Merewyn writes:
<Also, day 2, how many mothers could express 20 ml easily?>


I suspect many more than we think. Colostrum can already be expressed in
the late third trimester from many mothers, and there is more colostrum
backed up in the ducts and waiting at birth than most people imagine. The
"secret" lies in placing the thumb and two curved fingertips together 180
degrees apart in the exact right spot 2-3 cm. from the nipple base, then
first pressing straight inward and maintaining pressure inward toward the
ribs while the thumb is rolled against the resistance of the fingertips
underneath, as in taking a thumbprint (a la the Marmet method). Whether
one prefers to refer to them as subareolar ducts or lactiferous sinuses,
there is definitely a specific "place where you put your fingers" as
Winnie says, that yields much more than the same amount of pressure in
any other area. The depth of the "spot" (which is "right behind" the
palpable structures) is individual with each mom, sometimes with each
breast, and can usually be palpated by practiced fingertips (Providing
that edema isn't interfering.)

The finger placement works on a principle just like trapping and
extruding the last possible bit from a toothpaste tube. It won't yield
much if the fingers are too far forward or behind, or any "pulling"
motion is used. Release between times, and more flows into the subareolar
ducts. Would that more hospital (and other) personnel knew how to
"extrude" colostrum/milk effectively and teach moms! Each drop is so
precious it's a shame to waste it coating the inside of a flange or a
bottle. A 30 cc. medicine cup makes a fine receptacle, and can even be
used for cup-feeding.


Especially if the baby is small, if a few cc's were expressed first, this
would trigger the MER first and soften the areola so that the baby could
get a better, deeper latch and more cc's than he otherwise might. And the
baby never removes 100%. So IME, mom can almost always still get a little
more after baby lets go, especially with a little forward massage to
help. 


How many lactnetters feel comfortable getting mom's permission and using
hands-on to teach mothers to express? I'd like to hear if anyone shares
my impressions (or not). When staff or mom don't feel comfortable with
early feeding effectiveness, and/or the pediatrician feels the need to
verify visual amounts before discharging the baby, I think that teaching
the mom this skill would be a better, much less expensive and more
reassuring compromise than jumping to a pump first off or keeping the mom
an extra day.

Jean
************
K. Jean Cotterman RNC, IBCLC
Dayton, Ohio USA

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