The BFHI guideline on providing EBM is that mothers whose infants are unable
to breastfeed after delivery should begin expressing within 6 hours.
*Pumping* as such is not very productive at this time because of the small
quantity of colostrum that is usually produced (which would be wasted on the
inside surfaces of the pump) - manual expression into a small container
(medicine cup) is more efficient to conserve those precious drops of gold.
For a baby who is not separated from the mother, but is not able to suck for
any reason, expressing colostrum drop by drop into a spoon and feeding
directly is also very efficient. *Pumping* can be initiated as the quantity
of breastmilk increases and if the mother finds manual expression difficult.
However, if the mother expresses frequently enough to prevent engorgement
(at least 8 times/24 hours) then manual expression continues to be easy.
The BFHI criteria also demand that every mother should be taught manual
expression, and hospital staff are required to demonstrate to the Assessor
how they teach this valuable skill.

Pamela, Zimbabwe