Nikki writes, preceding her descriptions of 3 methods of hand expression:

<It is best to do some nipple stimulation first, or  warm compresses, or
do it when she is leaking already.>

IME, hand expression with the fingers just behind the sinuses is immediately productive, because that milk is already there, in the subareolar ducts. This areolar compression alone often automatically starts triggering the cascade leading to MER. However, I agree that deliberately stimulating the MER in advance can encourage the mother and make the whole process more productive. Especially when you make sure she understands about this marvelous reflex she can bring to her assistance at will.

Please remember that 60 seconds of reverse pressure softening technique at the base of the nipple any time during lactation (not just during engorgement)is a surefire way to stimulate the MER promptly. This may be happening both because stimulation of the shallow position of the nerves to the oxytocin pathway, or because of the 'tap reflex' of the myoepitelial cells themselves as well.  So this may be of some help for mothers with spinal cord injuries, as asked in a previous post.

Jean
***************
K. Jean Cotterman RNC, IBCLC
Dayton, OH USA

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