Robin mentions a video purporting to show hand expression, which can be
viewed at http://newborns.stanford.edu/Breastfeeding/HandExpression.html

I was alerted to this video by a mother from Norway who was living in the US
and had been taught to hand express this way.  I'd somehow missed seeing it
before.  I have to say it's been a long time since I saw something that
horrified me more.  I couldn't even watch it through to the end before I had
to write to that mother and say EEEK, this is BAD.  It made my breasts hurt
to watch the placement of the expresser's fingers or hands, which were in my
*not at all humble* opinion at least three centimeters too far back from the
nipple, pressing on parts of the breast that can be acutely tender to that
kind of palpation.

I positively ITCHED to push them out of the way and show those mothers how
they could at least quadruple their yields by finding their sweet spots, the
spots where babies compress with their jawss and tongues.  Every mother in
the film had breasts from which white milk ran in a steady stream with
compression way too far back from the nipple.  If the people demonstrating
technique had done it correctly instead of like they were trying to squeeze
pus out of a giant zit, there would have been milk spraying out of those
breasts and they would have needed more than eentsy weentsy vials to collect
the milk.  They could have collected it in cups.  

Midway through the video there is a very misleading animation supposedly
showing how babies suckle at the breast, the purpose of which is to show the
difference between where the compression is applied by baby and where it is
applied during hand expression.  In the animation the nipple appears to be
barely inside the oral cavity, and it is clearly deformed in the way that we
see when mothers have scabs on the tips of their nipples on day three.

The commentary claims that in the first few days, the average size of a
breastfeed for a term baby is only a teaspoon which is five milliliters.
This may be true on the first day but I normally see women whose term babies
are feeding effectively, producing many times that amount by day three.
Mothers are instructed specifically to avoid stretching the skin over the
areola, but rather to *pooch* it together, and it is implied that the nipple
and areola are normally a bit wrinkled as the breast goes into the baby's
mouth.  

Victoria Nesterova's vastly superior animation of hand expression
http://users.iptelecom.net.ua/~vylkas/expressanim.html which I believe is
based on Chele Marmet's technique shows the difference between good
technique and one bad technique, in which the fingers are placed too far out
on the nipple shaft.  The other film shows the other kind of bad technique,
in which the fingers are placed too far away from the nipple and areola, so
compression is applied to a spot that even a large adult would be hard put
to reach with her/his jaws, and if one managed it, the woman would be
writhing in pain.  

If this is the source many people are using to show mothers how to hand
express, no wonder pumps are all the rage in the US.  

Rachel Myr
Who may not know everything, but who at least knows how to get milk out of a
lactating breast effectively 
Kristiansand, Norway

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