One of the core tasks a Baby-Friendly hospital must teach mothers, is how to
establish and/or maintain milk supply even if separated from the baby.  All
maternity wards in Norway have hospital grade pumps but we also teach all
mothers how to hand express, and we do so as early on in their post partum
stay as we can.  Particularly in the case of babies who don't show much
interest in feeding in the first 24 hours, it has changed how we use our
time and the mother's energy.  Before, we would just suggest the mother use
a pump to stimulate her breasts every few hours if the baby was showing no
interest.  Now we suggest she practice hand expression onto baby's lips or
into a small cup.  Empowers the mothers because they learn a skill AND
because they can see that something is coming out.

So I would want to hold an inservice with breast models so staff can be
shown a demonstration of the technique and then do a demonstration for the
instructor so the instructor can tell whether or not they have understood
the technique, and I would consider teaching of hand expression to be a
basic skill that no staff should be without.  Our in-service sessions were
done in groups and in a couple of groups we had staff who were lactating and
allowed us to use them as models.  It was stunningly effective in increasing
the number of mothers who can hand express, but also in giving the STAFF the
skills they never got in their basic nursing/midwifery/maternity care aide
training.  

We've discussed the different cultural attitudes toward touching breasts
previously.  Here, we find it is not at all difficult to teach a woman to
hand express while fully respecting her privacy and her sense of modesty,
even in group rooms, but then this is Scandinavia.  But it goes for
immigrant women as well.

Rachel Myr
Kristiansand, Norway

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