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
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