First, HI ZAB!  I feel like you are practically in the neighborhood, as I am
sitting in Gothenburg as I write this.  
You aren't the only one who misses the lactiferous sinuses!  The good news is we
can continue to behave as if they do exist - the technique for hand expression
is unchanged even in light of the new proposed model for breast anatomy
stemming from Donna Ramsay's work in Hartmann et al's lab.

I don't know what influences amount of colostrum produced, but I strongly
suspect that frequency of colostrum removal is central to the equation.  

There must be a couple thousand people on this list who have heard it said of a
new mother that 'she pumped (on day 2) and there was NO milk yet'.  In my ward
there is also a surge of interest, fascination really, with hand expression for
those couple of days in the beginning when a lot of babies just haven't gotten
going.   Still, I hear staff saying 'she hand expressed and there was NO
colostrum'.  But when I check, it seems the attempts at expression were too
short-lived to have any effect.  Sometimes there will be a couple of drops
right away, and then nothing for a minute or more, and the mother stops,
thinking she has obtained all that was possible.  But if the mother just keeps
on, while we keep her company and keep the conversation pleasant and diverting,
and keep an eye on her technique so she doesn't get too eager and start hurting
herself, after two minutes or more it almost always gets results.  First a drop
or two, and then sometimes even a trickle, which lasts for a couple of minutes
more.  Keeping her company in a friendly way is probably every bit as important
as the time she spends stimulating her breast physically.

Jean Cotterman points out that there are pressure receptors deep under the
nipple-areolar complex which are instrumental in eliciting the MER, and it
seems that sustained pressure on these is as effective as the intermittent
pressure that occurs when a baby suckles.  

Given the circumstances that are most conducive to oxytocin release, namely
privacy, intimacy, pleasure in love and all the time in the world, it doesn't
surprise me that a lot of new mothers experience a wait for the MER those first
days, especially in hospitals.

Now we need to figure out how to shift some of the enormous resources being
expended on women during the last hours of their pregnancies, to the first
hours of their babies' lives.  I think the pregnancies would benefit at least
as much as the babies would.

Rachel Myr
Kristiansand, Norway, temporarily in wonderful Gothenburg, Sweden

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