My MLCA friend, Cindy Turner-Maffei [Hi, Cindy! I miss seeing you!] lamented: "It sounds as if pumping may have become the second line of treatment after application of hot/cold for many practitioners. Why is this--where is the baby in the midst of all this treatment?" To which I reply: AIN'T IT THE TRUTH!?! Pump marketing has been as subtle and effective as formula marketing. I see pumps listed on layette lists in magazines aimed at pregnant women. Most of the prenatal patients I see ask me about which pump they should have on hand before the baby arrives :-0 Patients who call me about engorgement often tell me their doctor, or a hospital nurse, or a friend, told them to get a pump. (I hear the same thing from women with mastitis, who get the impression from their HCPs that they should pump after the baby nurses on the mastitic breast -- lest a drop remain in the breast?). I've always had positive results by treating engorgement with cryotherapy and massage/hand expression. Even when a woman can't express any milk she can usually massage to the point where the tissue is "soft" enough that baby can latch. My message to women is "get the baby to help you." Now, I KNOW there are times women need pumps in the early days. However, for most women, in most engorgement situations, IMO it sends the wrong message when we tell them they need technology to conquer a bump on the breastfeeding road. I try to find ways to bring new moms to see the baby as a solver of breastfeeding issues ("Let the baby be the Captain.") Some women later admit their partners stepped up to the plate to help with engorgement...but that is another subtopic ;-> Technology is seductive. Be strong. Resistance is not useless. Margery Wilson, IBCLC (Not really a Luddite) in freeeeezing Cambridge, Massachusetts Happy 1999 to all!