I am just catching up with accumulated posts and responding to a post by
Jane Kershaw on behalf of Kristi Downs, 25 November 2015.
What concerns me is the assumption that using a pump is essential and only
pump problems are inquired about. A solution would be well-taught hand
expression. I acknowledge that a) there are cultural barriers to manual
expression in the US and b) that breasts that have lost fatty tissue
and have a lot of loose skin will require working out the best way for that
mother to hand express that breast.  However, it is an option that could
well be tried, if the baby isn't directly breastfeeding or isn't yet
transferring milk effectively.
Finally, cultural barriers to breastfeeding can be changed. This has
happened with - for example - the practice in England of withholding
colostrum in for many generations up till the early part of the 19th
century and feeding babies on a variety of other foods, none of them
suitable as colostrum replacements (Cadogan, c.1748). This custom
disappeared in England by the end of the third decade of the 19th century
(Smith, The People's Health, 1979). I live in hope that the aversion to
hand expressing - like the aversion to colostrum - will also evaporate.
Virginia

Dr Virginia Thorley, OAM, PhD, IBCLC, FILCA
Private Practice Lactation Consultant (cohort of 1985)
Cultural Historian of the History of Medicine

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