I teach a 3 hour class 2X a month.  At the beginning of class, I tell
everyone that we will be talking about pumping and storing milk during
the last half hour of class - this way they concentrate on what we are
talking about at the moment instead of worrying about or constantly
asking questions about pumping.  During the section on preventing
engorgement, I had out balloons to everyone.  By slowly blowing them up,
they see what happens to the nipple/areola as the breast becomes more and
more distended andt is not emptied frequently.  The balloons are then
taken down to a much smaller, softer size and tied off.  I then teach
them how to hand express using the balloons in place of their breasts -
dads help, too.  I talk about what a great technique it is to learn and
how I never bought a pump because I could hand express just as easily and
quickly. (learned the balloon thing at a BF conference long ago, I think
from Linda Smith - thanks, it is a great teaching tool and cheap to
boot).  When I get to the pumps, I show them the "bad" ones (anything
with a bulb, basically) and all the others which I consider to be equally
"good" depending on what you need one for and personal preferences.  I
pass the pumps around and the couples use the balloons to test them out.
Makes a huge impression on them when they see the suction that can be
developed which makes them more likely to take to heart my admonition to
start on the lowest setting and work their way up slowly.  Anyways, we
never end up spending a whole lot of time on this, but it is enough to
make a few good points and satisfy their curiosity  about the whole
subject.  I tell them that those who are considering going back to work
should call me a few weeks after the baby is born if they have questions
about pumping, storing, leaving the baby, etc.  The emphasis is that
getting breastfeeding established is the most important thing, no matter
what is going to happen later.  When they ask about buying a pump before
the baby  comes, I try to steer them in the direction of concentrating on
bf  and trying hand expression first.  They do get a list of all the
local breast pump sales and rental stations as well as local LCs and LLL
Groups.  I am comfortable with this fairly balanced approach and it seems
to work well.

Just an aside, there are indeed some very experienced bf mothers who
cannot hand express.  I have a friend who is a long-time LLLL with four
children and was never able express more than a drop or two of milk.  She
could teach other moms how to do it, but couldn't herself.  I have been
able to express large streams of milk from some moms breasts (at their
request) and yet when they would try to do it themselves, in exactly the
right way as far as I could tell, they couldn't get a drop.  They just
can't find the magic spot or touch or whatever it is.  I just found it so
easy to do, it really confounded me when others did not.

Sharon Knorr
Lactation Consultant Services
Rochester, New York
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