, left and right, repeat.  Repeat on other breast.  Pump for 4-6 min. When the stream of milk stops or slows,  remove flanges. Massage again.  Finish pumping for another 5-8 minutes.  Total pumping time is 10-15 min. Mothers are usually amazed when seeing more let downs of milk during the 2nd half of pumping!  Can hand express each breast for 3-5 min after pumping if mother is willing.   I teach this with the first pumping during the hospital stay if I am there. Sometimes a mother begins pumping during the evening or night shift. Susan in Minnesotarn ibclc

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