Jean, once again you have answered this questions so well and given us all  
something to think about!
I just want to add a couple more comments.  I think what Peter  Hartman's 
studies did point out is that what we know as lactiferous sinuses  change through 
pregnancy and postpartum.  The ultrasound images he showed  in his studies, 
at least the ones I saw, were of women past the first few days  pp, with 
established milk supplies.  
In those first few days pp prior to the mature milk starting to come  in, 
therefore the smaller volumes, the lactiferous sinuses can be palpated  and are 
distended with awaiting colostrum for the new baby.  Once the  mature milk is 
coming then these sinuses expand by fullness and once the  milk ejection is 
over they become smaller again.  
Jean's thoughts on MER coming later once the volume increases are very  
interesting and I can see this but maybe only for a few hours pp.  If a  baby has 
unlimited assess to the mother and breast and the initial  colostrum is 
withdrawn then MER would be needed to bring more milk down for  future feedings.
I also find the Marmet method the best for hand expressing.  I teach  it to 
every mother I meet.  I use Jean's RPS on the edematous nipples  and even this 
process illicit droplet of colostrum on the nipple.  I  praise even slight 
wetness to a mother that this is her milk and each time she  does this it gets 
easier to do and more milk comes out.
I would like to see research on use of hand expression in the first 6-24  
hours pp with mothers whose babies are unable to feed.  Then to  compare them to 
the mothers who have been given a pump to bring in  their milk supply.
Ann Perry, RN IBCLC
Boston, MA  

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