Hi Laurie Yes, guilty! It was me who suggested using breast compression _between_ sucking bursts, instead of _during_ sucking.... I've just watched Jack's video again and you're quite right - Jack suggests compressing the breast _during_ sucking. So I think I may have misnamed this technique. Marsha Walker describes the between-sucking compression as "alternate massage". See http://www.llli.org/ba/nov00.html "A technique called alternate breast massage has been shown to significantly reduce the incidence and severity of engorgement while simultaneously increasing milk intake, the fat content of the milk, and infant weight gain. Alternate massage involves massaging and compressing the breast when the baby pauses between sucking bursts. Massage alternates with the baby's sucking and is continued throughout the feeding on both breasts." So it seems, for the purposes of definition, that Breast Compression = squeezing the breasts during sucking Alternate Massage = squeezing the breast during pauses I meant Alternate Massage. And thanks for asking for clarification!! To take this even further, while using alternate massage to compress the breast, I use another technique I've seen described somewhere! but so long ago I can no longer remember where, which also involves stimulating the baby.... so it goes like this: 1. Latch the baby in the cross-cradle position with mother sitting up, and supporting the breast very well to take the weight of the breast off the baby's chin and maximize milk flow to baby...the mother's palm to support the baby's back with her thumb and forefinger spread to support the baby's neck below and behind his ears 2. Allow baby to suck and drink. 3. When baby pauses more than just a few seconds, or starts to close his eyes, then mother should compress the breast at the back, or lift the breast ever so slightly, being very careful not to disturb the latch, but this small compression and/or movement will trigger another let-down. 4. At the same time, with the hand holding the baby, the mother can _very gently_ move the thumb and finger supporting the baby's head, to wake him up, so that he will drink the new let-down 5. When the baby is drinking the mother should keep still and not distract or disturb him but when he closes his eyes, stops drinking and dozes again she should use more alternate massage, eg stimulate breast, stimulate baby, keep still and note baby's renewed swallowing. These little movements should be quite subtle - above all you don't want to disturb the baby's latch, nor distract the baby from the business of getting as much milk as possible.... 6. When the breast has been drained pretty well so that alternate massage/breast compression results in very little additional swallowing , then the mother should switch-nurse/swop sides and repeat. She should definitely use both breasts per feeding to maximize milk transfer, but she can also use 3-4 breasts per feeding if the supply is very low. In this way, the baby obtains the most amount of milk with the least effort. She should stop breastfeeding after 30 minutes at the most, and offer supplements by cup, spoon, bottle, SNS, or whatever, then express/pump whatever the baby has left behind, ready for the next top-up. I do find that Alternate Massage works better than Breast Compression. Why? Because I sometimes find that mothers use Breast Compression instead, and it seems to distract the baby more to squeeze the breast while he's actually already sucking well.... just my observation. Pamela Morrison IBCLC Rustington, England ------------------------------------------------- Date: Fri, 13 Nov 2015 21:18:19 -0600 From: Laurie Wheeler <[log in to unmask]> Subject: long inefficient feeds and question on Breast Compression When babies have long inefficient feeds, of course it is because they are unable to nurse effectively. Tongue-tie seems an obvious thing, however there can be so many things having an impact on feeding ability. For example, facial asymmetry, slight hypotonia, unilateral smaller nare ( often seen with assymetry), slight laryngomalacia or related anomalies, etc. And then there can be infant mouth to maternal breast disproportion (large nipples, small mouth), and suboptimal milk production (which often ensues due to early , infeffective feeding. I agree with Pamela re the strategies she suggested, e.g. breast compression, switch nursing, keeping feeds reasonable in length and then comping with pumped milk after. Often babies need extra volume for catch-up growth. Here is a question about breast compression. My understanding was to compress the breast when the baby was sucking, in order to increase the milk transfer and keep the baby drinking. Then to release the compression during the pauses and when baby starts sucking again, compress again. I think this works, it’s how I do it and teach mother. However, I see that someone else said (Pamela?) to compress during baby’s pauses to get him drinking again. I think both ways could work, but which do yh you think might work better? Laurie Wheeler RN MN IBCLC New Orleans LA and Mississippi Gulf Coast, USA Sent from Mail for Windows 10 --- This email has been checked for viruses by Avast antivirus software. https://www.avast.com/antivirus *********************************************** Archives: http://community.lsoft.com/archives/LACTNET.html To reach list owners: [log in to unmask] Mail all list management commands to: [log in to unmask] COMMANDS: 1. To temporarily stop your subscription write in the body of an email: set lactnet nomail 2. To start it again: set lactnet mail 3. To unsubscribe: unsubscribe lactnet 4. To get a comprehensive list of rules and directions: get lactnet welcome