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> On May 12, 2014, at 12:00 AM, LACTNET automatic digest system <[log in to unmask]> wrote:
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> There is 1 message totaling 138 lines in this issue.
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> Topics of the day:
> 
>  1. extended nursing strike - long history (and how to advise moms)
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> 
> Date:    Sun, 11 May 2014 20:10:34 -0400
> From:    "K. Jean Cotterman" <[log in to unmask]>
> Subject: Re: extended nursing strike - long history (and how to advise moms)
> 
> Catherine Watson Genna wrote:
> 
> < Tell me how you are taking milk out. . . .How many times a day are you managing to pump? 
> How many times did you get to pump yesterday? (gets a better answer, and "managing" and 
> "get to" are clues that we are talking reality, and reality is sometimes difficult). . . . Mom: but 
> I pump for an hour each time.... Me: I can see how that would be very difficult. I wonder if we could 
> help you with milk expression so it would be much shorter and then it 
> would be easier to do it more often.  . . . .THEN we talk about where she 
> keeps the pump, what the flange size is, does she use massage and compression. . . . .>
> 
> 
> Her answers came the closest to some I have found helpful. As Cathy's example showed, 
> too many mothers interpret "more pumping" as instruction to "keep on pumping as long 
> as they are getting even a tiny bit out" as if likening it to keeping on tilting a bottle till 
> it's completely emptied out, or continuing to keep on wringing out a dishcloth to get the 
> most liquid out of it! 
> 
> In particular, 
> she notes that explaining is only part of the equation. It is often crucial to 
> interpret the mother's own interpretation of the words you used! Asking 
> questions to figure out just how she is planning to put the words into 
> action is often very revealing, because she may be having trouble 
> dropping other self-defeating ways of looking at it. The questions about
> where she keeps the pump etc. are very helpful if you explain to her to
> simply use a zip lock bag to cover the flanges (in case of toddlers or pets).
> If the room temperature is less tha n 75 degrees, there is no need to go to 
> the bother of washing the flanges or refrigerating the milk until every 6+ 
> hours or so (to be on the safe side.) Many moms feel relieved to find this
> work-saving reassurance. 
> 
> The very first thing I always check on is whether she understands what 
> the letdown reflex is (can she explain it back to me) and whether she 
> understands she can trigger it herself by hand as often as every 5 to 7 minutes 
> if she wants. She can easily do this by pressing for "the slow count of 50" on 
> the nerves under the skin of the areola, either with finger tip expression or 
> RPS. Some moms  find it empowering to know they don't have to depend 
> on a piece of electrical equipment (or other "picture" or "baby aromas" to 
> do that for them, if they don't want to!  It's a good idea to teach them to do 
> alternate breast massage at the same time, (to move milk closer to the 
> flange, because "vacuum doesn't pull-other forces push.)
> 
> Diane Wiessinger has a very helpful instruction sheet  called 
> "How We Make Milk" in which she uses simple language to 
> explain the concept of FREQUENCY OF REMOVAL being the key 
> to increasing supply. (Pardon the capitals, they are the only
> way I can ever think to add emphasis on LN;-) 
> 
> 
> I have found it very helpful to explain it by blaming it on the milk itself! 
> 
> Actually using a "cartoonish" word picture to stand for feedback inhibitor of lactation (FIL) 
> has seemed to help. I tell them that one of the neat special ingredients in her 
> milk has two separate jobs: If it goes into the baby, it's good for the baby; if it stays in 
> the breast for very long, it has another job it's supposed to do, which is to start to act 
> like a policeman! (sometime I go so far as to name the cop "Phil"!) 
> The longer he is "on duty" the more likely he is to start to hold up his hand, 
> blow his whistle and begin to yell at the milk making cells:"Slow down . . . 
> we don't need so much right now!!" So "giving the cop a break" by 
> taking him off duty more often gives permission to the milk-making cells to speed up
> production again for the next hour. 
> 
> The original Egnell graph enlightened me, so I just reduce it to "The breast makes
> milk fastest the first hour after milk is removed, slower the second hour, slower yet
> the third hour, and very slow the fourth hour." I encourage moms to trigger the MER
> and spend only just 5-7 minutes pumping, pause,massage milk forward from the 
> back of the breast, trigger the MER a second time, and pump for another 5-7 minutes.
> Then, during their waking hours, for just a few days, I encourage them to jot down 
> the time of each short milk removal, both by nursings and by these short periods of 
> milk removal afterward, or at 1-2 hour short intervals between nursings. This may 
> mean much less total time spent in actual pumpings but result in larger total number 
> of milk removals.
> 
> Maybe a few of these ideas might add to the "tricks" others have developed.
> 
> K. Jean Cotterman RNC-E, IBCLC
> 
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