Hi,
Hi, this is my first post, after a long time lurking!
I work on a relatively large post-natal ward.
We have many babies who do not latch following birth. The usual follows:
countless attempts by staff to "put the baby" to the breast, resulting in
an infant showing signs of oral aversion, and a stressed mother. After a
few more hours have passed, it is a blood glucose and often the start of
supplementary feeds (donor breastmilk at least.....that is one bonus!)
In order to avoid this downward spiral (!), we have been encouraging early
hand expression and cup/spoon feeding of colostrum. I am glad to say it is
starting to catch on. There has been a sudden upsurge of interest in hand
expression amongst the staff, and there seem to be more babies receiving
golden drops of colostrum rather than prolonged periods of nothing.
Discussions about the technique for hand expression, have in the past
revolved around locating the lactiferous sinuses. Linda Smith had a great
post about this in Feb. 1996 (week 3 #283).
Recent research from the Hartmann Human Lactation Group, has now revealed
that humans do not have Lactiferous sinuses/cisterns. Instead, milk
removal from the breast is dependent on the positive pressure caused by
the Milk Ejection Reflex (MER), corresponding duct dilation and the
negative pressure achieved by the infant's seal on the breast. Milk
transfer thus only occurs in significant volumes during the MER.
(Ramsay, Kent, Owens, Hartmann. Ultrasound Imaging of MER in the Breast of
Lactating Women. Pediatrics 2004;113;361-67)
Ok....(hoping that my summary of this amazing research is worthy) here
come my questions!!
*What determines the volume of colostrum produced during pregnancy?
*Without sinuses to massage(!!!)what is the physiological reason for
hand expression being the most effective technique for obtaining
colostrum?
*What is the role of the MER in removal of colostrum immediately post
partum? (Instead of "pressing" the milk out of the sinuses as previously
thought, are we simply stimulating an MER when we hand express?)
*Assuming a good hand expressing technique, what accounts for the
variation in women's success in hand expressing colostrum? (some women get
2 drops, whilst others get many mls!!)Is it variations in volume,
effectiveness of the MER,both .....or is there some other physiological
reason?
It makes me miss those lactiferous sinuses!
Zab Franklin.
New Zealand Midwife/IBCLC resident in Sweden.
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