I totally support Robin in wanting to help mothers who need to obtain  
colostrum for an ill baby.  The reason I responded about the video in  
question is that I believe that particular video is more likely to do  
harm than good.  It has some gross factual errors, including the  
animation showing how babies nurse.  The technique for hand expression  
is vastly different to what we use in the tertiary hospital in which I  
work.  Our standard procedure is to teach hand expression as soon as  
possible to all mothers whose babies are unable to feed, especially  
when the baby is premature or ill and in intensive care.  We don't  
recommend using a mechanical pump at all until the shift from  
concentrated colostrum to more dilute, higher lactose milk on about  
day three post partum, because hand expression makes it easier to  
collect the early milk without losing a lot of it as a film on the  
inside of pump parts.

One of the many things that bothered me with this video is that a lot  
of the breasts were clearly tense and engorged, lactogenesis had  
progressed to the point that there was a steady stream of milk with  
general compression on the body of the breast itself, telling me that  
there was actually a large volume of milk present, and yet the mothers  
and the viewer are told not to expect to see anything the first few  
days.  Well, if you use that technique, then no, you won't see much of  
anything, and probably not much of anything later either.  You will  
also find that mothers complain of pain from hand expression when this  
technique is used, while they rarely find it uncomfortable to express  
when they know how to do so effectively.

We show mothers how to express colostrum/milk if the baby is very  
drowsy and not showing an interest in feeding during the first 24  
hours, and we try to make sure all mothers know how to do it, so they  
can soften up a tense breast to help baby latch, if necessary.  You  
never know when your electricity might go out, and you don't have the  
facilities to clean your pump, but your hands are pretty much always  
available.

I did follow one mother who had not been shown how to hand express,  
and she had landed on the technique shown in the film, purely by  
chance.  It worked on day three, but she was experiencing painful  
engorgement on day ten, while getting almost nothing out of her  
breasts because she was never compressing anywhere near where the baby  
would have been.  We showed her how to express effectively and her  
engorgement quickly resolved, while her milk yields soared.  She was  
expressing due to badly damaged nipples, and she went on to hand  
express a full supply of milk for her baby, with surplus to freeze, in  
the two weeks it took the cracks to heal.

I think we have a responsibility to speak out when we see something  
that is so clearly substandard.  Anyone who cares to take a detour to  
Kristiansand on their next trip to Europe is welcome to come to my  
unit and see effective hand expression in practice.  I agree, we need  
better moving pictures of this.

Rachel Myr
Kristiansand, Norway

             ***********************************************

Archives: http://community.lsoft.com/archives/LACTNET.html
To reach list owners: [log in to unmask]
Mail all list management commands to: [log in to unmask]
COMMANDS:
1. To temporarily stop your subscription write in the body of an email: set lactnet nomail
2. To start it again: set lactnet mail
3. To unsubscribe: unsubscribe lactnet
4. To get a comprehensive list of rules and directions: get lactnet welcome