When my babies were little, I depended on manual expression when I returned
to work (and before to have some for storage). I'll admit I hated manual
expression! Hated it... Got milk via manual but it was painstaking. (And a
friend who could get 5-10 oz in less than 5 minutes helped me when I
wondered about technique.)  Had no luck (but had a lot of laughs) with
manual pumps of that period or with the ever-entertaining juice-jar pump.
Never let down for any of it -- manual or the pathetic mechanical. Maybe
pre-expression RPS would have helped, although I think I did something like
that -- just didn't have a name for it! Some of my babies had latching
difficulties for many weeks (wish I could go back and look in their mouths
better), but thank heavens I didn't have to worry about 24/7 milk expression
via anything but baby/babies! (This includes my unmedicated, home birth baby
who didn't latch for the 1st 24 hours.)

I'm in the USA and in an area with more than enough birth interventions and
too many babies who apparently didn't read the "Babies Were Born to
Breastfeed" book. It can take them weeks to really wake up and smell the
milk on their own. Their moms grew up in a world in which they didn't see
breastfeeding yet it never occurred to them that they may need to know
something about breastfeeding before they tried it... These moms, about
30-35% of whom are recovering from major surgery related to birthing, often
go on to experience delayed L 2 and/or L 2 with extreme edema. Much of the
engorgement here is beyond the physiological type and into pathological due
to the amount of edema. (Thank you, Jean Cotterman, for RPS, which I can
explain fairly easily during a "warmline" phone conversation!)

There is little that is truly NORMAL about the birth or the early
breastfeeding for many moms in our area. I don't like it, work to change it,
but must deal with the reality I'm facing if I'm to help many moms continue
to breastfeed and eventually reach something akin to normal!  Needless to
say, milk expression is a part of many new moms' picture until baby and
breast can come together in a better way. We have enough trouble convincing
new moms to try manual expression for colostrum, much less 8 or more times
in 24 hours. (And while I recognize this is different in other parts of the
world, that doesn't help me where I'm working now. It's not just about
economics in the USA, which is experiencing higher unemployment and a
recession, it's also about cultural comfort.)

Mechanical expression (and hopefully in conjunction with pre-pum RPS and a
bit of manual expression) is the choice of most because it allows for most
moms obtaining more milk in less time, which translates to a willingness to
do it more frequently versus put it off and then off some more until
frequency is a joke.

I share Jaye's frustrations with personal pumps. I wish I had even a small
coin for the number of moms who call because production is tanking after
they've been depending on a personal pump for 24/7 milk removal. (These are
moms who still cannot yet depend on their newborn as their primary "pump.")
This includes NICU moms. This includes moms whose babies are beginning to
transition but aren't yet dependable. This includes multiples of which one
(or 2) may be breastfeeding fairly well but another (1-2) isn't. This means
I've first assessed for frequency of use, pumping routine,
flange/breastshield sizing, etc. Some moms get by -- often moms who've
breastfed or pumped for a previous baby -- and I often hear how well all
went the first week and then things started going downhill the second week.
Plugged ducts are another issue... Moms who've rented a pump for 2 weeks and
then think production is OK so move to their personal pump and call with a
plugged duct(s) (often in combo with lower volume obtained) -- and most say
they felt this pump wasn't emptying them as well as the rental, but figured
that was OK at this point.

If production depends on a breast pump because the baby is not yet the
primary milk remover, the rental hospital-grade pump is the better option. A
personal pump is terrific for the job it was intended for - back-up but the
baby is the dependable, primary milk remover. And there are a couple of
personal pumps that bear watching re: dependance on pump for lactation, but
more evidence or experience is needed to gain confidence in them yet.

On to a particular pump -- the most popular in our area -- which shall go
nameless... I also wish I had a small coin for the number of times a mom who
has been doing great with pumping at work, etc is finding she's getting less
and less over a brief period of time, although her pumping routine has not
changed and I've assessed for other possibilities. She'll tell me it feels
the same but something has changed. When I ask which pump a mom is using, I
now follow it with "how old is the pump; did you obtain it from someone
else?" Even if it was pre-owned by a little old lady who only used it on
Sunday, these things "poop" out or get gunk in them. I'm also wondering
whether the manufacturing process or the parts used have changed, because
newer ones seem less reliable than some from a number of years ago.

OK - almost the end of my rant -- must include a plea. PLEASE, if your
breastfeeding-helping reality is similar to mine (abnormal, interventionist)
so you're dealing with way too many mom-baby dyads with 24/7 dependance on a
pump for establishment/maintenance of lactation, please encourage a mom to
get the pump designed for that particular job (and that is NOT a personal
pump)! It will save most time and effort to obtain more milk, so these moms
may feel more able to keep plugging away (with less likelihood of plugged
ducts) while baby/babies transition. (And yes, unfortunately, too many don't
make it through the transition, but many of them do continue to pump and,
all things being equal, I'm glad their babies are at least getting mom's
milk!) If this is not your reality, feel free to ignore this post...

-- 
Karen Gromada
www.karengromada.com/

             ***********************************************

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