Hi, All:  Just have to chime in on my favorite topic - hand expression of milk.  I 
teach hand expression in the hospital - mom is usually not real impressed with 
the drops she gets because her mind is on getting lots of milk when she 
returns to work - and then tell mom to try hand expression again when her 
baby is 4 to 8 weeks old when she is preparing to go back to work.  She has a 
full milk supply by then and nursing is going well for her and her baby.  With 
baby on one breast and her hand on the other, she will "feel" where her hand 
needs to be to "milk" the let-down her baby has just elicited.  Because she is 
essentially "double pumping" using this method, she will get an impressive 
amount of milk in her collection container, while baby gets plenty on his side.  
I double hand-expressed at work, when my baby was not available to me and 
was quickly filling bottles within 10 to 15 minutes.  Unfortunately, Medela no 
longer makes the hand expression funnels that were available in the 1980's 
into the early 1990's.  They were handy to corral any stray milk streams during 
expression.
Remember, use of the electric breast pump is almost exclusively a United 
States (North American?) phenomenum - most of the rest of the world hand 
expresses, including those moms who have hospitalized babies from birth.

Pam Hirsch, BSN,RN,IBCLC
Clinical Lead, Lactation Services
Advocate Good Shepherd Hospital
Barrington, IL    USA

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