Karleen describes how she got less with hand expression after about
a week.  (And this is from a person certainly knowledgable and well
motivated.)  A couple factors come to my mind.  The first, as she
implied, may be the difference between single and simultaneous
double removal.  I believe a study did show higher prolactin levels
with the double pumping.  I suppose with the right setup, some very
adept moms might be able to hand express both at the same time, but
I think that would be logistically difficult for most.
The factor that would be difficult to quantify is that of fatigue.
Let's face it, it takes less effort to hold 2 flanges in place (a
rather passive acitvity) than to be repeatedly flexing (with
resistance) and extending the fingers.  Is there an unconscious
tendency to slow down or not compress as firmly or effectively after
a while due to the hands getting tired?  It might not even be
something the mom is conscious of but could be a factor.
Just speculating.

Winnie

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