In regard to hand expressing, a study was published in the May 2001 JHL, entitled, Randomized Study Comparing the Efficacy of a Novel Manual Pump....in Mothers of Term Infants. This study quoted earlier studies by Garza et al (1982) that found significantly lower milk volumes and a 25% lower fat content from hand expression compared to electric automatic pumps. Also Zinamin et al (1992) compared hormonal response to breastfeeding, hand expression and expression using 3 different pumps. The electric pump most closely reproduced prolactin responses seen during a normal breastfeeding session as well as higher volumes of milk than in hand expression. This is very significant information for any mother, most of all to a mother with a baby in the NICU. These babies need the volume as well as similar fat content that normal breastfeeding would cause. Our mothers who pump need to appproximate the hormonal situation of normal breastfeeding as closely as possible as well. In light of this data, I can't suggest hand expression for my clients in any but the most extreme situations. A low tech solution, in this situation, may not always be in the best interest of our clients. Mary Jozwiak IBCLC, LLLL, AAPL Private Practice *********************************************** The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(TM) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html