Good thoughts, Rachel. Your post ties together the threads hand expression and milk sinuses, which are very closely linked. As for myself, that is why I've always been so curious about the nature of milk sinuses, because it seems to me that having an idea where they can most effectively be compressed is the secret behind obtaining the most efficient milk transfer, be it by asymmetrical latch, fingertip expression or appropriate sized/shaped pump flange. (Since 'manual' denotes 'by hand', I couldn't count the number of mothers I've seen who place their hands on both sides of the breast as if holding a football, and just squeeze, and assume that that's the "way to do" manual, or hand expression, and "it takes forever" or "it doesn't work for me" "and so I need a pump".) That's why I always say 'fingertip expression'. Even some HCP's need to be better informed if they are taking care of new moms and babes. You can't teach it if you don't understand the principle thoroughly yourself. Thus, the need for solidly accurate anatomical info, for teaching those who apply that to actual moms. Even if some of them are pump manufacturers.) <Could it be that our notions of breast anatomy are based on a static image from the stage in the peristaltic movement where the 'bolus' of milk is under the areola?> This goes along with my impression of feeling "overfull" or "tightly distended" milk sinuses in late pregnancy and early lactation. It has been my impression that these "whatever it is I've been feeling" structures also grow more elastic and elongated after a month or so of effective feeding. And this would also go along with the impression of researchers assessing at a different point in lactation than I have mainly been assessing, that they are *not* bulbous, and are soft enough for compression by clothing, gentle pressure, etc. An assessment (by palpation or ultrasound), like a snapshot, captures an impression gained during only one window in time. The assessment may not apply to other windows in time. <Some years back we believed that an x-ray or two of a woman's pelvis could tell us whether she could give birth normally or not. Now we know that a single, still picture leaves out an important part of the equation: the mobility of the pelvic joints, and the expanded diameters in various positions used by the woman in labor.> Yes. Anatomy and physiology are multi-dimensional, and very hard to convey in two dimensions. < And imagine what we would think if the only anatomical models of organs containing erectile tissue, showed them filled with blood.> Yes, I must say that in public health, the first time I saw a condom-fitting model in the Sexually Transmitted Disease Counselor's office, I was taken aback momentarily, despite the fact I already had 6 children! <The first time we saw one taking a break, we would probably think it needed medical treatment, or maybe even surgery.> Maybe that's why even a diaper change can be an education to a young babysitter! < I suspect that when overly distended, they resemble the bulbs we are so familiar with from all the drawings.> Exactly. Heavily dependent on which window in time you are observing, I think. <Whatever they look like, it doesn't change a thing as far as how to latch on, how to hand express, or how to pump are concerned.> Nor need I change my simple, pictorial explanation to moms, in trying to change their mental model from that of a hollow artificial nipple: "There is no milk stored in the human nipple. It's stored in 'tiny balloons', sort of like 'tiny toothpaste tubes' under the circle and you get the most out when you start the compression from the far end." <And while we're at it, thanks so much to Pamela Morrison for her post on technique for hand expression, Monday 5 August. I have seldom felt so validated: I think I am using the exact same technique.> Amen to that! Jean ************* K. Jean Cotterman RNC, IBCLC Dayton, Ohio USA *********************************************** To temporarily stop your subscription: set lactnet nomail To start it again: set lactnet mail (or digest) To unsubscribe: unsubscribe lactnet All commands go to [log in to unmask] 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