In the early years post midwifery certification I worked for 3 yrs in a ward
whose clients were mainly C/section or difficult forceps/vaccum suction
deliveries.
My experience with the  elective C/S who had no previous laboring prior to
their section was that their milk often didn't come in till about day
10.These were the patients that it was difficult to express,they also
suffered from extreme venous engorgement.

In these days the only pumps we had were Kaneson hand ones no electric
ones.We did lots of hand expressing ,I'm sure I developed RSI after 3+yrs in
this ward.I became an expert on hand expressing though.
We demand fed and spent many hours helping these mums to confidently
breastfeed these babies before they went home.
As many mothers were covered by private health scheme many did stay in for
10-12 days so we were able to ensure their supply was in before discharge.
Babies couldn't be competed without their mother's permission,signed consent
forms eventually came in.Many of these babies refused to breastfed until the
milk came in,lived off their body fat.Put to the breast consistently and
eventually they attached and sucked.Many of them were knopwn as
barracuda's/vaccuumcleaner suckers once they got going when mum's milk came
in.

I wonder what this mum's Hb is .I was one of those mum who could pump a drop
with a pump but could hand express a reasonable amount.With my first son who
is now 15yrs I had a 3rd degree tear and went home with a Hb of  7
,struggled to make enough milk for him or even express enough when I
returned to work.

Anne Clements RN RM BNS
Brisbane QLD
Australia

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