In response to the recent posts on equipment, all I can say is this:  I work
with the population in NYC, where one could argue that the sensibility of the
immediate reward is rather strong; I know that if I offer hand expression vs.
pumping as an option, that women will choose pumping, hands down (pun
intended).  I also know that many women would feel strange squeezing and
manipulating their breasts, and that for those women, their lactation outlook
would be grim without an electric pump.  Is this telling?  Sure it is.  It's
telling of a lot of things, but then again, I drive to work and don't think
twice about how my body is missing out on the very exercise it has evolved to
experience.  We have become a technological world, and it is well established
that technology has increased productivity.  Word processing, the internet,
the ability to retrieve information without going to the library, or asking
the village Wise Man--these are realities, and most women (including me) have
acclimated to this world as the norm.  Touch is wonderful and I'm sure that
many let-downs have been facilitated by the human hand, but I can guarantee
that since pumps have become commonplace, many more have been elicited by
them.  The dairy industry would founder if it relied exclusively on
hand-milking, no doubt, and so would my lactation success cases.

Vague references to "reality" leave me flummoxed.  What does it mean to say
that "one might suspect that hand expression puts us in touch with reality
because we have a greater degree of skin-to-skin contact...?"  What does it
mean to say, also, that "we are being indoctrinated into believing that human
milk is so diseased and dirty that we cannot even suggest or whisper
wet-nursing?"  Because viruses like HIV pass into breastmilk or because
contraction of herpes simplex can be fatal to a newborn, I *am* hesitant to
"whisper" wet-nursing to my clients. Have I been indoctrinated?  Yes, I have.
  It is entirely outside the scope of what I am doing to recommend such a
thing.

Don't get me wrong; I'm all for the warm fuzzy; touch is a wonderful thing
and I value attachment parenting, etc.  But we need to realize that there
have been technological advances which are positive in our field.  Sure, it
bums me out that a woman may feel "icky" about hand expression, but it's not
my job to convince her not to feel that way.  It's my job to assess her
problem and give her the best advice I can on how to resolve it, and for
that, I am glad I have equipment.

Heather Kelly, MA

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