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Subject:
From:
"Kermaline J. Cotterman" <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Wed, 7 Aug 2002 12:17:55 -0400
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Good thoughts, Rachel. Your post ties together the threads hand
expression and milk sinuses, which are very closely linked.

As for myself, that is why I've always been so curious about the nature
of milk sinuses, because it seems to me that having an idea where they
can most effectively be compressed is the secret behind obtaining the
most efficient milk transfer, be it by asymmetrical latch, fingertip
expression or appropriate sized/shaped pump flange.

(Since 'manual' denotes 'by hand', I couldn't count the number of mothers
I've seen who place their hands on both sides of the breast as if holding
a football, and just squeeze, and assume that that's the "way to do"
manual, or hand expression, and "it takes forever" or "it doesn't work
for me" "and so I need a pump".)

That's why I always say 'fingertip expression'. Even some HCP's need to
be better informed if they are taking care of new moms and babes. You
can't teach it if you don't understand the principle thoroughly yourself.
Thus, the need for solidly accurate anatomical info, for teaching those
who apply that to actual moms. Even if some of them are pump
manufacturers.)

<Could it be that our notions of breast anatomy are based on a static
image
from the stage in the peristaltic movement where the 'bolus' of milk is
under the areola?>

This goes along with my impression of feeling "overfull" or "tightly
distended" milk sinuses in late pregnancy and early lactation. It has
been my impression that these "whatever it is I've been feeling"
structures also grow more elastic and elongated after a month or so of
effective feeding.

And this would also go along with the impression of researchers assessing
at a different point in lactation than I have mainly been assessing, that
they are *not* bulbous, and are soft enough for compression by clothing,
gentle pressure, etc.

An assessment (by palpation or ultrasound), like a snapshot, captures an
impression gained during
only one window in time. The assessment may not apply to other windows in
time.

<Some years back we believed that an x-ray or two of a woman's pelvis
could
tell us whether she could give birth normally or not.  Now we know that a
single, still picture leaves out an important part of the equation: the
mobility of the pelvic joints, and the expanded diameters in various
positions used by the woman in labor.>

Yes. Anatomy and physiology are multi-dimensional, and very hard to
convey in two dimensions.

 < And imagine what we would think if
the only anatomical models of organs containing erectile tissue, showed
them
filled with blood.>

Yes, I must say that in public health, the first time I saw a
condom-fitting model in the Sexually Transmitted Disease Counselor's
office, I was taken aback momentarily, despite the fact I already had 6
children!

 <The first time we saw one taking a break, we would probably think it
needed medical treatment, or maybe even surgery.>

Maybe that's why even a diaper change can be an education to a young
babysitter!

< I suspect that when overly distended, they resemble the
bulbs we are so familiar with from all the drawings.>

Exactly. Heavily dependent on which window in time you are observing, I
think.

<Whatever they look like, it doesn't change a thing as far as how to
latch
on, how to hand express, or how to pump are concerned.>

Nor need I change my simple, pictorial explanation to moms, in trying to
change their mental model from that of a hollow artificial nipple: "There
is no milk stored in the human nipple. It's stored in 'tiny balloons',
sort of like 'tiny toothpaste tubes' under the circle and you get the
most out when you start the compression from the far end."

<And while we're at it, thanks so much to Pamela Morrison for her post on
technique for hand expression, Monday 5 August.  I have seldom felt so
validated: I think I am using the exact same technique.>

Amen to that!

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

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