Hi Julie,



Hand expression has been such an amazing positive change in our culture!  I can say that almost EVERYONE was skeptical at first, but as staff and moms began to see that hand expression really works, it became more accepted.  Moms are very happy to see even the smallest drops of colostrum.   Rarely do we get a mom with no expressable colostrum.  When we do - we don't panic, and we tell mom it can take some practice/time.   But also, if continued hand expression results in very little colostrum, it is an important part of the overall picture.   We slowly changed the culture by educating and re-educating; calling staff into the room to watch us hand express.   And because we are a Baby Friendly hospital, the nurses now rely on hand expression when baby is sleepy - especially in the first day - so that they can provide colostrum by spoon until the baby is more effectively feeding.    Teaching breast massage is also helpful.  For a multiparous mom, you may be able to just jump right in to hand expression, but particularly for a primiparous mom, starting with breast massage can really help with colostrum removal.      We definitely try to use hand expression first for all term healthy babies, and will add pumping if baby is preterm, separated, or if mom has a history of breast reduction.   We have found the best time to teach hand expression is as soon after birth as possible - with the first feeding is ideal.   Just a quick demonstration for mom.   Then we have a handout for moms, and we encourage them (and provide links) to watch some hand expression videos online.  Hope that helps - best wishes. 



Mary Foley RN, BSN, IBCLC

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-----Original Message-----

From: Lactation Information and Discussion [mailto:[log in to unmask]] On Behalf Of LACTNET automatic digest system

Sent: Tuesday, November 27, 2018 12:00 AM

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Subject: [EXT] LACTNET Digest - 23 Nov 2018 to 26 Nov 2018 (#2018-299)



Date:    Mon, 26 Nov 2018 13:52:41 -0500

From:    Julie-Ann Toalston <[log in to unmask]>

Subject: Re: Can Lact 2 be hastened?



Thank you for those responses. I'm glad to be armed with more evidence

supporting early hand expression!



I work in a hospital environment where most staff turn to the breast pump

at the first suggestion of breastfeeding difficulties. I regularly see moms

on the second day who have pumped every 3 hours for 24 hours or more

without removing *any* milk whatsoever, because no one coached them through

hand expression! (Can you guess whether their babies were supplemented with

artificial milk?) That is not ok, especially when the solution costs

nothing and is literally under our noses.  I'm doing what I can to

encourage a culture of hand expression, however, my hospital is not Baby

Friendly, and many nurses are not aware of what a difference it can make.

There is also the fear (even from some IBCLCs) that when mom practices hand

expression, she will not see any milk expressed. (There are many factors

influencing the flow of colostrum, as we know, but that is no reason to

skip teaching hand expression.)



Can any of you share ideas or lessons learned for encouraging staff to

promote hand expression? Thanks in advance.



Julie-Ann Toalston, IBCLC

Connecticut, USA



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