Valerie wrote
"I am fascinated, amused, and saddened by the thought that hand expression
is
considered unrealistic and too romanticized to be seriously considered by
our
profession.  I am fascinated because it really surprises me that people
believe that.  I am amused because I think most of us that have used hand
expression would never call it romantic.  And I am saddened because I think
hand expression is not unrealistic.  In fact, it's about as real as you can
get when looking for a way to release some milk without a baby.

Interestingly, the modern dairy farmer milks his cows by hand prior to using
a milking machine"

I have been following this thread with interest.  I agree with some of the
other posters when we are dealing with less than ideal situations and are
often trying to resue a breastfeeding relationship. Most times, in the
situation I work in in a Special Care Nursery, the mothers may not yet have
breastfed but are supplying essential EBM for their premature babies.  Many
of these mothers have to express for several weeks BEFORE breastfeeding can
be established. Generally speaking hand expression is much slower than using
a hospital grade electric pump, although some mothers do learn to do it
efficiently.  Our mothers are always taught hand expression in the first
couple of days because colostrum removal seems to be so much more efficient
with hand expression. Also hand expression is a very valueable skill to
have.  Like Valerie's analagy to the modern dairy farmer I also teach thethe
mothers to begin expression by hand expression to stimulate the MER.
However, it could be pointed out that modern dairy farmers recogise the
efficency of modern technology and complete the process with machines.  I
also teach breast compression to facilitate multiple let downs during
expression. Our mothers are given the option of double pumping to make useof
the advantage of simultaneous let down.  Some mothers do not have the means
to hire an electric pump when they are at home and use a combination of hand
pumping and electric pumping when they are visiting the nursery (we supply
sterilised collection kits for use in hospital).  In my experience it is
rare for these mothers to be able to express as much by hand as with a
hospital grade electric pump.

I think hand expression is just fine for the occasional supplemental feed
but unrealistic when, for whatever reason, expressing needs to be continued
regularly on a long term basis--whether it is expressing for the premature
baby or because the mother has needed to return to work.  In such cases I
consider modern technology a blessing.  I began my nursing training in the
days before breast pumps were rountinely used and hand expression was the
norm.  Not as many mothers of premature babies succeeded in expressing the
full requirements for their baby and not as many premature babies went home
fully breastfeeding.  Indeed 25 years ago it was a rare prem, in the nursery
I then worked in, to go home breastfeeding, whereas where I currently work
it is the rule rather than the exception. The availability of efficent
breast pumps is a major factor in this improvement.

Marian Rigney RN and (hopefully) IBCLC in waiting






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