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Subject:
From:
"Christina M. Smillie, MD" <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Tue, 14 Oct 1997 07:49:16 -0400
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A little anticipatory guidance helps.

If you tell a mom prenatally, and just after delivery, and again if the
issue comes up, that (1) many women never feel MERs and those who do
usually only feel some of them and (2) that MERs are at first very
erratic until they become later, after BF is established a "conditioned
response, but at first they are not, and they can be quite erratic, even
in the absence of stress or worry; and (3) that concnern about MERs,
sufficient supply, how the baby is doing, etc. actually can interfere
with MER in the beginning-- the old self fulfuilling prophecy, and that
(4) her body has worked for them so far, does she ever question if she
will make enough saliva, or bile, or lymph, or whether her lungs will
work today, or her spleen, (do NOT use the bladder as an analogy), and
look at this gorgeous baby her body just made. (5) She will make enough
milk, but she won't necessarily feel it, (and her body will continue to
make just exactly as much as her baby has been removing, and more if
s/he keeps going at it,) (6) nonnutritive sucking is what the baby must
do to get her hormones first to make milk and then to get the MER, and
she needs only patience and relaxation to let this happen; and (7)
nutritive sucking will tell her she had an MER and the baby is getting
her milk. (8)Stress that nonnutritive sucking is just as important as
nutritive.  this goes to the other topic I was discussing, which is
giving moms the information they need to follow the baby's lead re
finishing a side.

Stress that at the breast, nonnutritive sucking is not "{ the same as
"pacifier" sucking, pacifiers have been around for only 50 yrs or so and
were designed to be a breast substitute particularly for bottle fed
babies who cant NN suck at bottle, and that infants need that suck, and
they need todo it at the breast, especiallyin the first weeks to get
milk supply established and points 2 and 6-8 above. Patience. Relax and
enjoy the wait.  BF forces you to sit down and rest.

Also somebody asked if a mom doesn't feel an MER (or get one, as it was
misunderstood) does the baby just suck that milk out all the way from
the alveoli? NO! BF babies do not suck the milk out at all, they use
just enought suction to stay on the breast and then use the peristaltic
action of the tongue to strip the milk out ("milk" it out) by pressing
the tongue against the roof of the mouth. The milk has to be in the
lactiferous sinuses (which are then inside the infant's mouth) for this
to happen, which means the mom has had an MER to get it from the alveoli
to the ducts. No suction. And everyone has MERs.

Tina Smillie MD IBCLC

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