This is EXACTLY how I teach the hand-expression technique.  I learned it as a patient at St. E's in Dayton Ohio from Jean's booklet. Really works. 

-----Original Message-----
From: Lactation Information and Discussion [mailto:[log in to unmask]] On Behalf Of K. Jean Cotterman
Sent: Sunday, May 30, 2010 11:33 PM
Subject: Why I choose to use the word "fingertip" versus "hand" expression

I have had several private requests from European Lactnetters to explain why I use the term "fingertip expression" and how does it differ from what the questioners call "hand expression"?

I decided there might be others who wondered also, and that perhaps I have more to learn about how to explain it, and perhaps even how to do it. I have "more or less" used the Marmet model, however, without the shaking and stroking of the breast before expression. I find that any pressure on the areola itself triggers the MER within a minute ot less. I would be glad for any new insights on methods of performing it and explaining it that others have found helpful..

I have seen the Stanford video and confess I was initially "turned off" by the using of pieces of tape to "mark" the positions for finger placement, wondering what it felt like when the tape had to be removed. We at least put some tapes on our demo breast as a result of the video. My first reaction was also one of doubt, because the placement of the fingers was so far back from where I usually apply pressure or teach mothers to apply pressure, and if I remember correctly, the fingers were not curved much, if at all. But then, I couldn't very well argue with the success the mother had in expressing so much, so easily.

 This is what I wrote to those who asked me about my use of the term "fingertip expression".

<Well, this is my experience with the term 'hand expression'. Not many mothers learn it in the hospital, nor do they go to LLL. I have seen mothers, when I ask them to show how they do 'hand' expression", put one hand on each side of the breast, as if holding a football, and squeeze, or massage, etc. and wonder why nothing much comes out. 
 
I have also seen many moms try with their fingers, but too often, even with their thumb on the areola at the 12:00 position, about one 1-2 cm. from the base of the nipple, the second and third fingers end up more or less straight. Moms are often "circling the circle" with the curve between their thumb and first finger, and with their fingertips ending up somewhere "out in left field" about an inch outside the circle at about the 4:00 position, (if using the right hand on the right breast.) When they squeeze the thumb inward, it ends up more or less pressing against the second joint of the first and second finger.
 
It seems so difficult for some moms to hold their fingers in the shape of a reverse "C" with the second and third fingers curved so the tips end up along the 6 o'clock hand on the clock. On top of that, I have to repeat and repeat "You aren't made like a farm animal. There's no "forward pull"! Keep your fingers bent, and pressing inward against your chest wall, while you roll your thumb as if making a thumb print, so that it is pressing against the TIPS of the two fingers on the bottom." That's where the analogy comes in about pressing "behind the tiny toothpaste tubes under the circle".
 
That's the format I've ended up with to make the concept and the motions as clear as possible, but lots of people don't learn too well through listening, or from diagrams, for that matter. Once they FEEL the direction and motion of the fingertips, sometimes even feel the sinuses (or subareolar ducts), and SEE droplets of milk coming out, it seems to turn on a lightbulb over their head. So, eventually, so as not to be misunderstood, as in the first example, I have come to call it "fingertip expression".>

K. Jean Cotterman RNC-E, IBCLC
WIC Volunteer
Dayton OH

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