Morgan:  I don't know that a mom has to "feel" a let-down.  I discovered hand-
expression by accident when I was still on maternity leave with my 1st baby.  
I was sitting in bed and nursing her and my opposite breast started dripping.  
My curious mind wanted to know what would happen if I started squeezing my 
breast while it was leaking.  My husband happened to walk into the room as I 
let fly a stream of milk across the room.  His response was:  "Do it again!"  My 
response was to ask him to bring me an empty bottle.  When you have your 
hand on your breast, you can "feel" what's happening (the spongy 
emptying/filling sensation of the glands and ducts), and like other posters have 
stated, the actual technique is going to differ from mother to mother.  I 
personally cannot stand the written Marmet technique as there are too 
many "steps".  I find it almost impossible to understand written instructions for 
hand expression, as do most other moms I have discussed this with.  The best 
way to teach hand expression is to demonstrate on oneself (if you are 
fortunate to be lactating at the time) and ONCE on the mother, so that she 
gets the general idea.  I have taught it over the phone, but that's an art.  I 
occasionally get called upon to teach hand expression at my mom's group.  
The mother who volunteers is usually the one who "dares" me to get even a 
drop out of her.  I take a disposable coffee cup and a couple of napkins and 
stand behind her while she is seated.  I have her hold the cup under her 
breast, position my hand on her and demonstrate the technique.  It doesn't 
take much to have her squirting satisfying amounts into the cup.  After her 
initial amazement subsides, I have her express herself, so that she "gets it".  
And then encourage the other mothers to try it at home, using the baby, to 
make it easier.
Hope this makes sense.

Pam Hirsch, BSN,RN,IBCLC
Clinical Lead, Lactation Services
Advocate Good Shepherd Hospital
Barrington, IL   USA

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