Lynn writes:
<I also avoid the f-ball hold with these *choking* premies (at least
through
the initial "push" as Jean so aptly words it!) as inevitably flow seems
to be
faster in this position. Has anyone else noticed this?>
You can modify this if you can imagine how to align the breast to make
the milk emerge from the nipple traveling "uphill" like a fountain, or
else at least parallel with the floor like a stream, rather than letting
it emerge "downhill" like a waterfall, which adds the force of gravity to
the force of the MER. Next, you have to imagine where the baby's
nasopharynx is in relation to the direction of that milk flow. A lot
depends on the mother's body habitus, and the shape, size or
pendulousness of her breasts and the "perk" of her nipples, of course
My original wording: <might allow the mother to assume an "anti-gravity"
position when nursing (this might be accomplished with pillows and infant
in a semi-prone position or carefully propped football position).> I hope
my word picture below makes this more clear.
In our small WIC office, we have no recliner chair or rocker. We do have
about a 44" wide loveseat with arms, two 14" decorative pillows, and one
bed pillow which we always cover with a fresh paper pillow case. For many
mothers, who usually don't develop overactive MER problems till after
epesiotomy discomfort has crested, to get them in an anti-gravity
position means simply having them "skootch" their buttocks forward on the
loveseat so that they are leaning back more in a semi-reclining posture.
(This word picture works well over the phone too.)
We put a small pillow near the base of her spine to fill the space and
sort of support the small of her back. We have her use the bed pillow to
prop her baby-holding arm in cradle or cross-cradle. Often, this allows
her to "roll" the baby slightly upward onto her chest so the babe is more
"on top" of her nipple.This is enough antigravity to make a difference
and get the idea across in the consult.
By carefully propped football position, I meant that depending on the
size and pendulousness of the mother's breast, sometimes it can be
propped a bit with a rolled receiving blanket to stabilize it if need be,
so it is less pendulous and more parallel with the couch seat. A 14"
pillow goes behind her upper back to make more "legroom" for the baby,
another goes upright beside her to support the holding arm and the bed
pillow lays mostly to that side of her to allow the torso of the baby to
"drape" on its side on the pillow.
She is supporting the baby's lower back and hips enough with her elbow,
with hand supporting shoulders and neck so that the head is then higher
than the baby's torso. The chin can then engage the breast in the 6 to 8
o'clock position and the nose is at the 12:00 to 2:00 position. This is
usually sufficient anti-gravity position to keep the milk from rushing
into the naso-pharynx.
If we can't position the mother so that milk is actually running
"up-hill" in the breast (as in mother supine, infant prone position,
which we have done on the loveseat with slim mothers of medium height,
with knees draped over the far arm and pillows elevating head and
shoulders against the other arm), we can work toward getting milk to
emerge parallel with the nasopharynx. We at least don't have to position
the baby with his nasopharynx way lower, under the "downhill Niagra
Falls" of an overactive MER. Once the mother gets the idea, she will
adjust it to her own home nursing situations.
Jean
********
K. Jean Cotterman RNC, IBCLC
Dayton, OH, USA
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