In a message dated 6/18/2005 11:08:29 AM Eastern Standard Time,  
[log in to unmask] writes:

How many  lactnetters feel comfortable getting mom's permission and using
hands-on to  teach mothers to express? I'd like to hear if anyone shares
my impressions  (or not). When staff or mom don't feel comfortable with
early feeding  effectiveness, and/or the pediatrician feels the need to
verify visual  amounts before discharging the baby, I think that teaching
the mom this  skill would be a better, much less expensive and more
reassuring compromise  than jumping to a pump first off or keeping the mom
an extra  day.



Jean, every mother I visit in the hospital or an outpatient visit, I have  
them start with hand expressing.  The reason I start this way is to show  the 
mothers that they do have milk and to teach them at the same time how this  is 
done.
I do not do the expressing but show mothers where to place their thumb and  
fingers and if they don't understand my instructions I mimic on their arm and  
will place my fingers over theirs sometime.  I do not like to do the  
expressing myself for 2 reasons; one I may apply too much pressure, and two I  want 
the mother to feel the empowerment of her accomplishing this task  herself.  
Every mother gets some colostrum.  The mom with edema is definitely  more 
challenging but I still can get them to see some wetness.  The more  the mother 
does this the easier it gets for her.
When it comes to amounts a mother gets from the first day postpartum to the  
next, my challenge is to the medical model who is assuming that 1-4 ounces is 
a  normal intake because that is what bottles have and anyone can force these  
amounts down poor babies gullets.
Showing the pediatrician how much a mother can produce I think would be  
counter productive in general.  If that was where your question was  going.
Ann Perry, RN IBCLC
Boston, MA

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