I am looking at the free, downloadable materials on breastfeeding from
Wellstart, as referred to by Julianna Lim (thanks for the link!).  While
most of it looks good, as usual I'm unhappy with the instructions for hand
expression of milk.  The spots for the mother to compress are described in
terms of distance from the edge of the areola.  The thumb is to be placed
above the nipple, 3 to 4 centimeters back from the EDGE of the areola, and
index finger at the same distance back, on the underside of the breast.  It
makes my breasts hurt just to think what it would feel like to apply
compression between these points. (Sorry if that was Too Much Information!)
Of course it is more complicated to explain to women how they can tell when
they are in the right place to compress on their own breast, but the
description in this manual is fraught with risk.  Areolas vary a LOT in
diameter.  Some women will have their fingers 10 or 12 cm back from the
nipple tip if they use this method - hardly the spot likely to be compressed
by the baby's gums during breastfeeding, unless they have given birth to a
calf or perhaps an alligator.
I don't know how I can tell where on a breast the best place to compress is,
but I can usually tell, and I show it to the woman when we talk about hand
expression.  She puts her hand on her breast and I place mine over hers if
need be, to help her find that spot.  
Using the areolar edge as a landmark to follow is problematic, as we all
know from working with mothers who are unable to make sure that the ENTIRE
areola is in the baby's mouth.  Hand expression is not a difficult skill and
most mothers pick it up easily in one or two quick sessions with someone who
knows how to do it, but it is not a skill that is easily transmissible by
the schematic written descriptions I so often find.  Since it IS an
essential skill, I am constantly on the lookout for good educational
materials about how to do it, and I am generally disappointed.
Rachel Myr
Kristiansand, Norway

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