<  * emphasizing BACKWARD (that is, inward
    toward the chest wall) pressure as the first step,
    and

* maintaining that pressure during the second step,
  of actual compression of the fingers, as in the
  Marmet method or anything similar to it,

produces results so much more quickly and efficiently.>

<I think you are right on target with this---I like it.>

Thanks, Laura. I hope more people can be persuaded!

Actually, it just came into my mind how I learned hand expression. It was
40 years ago, and I had a nursling not yet 9 months old. A lesson on
ancient history in the professional breastfeeding world:

I was active in LLL at the time, but at that stage in the local group, I
apparently offended them immensely with my suggestion that visual aids
(diagrams, etc.) would be helpful at the meetings! We soon parted ways,
at their suggestion. In retrospect, I guess I was pretty obnoxious.

I do not recall that hand expression was ever discussed. Otherwise, I am
certain I would have tried it on myself had I known about it, for that's
just how I am!

Besides, I was an employed mother. While I was on night duty on
postpartum, in those days of no recovery rooms, but very few IV's and
medications, I had much time to assist nursing mothers, but not much clue
how to do it.

I had been caring for nursing mothers for years in the standard routine
way of the late '40's and early '50's. Lots of time for knitting and
letter writing between call lights and ergotrate pills and first trips up
to the bathroom!

But my attitude, and my desire to change my practice came from what I had
learned in my personal motherhood.

All I had to go on were my first three 5-day long nursing experiences
when I threw in the towel with unbearable nipple pain, and my 9 month
nursing experience that I was finding to be one of the most rewarding
experiences in life thus far.

Believe it or not, I learned about hand expression from a Ross inservice
publication which had diagrams and complete directions for hand
expression. It came with the famous detailed color illustrations of
uteri, pelvic bones, placentas, etc. punched for a 3 hole binder.

And now that I think about it, my "education" was further enhanced by the
old Carnation publication that had the multiple overlying transparencies
of the uterus at different stages of fetal development. Does anyone
remember?

The last 3 transparencies were overlays of outer and inner views of the
breast, and I believe, were my first insights into the "grape-like"
configuration of the glandular tissue, the existence of lactiferous
sinuses, and the "pressing inward" concepts of hand expression.

At the bottom of the pages were diagrams of effective and ineffective
application of forces in hand expression, as well as effective and
ineffective application of the baby's jaws in relation to the milk
sinuses.

I still have a frayed and tattered copy of this particular book. I sort
of wish now that I could get a copy of that particular segment in the old
Ross book, just for my personal "archives",

Finding these things in print, on the unit, gave legitimacy to my
"wilderness exploring" experiences in the as-yet unnamed frontier of
lactation consulting.

Talk about "hands on"! I was all alone except for a nursing assistant,
with 20-30 mothers, sometimes a third or more of them breastfeeding.

I was half a city block from the central nursery, starched white cap on
my head, at the bedside behind the curtains, in the dead of night, with
the mothers practically to myself.

I had really begun to "fly" at this new way of clinical practice, much
like the Wright brothers began to fly with their insights 50 years
earlier. Haven't knit much since.

I do resonate with the collective anger about marketing and inordinate
use of AIM by the often thoughtless guidance of HCP that continues into
this day and age. But I have to admit, without Ross and Carnation, I
would not be where I am today.

I would never have had those clandestine, pioneer patient-care
experiences in the middle of the night that fueled my dedication to
change the care in my institution in the early 1950's, and the local
childbirth education group in later years.

It was from these clinical experiences that I got the positive feedback
for my efforts that allowed me to hitch my wagon to a star and proceed to
where I am today. Now, I want to do my bit to help to change the world.

My former hospital stands tall and dark against the horizon, having
recently closed for good. Much of what I was able to do there got
ploughed under with each new change of staff, and I'm sure there were
many who constantly tried to reinvent the wheel over the years.

But I tell this so that those of you who are having a discouraging day
can step back and say "We've come a long way baby!" Hang in there. It's
worth it!

Come away to Lactnet for a while now and then for a personal "retreat".
Visit the well, and slake your own thirst. Refresh yourselves, then go
back out into the fray armed with ideas and renewed spirit to hack your
way through your own jungles! "Brighten the corner where you are!"

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

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