okay folks, probably these thoughts have no one answer but I need to put
it out to all the wise ones.  I have worked in immediate postpartum
lactation for 10 years and have always wanted the secret about how to
express colostrum from women who seem to either have no oxytocin surge
or something that prevents any drops from being expressed during the
first few days.  I work in a large US hospital which does pitocin
inductions, unnecessary c sections and all the rest that go along with
iatrogenic breastfeeding difficulties.  When a full term baby doesn't
latch after 12 hours of skin to skin nurses and neonatologists get very
nervous.  The pressure is on lactation to get some colostrum.  Some
women easily hand express or pump 15 to 20 ml of colostrum, others maybe
3-4 ml which we try to 'stretch' into 6-8 ml.  Sometimes my old eyes
just don't see the numbers quite right on the syringe or my guessitmate
on the teaspoon a little generous (wink).  Sometimes I take drops of
colostrum and mix with water, although I don't like doing this.  Do
others do this?  Still, some moms, I can not get a drop out of.  I have
tried many 'techniques' and suspect it is a oxytocin release issue.  I
have used the Marmet method and Jane Mortan's hand expression. I try to
ensure that the mother feels safe and private and work on having a good
rapport with her.  Usually I will explain and demonstrate hand
expression to her and then leave her to herself or with her partner to
work at it.  I will check back with them in a few minutes and usually
ask if I can assist them if need be.  Most women can get out a little
colostrum this way.  I also have them start double pumping for
stimulation.  There is a percentage that get nothing for a day or two
despite s2s and lactation nurses standing on their heads trying to eek
out milk.  So here are some questions.  I have not read Kerstin Moberg's
Oxytocin Factor, but if any of you have does she address this?  Why does
exogenous oxytocin not act like normal oxytocin?  If it doesn't cross
the blood brain barrier why can't pharmaceutical engineers make it do
so?  Has anyone had experience with oxytocin nasal spray and have they
found it helpful?  Is it not an oxytocin problem but something else? It
seems to happen more with primips and American mothers, rather than
women from countries where breastfeeding never practically disappeared,
is it something cultural?  Over 90% of new mothers who deliver here tell
me that they do not have any milk, is it a mind-body thing?  I hope this
rambling makes sense to you in the cyber world and thanks in advance for
assistance.
 
Mary Westra R.N., IBCLC
in sunny (but near freezing!) South Florida

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