On Sun, 7 Jul 2002, Wendy Thomson wrote:

"What is worse is the NEW pumps that are being sold as less than the Medela 15% clause .... That is against medela pricing policy.  How can we report these people to Medela?"

Wendy,
    A solution to the price under-cutting of new pumps, to the potential for cross-infection and ineffective used pumps, is to teach all new breastfeeding mothers hand expression.  This hasn't been mentioned even once in the last couple of days' discussion of pumps.  I can visualise some of you out there freaking out - "hand-expressing?  Our mothers couldn't be asked to do that!"  Yes, I know it requires a culture shift;  BUT it required a culture shift to kick hand-expressing out and replace it with an assumption that "expressing" = "pumping".  Knowledge of this technique, hand-expressing, is part of the BFHI assessment.  To my mind, that gives a powerful opportunity to foster competent hand-expressing skills, rather than just going through the motions for the assessment.
   I've noticed a real culture shift here, too, as regards mothers assuming they *must have* a pump, preferably a powerful electric rental model, to do even short-term expressing.  Yet, in many parts of the world, electric power loss is more than a theoretical risk in the stormy season.  (If they are using manual pumps, we discuss the adequacy of the particular one they are using.)
   Some of us, I'm sure, have had mothers who've expressed for a considerable period of time.  I had a Mum with a baby with a severe cleft palate, who hand-expressed for 8 months before his surgery. She lived on a farm with no main-line electricity, and became very efficient at hand-expressing.  One of the mothers in my study of postwar infant feeding advice hand-expressed, in the 1940s/1950s, for 4 or 5 of her babies for 8 months each, because of a familial suck problem.  (It is impossible at this distance in time to determine what it was, and whether there was a diagnosis.)  At an education session at a Queensland Lactation College meeting (our local ILCA affiliate) a few years ago, at least one colleague was able to top that (8 consecutive months), with an example of a mother who had hand-expressed much longer.   What is the longest hand-expressing period any of you know of?
      Virginia
       in Queensland

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