Dear Jen, Kathy D is right, hand expression can probably be just as efficient as a good quality pump, even lacking the ability to express both sides at once. What convinced me was seeing a film from UNICEF, I believe it's called 'Breastfeeding Low Birth Weight Babies', it is included on a tape(Breastfeeding 4x4) UNICEF requires for facilities that are preparing to become Baby Friendly, and it was filmed in Nairobi, Kenya. The moms in the film use hand expression to obtain milk for their premature babies, and they are FAST!!! given the fact that there's no equipment to set up or clean afterwards, I think skilled hand expression could be just as efficient as double-pumping. And UNICEF requires that any Baby Friendly facility teach every breastfeeding mother this skill. If you want to try another tack with your insurance company, some mothers in my area have had good luck getting insurance to pay for purchase (not rental) of a breast pump as 'Durable Medical Goods". Call your company and see what they say to this. Martha Johnson RN IBCLC Eugene, Oregon ___________________________________________________________________ You don't need to buy Internet access to use free Internet e-mail. Get completely free e-mail from Juno at http://www.juno.com/getjuno.html or call Juno at (800) 654-JUNO [654-5866] *********************************************** The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(TM) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html