I wonder if this mother's low yield in hand expressing is partly a mental block, as some mothers consider it culturally unusual or even weird? Yet mothers where it is culturally acceptable (including our own countries decades ago) manage to express just fine. Why not help her learn some techniques of breast massage, such as the excellent one by Maya Bolman. I think it may be on YouTube. (Does anyone have a link to share?) For some, it can be the reverse - not letting down the milk into a plastic flange with a pump behind it, but the MER works just fine directly into a real baby or expressing by hand. Virginia Dr Virginia Thorley, OAM, PhD, IBCLC, FILCA Ipswich, Queensland, Australia *********************************************** Archives: http://community.lsoft.com/archives/LACTNET.html To reach list owners: [log in to unmask] Mail all list management commands to: [log in to unmask] COMMANDS: 1. To temporarily stop your subscription write in the body of an email: set lactnet nomail 2. To start it again: set lactnet mail 3. To unsubscribe: unsubscribe lactnet 4. To get a comprehensive list of rules and directions: get lactnet welcome