Nuria,

 Exactly. Hand expression should be the *first* choice for expressing to
build/maintain supply - as demonstrated by the mother's extreme pain with
any form of suction. Hand expression makes eminent sense.

A pity it isn't taught and professionals and mothers tend to cringe at the
idea.  This is a cultural change over the last 2-3 generations, and the
culture can be encouraged to change to accepting this accessible skill, one
mother at a time. If taught well, it is effective.

Virginia Thorley, OAM, PhD, IBCLC,FILCA
Private Practice IBCLC
Ipswich, Queensland, Australia

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