Regarding the post about no flow in one breast, it can be a blockage deep in the breast. Sometimes it is possible to palpate when the breast is soft, but harder on engorged or full breast. Last September when I went to Russia and Belarus to teach seminars for local lactation consultants, I learned great techniques of breast massage and manual expression. Some of the lactation consultants there can do magical things with their hands. They can "feel" with their hands where in the breast is a blocked area, they call it lactostasis, and then using breast massage, RPS and manual expression, they can "unplug" that area and the milk will be flowing! The hand expression that I use is more what Jean calls fingertip expression. I start expression close to the nipple moving upward. I found that it works really great in multiple situations as engorgement, blocked ducts, periareolar edema. I do have videoclips from Russia, trying to put them together in one video.  I think that hand expression has to be one of the clinicals skills that need to be taught. I always love to learn new techniques from others.

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