Jean and Others:  OK, I will attempt to tell it like it is re: lactiferous 
sinuses and hand expression from the viewpoint of someone who has been 
there and done that.  When a mom is hand expressing milk, even the small 
amounts of colostrum in the early days, there is a certain spongy "feel" to 
the areolar/nipple complex. Mom has to position her hand with all four 
fingers below the breast with thumb above just at or just beyond the 
areolar margin. I believe that the instinctive "push-back" into the chest 
that moms seem to just know to do is what helps her seat her fingers just 
behind the lactiferous sinuses (sorry, Peter Hartmann, but I know there is 
something there) and this is what causes her milk to squirt as she 
compresses her areola/nipple between her thumb and fingers.  When she lets 
go of her nipple with her fingers and moves back to reposition, the 
nipple/areola "refill" causing a spongy feel to the areola and nipple.  
This "emptying/refilling" occurs quite rapidly and is how an experienced 
hand-expresser can fill a bottle in just a matter of minutes.
When I teach hand expression to a mom who is in full lactation, I will 
place my fingers over hers while she expresses so that she can see the 
pressure/rhythm she needs to attain.  When I take my fingers away, she 
continues, happily squirting milk into a cup.  I have never not been able 
to hand express a lactating mother.  It's all in the hand position and 
rhythm.
I hope this makes sense, as it's hard to put the feeling into words.

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

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