I find it effective to teach mom manual expression on her hand. I have 
her make a fist, and point out that the tip of the index finger 
represents the nipple, and the rest of the fist is her breast. I then 
use my hand to "express milk" from her fist as if it were a breast. I 
point out how I press back first, then hold that back pressure while my 
fingers roll toward the nipple slightly. I then show the difference 
between rolling and stroking, the latter of which causes friction to the 
skin. I then have her try it on her breast.
I find that this tells her what it should look and feel like, and she 
can usually do a reasonable job herself on the first try. I do put my 
fingers over hers on the breast if she does not "get it", and only 
express from her if she can't get it herself. I just feel it's more 
empowering this way for her. I'm not afraid to palpate and examine 
breasts, with permission, but when teaching skills I like to demonstrate 
and let her try rather than doing it for her.
Catherine Watson Genna, IBCLC  NYC

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