I wanted to share with this group something I noticed at work yesterday  that 
fits right into the discussion of hand expressing and lactiferous sinuses  
(LS).
This mother just had her second baby and after only 24 hours post delivery  
had developed sore nipples and was requesting to pump.
On exam she has large breast with everted nipples, soft areola and damage  to 
the tips.  Mother describes that the baby has been feeding constantly  all 
day and "tearing chunks off my nipples."  
I asked the mother if she could hand express some milk onto her  nipples.  
The way she demonstrated this was to take her finger and  thumb just behind the 
nipple and squeeze.  Nothing happened.  I  had her move her finger and thumb 
farther out from the nipple and then compress  stopping about 1-2 cm from the 
nipple.  There was the milk.  Now the  baby is still rooting so I asked her to 
try breastfeeding again.  The  baby's tongue is slightly short due to a 
posterior tight frenulum.  The  baby starts by just grasping the nipple, when I had 
her adjust the latch so the  baby came on with more head extension and 
allowing an asymmetrical latch, she  had no pain.  The baby went onto breastfeed with 
noted swallowing and then  came off satisfied.  
The light bulb for me was that this mother assumed that the milk was behind  
the nipple and therefore not thinking anything about how the baby was  
latching.  As I corrected where to compress all this discussion came to  clarity.  In 
my practice, I adjust mother's fingers to basically stop where  their LS are 
but not really thinking about how far out some moms need to  stop to find that 
point until now.
I hope I am being clear in what I have observed and I plan to be even more  
aware of where I have moms stop to compress based on when the milk is  
expressed.
Ann Perry, RN IBCLC
Boston, MA

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