Even in countries where pumps are readily available, some women prefer  
to hand express, and I have worked with numerous mothers who simply  
won't let down their milk to a pump but can express ample amounts of  
milk by hand.  Most recently we had a mother of twins who couldn't  
stand the barn feeling she got when she heard the motor of the pump,  
but who managed with hand expression to bring in a full supply for her  
twenty-nine weekers, and maintain it until they were able to suckle at  
the breast.
I've also seen some fierce nipple fissures at the base of the areola  
which made both suckling and pumping impossible, and one mother who  
managed to heal by using hand expression for two weeks, during which  
time her baby gained by leaps and bounds on nothing but her mother's  
milk.
If women are told that they won't be able to bring in or maintain a  
full supply by hand expression, the chances that they will fail are  
increased.  Likewise those who are told that pumping inevitably leads  
to a tapering down of supply.  Bottom line: frequent enough  
stimulation by whatever method mother prefers is the most effective.

Rachel Myr
who had children in the days of the double cylinder pump, which was a  
great incentive to become expert at hand expression :-)
Kristiansand, Norway

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