< * 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 *********************************************** The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(TM) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html