About 17yrs ago when I uaed to work in the postal wards of maternity one
ward was devoted to caring for c/sections and bad forceps deliveries.

back then we didn't have hospital grade electric pumps ,only kaneson hand
pumps etc and the good old hands of the staff/mothers to express breasts
with.
we use to joke that the staff got RSI in their hands/arms from all the
expressing we often did for the mothers when teaching them and doing it for
those who found it hard to get anything out.

The *main* thing I found with these mothers was that they often had delayed
let-down,milk supply come in.Many didn"t  get  a reasonable milk supply
until about day 14.

other things they suffered from first  were extreme venous engorgement
around day 3-5, saw some terrible engorged breasts that were difficult to
express anything some.
Learnt to spend time teaching mums about wearing correctly fitting nursing
bras .particularly about pulling up the shoulder straps if they were
loose.Became efficient at making vests out of soft draw sheets for extra
support for those very large breasted women  who's bras simply would fitted
once they became engorged from either venous or normal engorgement.A couple
of days wearing  this vest help to reduce their breasts back to normal.

The other problem was that often their babies were too sleepy to latch or
had tummys full of fluid and blood refusing to do anything at the breast
until they had got rid of everything that was in their tummies.This often
took up to 3days ,then it was amazing to watch them go at the breast like
"pirannas" ,constantly wanting to be fed.

How do I teach hand expression,I went to a NMMA  seminar (now Australian
Breastfeeding network) and Cherle Marmet was there and gave a talk on how to
hand express  correctly with her technique.I began using this and found it
worked better and obtained more milk then my previous technique.

I am one of those people who was a late bloomer due to low hormonal levels
and found that I could hand express more then when using a "pump" of any
type.managed to breast feed for up to 10 months with some supplementing
towards end as supply diminished.
Had my last 2 babies at 37 and 40 yrs of age and was already going through
pre- menopausal with oestogen levels etc falling off.

Anne Clements RN EM BNS
Brisbane QLD
Australia

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