Hi, Karen:  Amen! to everything you said!  As an aside, you must have a 
stronger back than me because I used to bring the custard cup of cereal up 
to my breast while hand-expressing milk into it.  A few squirts, a quick 
mix with the spoon, maybe a few more squirts and mix until you hit the 
right consistency!
To further comment on moms NEEDING breast pumps.  I like to put it to a 
mother this way. We strive for the ideal in all areas of our lives.  We 
strive for the perfect body, for perfect health, the perfect job, the 
perfect house, the perfect lifestyle.  Why should we view breastfeeding any 
differently?  The IDEAL breastfeeding experience is EXCLUSIVE breastfeeding 
with the baby at the breast.  I ask the mother to place the ideal 
breastfeeding experience up before herself and strive towards that goal, 
just like she strives towards other goals in her life.  Now, depending on 
her particular lifestyle, she can decide how close to the ideal she can 
get.  If she is a stay-at-home mom who never goes out, or on the rare 
occasions she does go out but has her baby with her, she can continue the 
ideal of exclusive breastfeeding.  If she is a working mom who must be away 
from baby on a regular basis, then she will be doing the pumping/feeding 
EBM route, but ONLY for the feedings she is gone for.  When she is with her 
baby she reverts back to the ideal of exclusive breastfeeding.  If a stay-
at-home mom wants to go out on occasion without her baby, then she uses a 
pump (or my preference - hand expression) and bottles. By the way, I went 
back to work full-time (not by choice, but necessity) with all 3 of my 
children and NEVER used a pump.  I hand expressed for all 3.  So it is 
certainly possible.  One handy piece of equipment I did use, which Medela 
no longer makes, is a hand expression funnel.  I double-hand expressed by 
placing 2 bottles with the funnels attached on my desk and hand-expressed 
simultaneously into them.  I usually had 4-6 ounces of milk in less than 10 
minutes. 
We need to emphasize as much exclusive breastfeeding as is realistic within 
a mother's particular lifestyle.  It really bothers me that so many women 
out there think that they cannot successfully breastfeed without the best 
and most expensive pump/equipment on the market.  And a woman feels really 
empowered when she finds that she has successfully, exclusively nursed her 
baby up to and in many instances, beyond her original goal, without 
the "help" of gadgets.  Just her breasts and her baby, just like Mother 
Nature intended!

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

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