Responding to Meg Kingsley's post about hand expression:

"Jean Ridler asked about hand expression as a way to solve our pump
problem (or lack of them!). according to our info (and correct me if I
am wrong) hand expression alone doesn't increase serum prolactin levels
high enough for the purposes of relactation. .... Unfortunately we see a lot
of mums interested in relactation after a less than optimal breastfeeding
experience in the early weeks/months.  We feel that hospital grade
electrical pumps with double pumping are the most suitable for them, but
if you have experience otherwise please let me know."

The mothers I have worked with to re-lactate, or to induce lactation for a
planned adopted baby, have *all* commenced lactation by manual expressing
techniques.  I actively promote this, even if they already have a pump, and
actually I have never even seen a hospital grade double pump!

With regard to the fear that prolactin levels would not be high enough for
the purposes of relactation if a pump is not used, it is nipple/breast
stimulation, by any means, which stimulates prolactin release.  The
skin-on-skin stimulation which occurs when a woman uses hand-expression
facilitates this as easily - in fact *more* easily, than a pump, because it
more easily stimulates the release of oxytocin, necessary for the milk
ejection reflex, which in turn is necessary for drainage of the breasts, and
this in turn is necessary before milk production can be increased.

Another reason why manual expression is advantageous is that it is easier to
"catch" the small drops/dribbles of milk in a spoon or little cup, so that
the baby can receive them, when the milk supply is very low. If using a
pump, then these precious droplets are "lost" on the inside of the flange
and as they run down into the bottle.  I find that using a pump later - when
breastmilk production has increased to say 30 - 40 ml per session - can be
helpful, but when the amount of milk being produced is very tiny then it is
a pity to waste these little drops of liquid gold!

Because pumps are a rare luxury in this country, and electric pumps are
almost never seen, the large majority of mothers who need EBM for any
reason, quickly learn to hand-express.  Truly, this is not difficult,
although some women are better at it than others.  But I have seen a mother
so good at hand expressing that the multiple strong jets going into the cup
created thick froth on the top of the milk, like a milkshake, and she easily
obtained about 50 ml in just a few minutes for the little pre-term boy on
her lap.

There is no doubt that manual expression of breastmilk takes practice,
probably so that the MER can become conditioned to respond.  But you can
even express both breasts at once (a pillow on the lap, two bowls, maybe a
closed door because it's very undignified!)  There's also the question of
technique.  But this can be taught and it can be learned.  When I had my
babies I was never able to do it, but realized I had finally mastered the
technique when I inadvertently expressed a jet of milk right up over the
curtain round a hospital bed some years ago while helping prevent
engorgement in a mother who had had brain surgery and had to lie flat for
several days.

So back to your wish to assist your relactating mothers, the fact that pumps
are not available in Dubai could be an advantage.  It is wonderful that they
want to do this, and that you want to help them do it.  I would suggest hand
expressing 8 - 10 times each 24 hours until the quantity of breastmilk
produced is enough to reward the baby who is encouraged back to the breast.

In this country we also use sulpiride to increase prolactin levels, and I
think this is commonly used in South Africa too (Jean could confirm?)  I
think some of our OBs have been "poached" to Dubai too, so they may be aware
of how this drug works and maybe you could explore this possibility.

Best wishes.

Pamela Morrison IBCLC, Harare, Zimbabwe
[log in to unmask]

             ***********************************************
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