Jeanette, I just listened to a tape from a session at ILCA 95 by Sandra Lang(I think), a midwife in England. The topic was mechanical versus hand expression. She works with mothers of preemies and they have compared hand expression with mechanical. Apparently the milk extracted by hand is different in composition than that gotten mechanically. Mothers did not get as much volume expressing by hand but were able to keep up with their babies needs. They tested the milk for some components and found it higher in sodium for one. They hypothesize that hand expressing is more like a baby, being a compression method, than the electric pump which is a vacuum method. She went into great detail about how to effectively hand express, including nipple stimulation, massage and finding the lactiferrous sinuses when expressing. I find this fascinating. I don't remember her addressing the need for fortifiers. Was anybody at that session? Could hand expression be better for moms of preemies and others for that matter? I can see a difficulty with American moms. We want things to be fast and easy. Marilee Woodworth, IBCLC, LLLL, Ann Arbor, Michigan [log in to unmask]