I haven't read the study Nancy Wight refers to, so I don't know the  
parameters nor the yields in the various study groups.  I will be  
interested to read it when I get hold of it.
As I have said before, we do teach hand expression to mothers  
routinely, precisely because we see that it is more effective for  
establishing lactation when a baby can't suckle enough.  We  
demonstrate on a cloth breast and then the mother tries it herself on  
her own breast. Many women ask for more hands on help, and we give it  
as requested, by placing our hands over hers and helping her to find  
the spots to compress.
I teach several mothers every time I am at work, generally before  
lactogenesis II has set in, but also afterwards.  In mothers of babies  
in NICU, it is rare to see a woman who is not producing upwards of  
twenty ml per session by the end of day two, if she has begun  
expressing effectively on arrival to postpartum.  I have rarely seen  
such pitiful amounts as in the video except where there is some kind  
of pathology present.  We also counsel women who are using pumps to  
hand express until the MER occurs because it seems to work faster and  
better for most women than eliciting the MER with any pump I have ever  
seen.

I have interviewed postnatal staffers and new mothers all over Norway  
in the course of BFHI assessments.  They have to demonstrate hand  
expression technique on a cloth breast model as part of the  
assessment, and mothers are asked to do so if they don't mind, as  
well.  There is good correlation between pain during expression and  
placing the fingers too far back from the areola.  In places where the  
staff demonstrated what looks like the technique used in the Stanford  
video, the mothers uniformly complain that hand expression is painful  
and doesn't get colostrum or milk out so their breasts remain  
uncomfortably tense.  In places where the staff seemed to have a  
better feel for the actual mechanics of milk removal, the mothers were  
adept at expressing copious amounts of colostrum, far more than what  
we saw in the video, even on day two post partum.  The first hospital  
we evaluated where the entire staff knew how to hand express and all  
the mothers were able to demonstrate it too, we asked where on earth  
they had learned how, because we were accustomed to seeing all kinds  
of bizarre maneuvers, none of them very effective, before that.   
Turned out they had just watched the sequence in 'Breast is Best',  
over and over and over, and tried it out, until they felt they could  
do it.  I like the Danish video better, but both are far more to my  
liking than the Stanford video.

I'm with Laurie that by the appearance of the breasts in the Stanford  
video, I would be expecting much greater milk yields.  And, did no one  
else find the animation of the baby suckling to be a bit disturbing?   
It didn't show a good latch, and for some reason mothers were  
instructed *not* to place their fingers where the baby's jaws compress  
the breast when they are going to hand express.  We tell them just the  
opposite, to find the spots the baby compresses when feeding  
effectively, because that is generally where they will have the most  
success.

I am an autodidact in hand expression, can't remember not knowing how  
to do it, but likely I figured it out when my daughter was about six  
months old and I was going back to school and couldn't let down to the  
cylinder pump I had.  That was nearly 27 years ago now.  I might have  
read something like what Diane W quotes, though I have to this day  
never read The Womanly Art of Breastfeeding.  I think I have read the  
same text on the LLLI website, in my never-ending search for good  
instructions on hand expression.

Are there any studies showing higher milk yields if the mother brushes  
or combs the skin over her breasts before expressing?  This advice has  
always intrigued me because I can't figure out what part of a typical  
feed it is meant to mimic.

Rachel Myr
Kristiansand, Norway

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