I would say - hand-expression and reverse pressure softening first.  Pumping is for sustained stimulation since most women won't sit there and hand-express for 15 minutes, but hand-expression is much more rewarding.  Remember that pumps remove milk by eliciting let-down and then keeping milk moving forward out of the breast as the alveolar musculature contracts pushing milk through the ducts and out the nipple.  Or as Jean Cotterman says - forces push, vacuum does not pull.  SOOOOO if there are very low volumes and the alveoli don't have much in them, not much is going to come with the instant demand of the pump.  Even with volume and pushing, the pump does not remove all the available milk and it does absolutely NO reverse pressure softening.  The pump flanges that squeeze down on the nipple don't work to do what the baby can do either.  This is why research has shown that pumping PLUS hand-expression gets the best results in building milk volumes - by sustaining stimulation and removal of milk throughout the let-down(s) and by removing small amounts remaining in the ducts right in the areola (that used to be called lactiferous sinuses but really aren't there LOL).  

-----Original Message-----
From: Lactation Information and Discussion [mailto:[log in to unmask]] On Behalf Of Pat Young
Sent: Wednesday, February 27, 2013 12:26 PM
Subject: Re: Pumping in first 6 hours

We used to have a standard - if mom and baby are separated for any reason, pumping was to begin in first 12 hours.  PP Nurse could get written up, if it didn't happen. It wasn't negotiable.(25 years ago :-)  First 6 sounds even better.  Really first hour would be best, just as if baby were there. 
Pat in SNJ 

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