Inclusion Criteria:  inclusion to breastfeed no contraindications to vaginal delivery multiple gestation only if cleared for vaginal delivery  Exclusion Criteria:  intention to formula feed antenatal hand expression training provided by staff outside of study protocol practiced antenatal hand expression prior to 36 weeks gestation breech presentation history of preterm labour, preterm birth or threatened preterm labour history of (or current) cervical insufficiency any contraindication to vaginal delivery (ie. placenta or vasa previa, classical uterine scar, etc.) intrauterine growth restriction antepartum hemorrhage any contraindication to breastfeeding (eg. HIV) multiple gestation requiring Cesarean delivery