Hi, Cindy:  I like your transportation analogy except for one thing.  I
would not compare hand expression to walking.  I think it's way past time
to seriously look at the value of hand expression.  I was at a Medela Grand
Rounds yesterday, that was unfortunately poorly attended due to the
weather/time of day, at which Leon Mitoulas (colleague of Peter Hartmann)
spoke regarding the ongoing Medela pump research.  Medela's research looks
at how a baby breastfeeds and compares this (with bar graphs) with
different patterns of pumping (manual and electric, also comparing speed of
milk expression and vacuums).  It was quite interesting.  He did briefly
mention hand expression, but immediately made the assumption that hand
expression is barely worth mentioning.  He did say after I asked a question
about any research being done on hand expression, that Medela is trying to
set up a research project in Japan, where hand expression is almost
exclusively practiced.  He seemed quite surprised when I said, based on my
personal experiences with hand expression as well as in talking with other
successful hand expressers, that I would rate the baby as number 1,
followed by hand expression, then the hospital-grade pumps, in efficiency.
He did have a slide showing this rating, but unfortunately did not include
hand expression.  We just cannot ignore hand expression as a very viable
and efficient method of milk extraction, especially in situations where a
pump is not financially feasible, or electricity is not available.  How
many mothers in the tsunami affected areas of southeast Asia do we think
are using hospital-grade electric breast pumps?  I strongly suspect that
many of these mothers who need to express their milk and have no access to
a pump have been instructed on how to "safely" prepare formula for their
babies, rather than having been taught hand expression.  Unless their
relief worker happened to be Japanese, maybe. (tongue-in-cheek)
I will be the first to agree, that especially in the US,hand expression is
a hard sell because it is free and no-tech, in direct contrast to the
American way which is expensive and high-tech.  Once a mom learns hand
expression, she is a convert for life!
Sorry for the length, but this is obviously a subject I feel very strongly
about!

Pam Hirsch, RN,BSN,CLC
Clinical Lead, Lactation Services
Advocate Good Shepherd Hospital
Barrington, IL  USA

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