Thank you very much for this Virginia. It is very interesting to hear that expression to maintain supply is not a new phenomenon and can be with good reason if feeds are being restricted.
Karleen Gribble
Australia
On 05/12/2013, at 10:06 AM, vgthorley wrote:
> 
> 
> In an era when restrictive feeding times were unquestioned, Waller saw hand-expressing as the way to get breastfeeding off to a good start and support the MER. He implemented hand-expression to prevent what was clearly engorgement, drain the fattier milk that remained, and safeguard the supply. He advocated teaching expression antenatally, and hospital stays were 12-13 days, but longer if there were breastfeeding difficulties. I have been unable to find evidence of any instructions for when to stop. In the introductory part of a 1947 lecture he talked about dairy cows and how the milking at set intervals caused excess milk production and the stretching of the cows' udders, and he also described his observations of sheep in the field and the lambs' response to the MER. Although he described the very frequent feeding by the lambs, he didn't apply this to human lactation. The milking of dairy animals seems to have influenced his thinking.
> 
> Other systems also used expressing after feeds in the 1960s and 1970s, whether influenced by Waller's Woolwich methods or local adaptations of the Truby King system. These were systems in which the 4-hoursly schedule was considered sacrosanct and the length of the feed restricted, too.  Back in 1965 in the after-care Maternal & Child Welfare hospital, I myself was forced to express after each feed in my first baby's early weeks and the mothercraft trainees did hot-and-cold-splashed and breast massage for external stimulation, but my supply continued to decline. Why? - because my baby was kept in the nursery or shut in the Matron's office, to which I had no access, and she screamed for about 45 mins before each feed. After unsuccessful feeds by an exhausted, sleepy baby, she was topped up by bottle and I expressed, hardly anything. It didn't help that come staff made negative comments, including that I was a bad mother who "didn't love [my] baby", because "if I loved her" I'd have her exclusively on the bottle. That really hit my MER!
> 
> Heroic methods to maintain lactation are used when access to the breast is restricted (whether by hospital regimens or long working hours). In the mid-nineteenth century, under the gang system of agricultural labour, mothers were obliged to be away all day in distant fields, with no access to their babies. To keep the babies calm, they left opiates in the rags the babies sucked on. Opiates were commonly used in England for babies by the urban and rural poor, usually in "soothing syrups", for a variety of reasons (Phillips V, 1978).


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