Allison,
I agree wholeheartedly with what Gonneke wrote:
< Use all kinds of massages the mother feels good about (her own
interpretation
of how she feels about the massage is the key to this!), maybe she will
need
firm massaging or maybe just efflleurage (very light, caressing, tingling
massaging).
- Apply heat at the level the mom appreciates most (again like in
massage, her
own interpretation matters) as often as she likes, but in all cases ab.
15
minutes before pumping or breastfeeding.
- Have mom accept that it is not that important to have milk; she can use
donor
milk or ABM in a nursing system while having the baby at breast. When she
lets
go of the pressure to produce milk and instead focusses on being the mom
to this
baby, experiencing lots of skincontact, perhaps some co-bathing, she may
at some
point notice to have milk when she least expects it to be there. it can
also
have to do with getting to know and love this special child and
recognising it
as her own. Once she accepts this in her head and heart, her body will
follow.>
I think we ought to place greater priority on the importance of
stimulating the MER before nursing or pumping to ALL moms, not just
adoptive moms.
I have been doing some serious reading in research texts with people
whose first expertise was veterinary medicine before they specialized in
lactation research. They emphasize strongly that the main force in
transfer of milk out of the glands is the MER in all other mammal
species.
So much of the cellular anatomy under the microscope and secretion
physiology is indistinguishable between the species, so I figure why
would the milk ejection reflex be any different in humans except that the
mother has the mental capacity to generate stress hormones about her
capability, which other mammals don't. (At least your client does not
have delivery interventions and edema to contend with!)
It is adrenalin caused by stress which constricts circulation to the the
pituitary, keeping it from secreting sufficient oxytocin (and probably
prolactin). It also interferes with the circulation to the mammary
tissue, which hinders the effectiveness of the MER. And of course, it is
the thoroughness of milk removal, starting from the glandular area, which
is essential for continued production.
So, once again, I agree with Gonneke about supportive reassurance on the
overall importance of the mothering actions, skin to skin, falling in
love with the baby as the main priority.
And to her suggestions about proactive stress management by relaxing
stimuli to condition the MER, I would add one thing. I have found it is
helpful to teach moms to do a minute or so of manual extraction (even if
no milk comes out) which often stimulates the nerves deep in the
nipple-areolar complex better than the pump does.
I wish all that is now known about adoptive nursing had been available to
me when we completed our family by adopting our 6th child 28 years ago.
Best wishes to her (and you)
Jean
***************************************
K. Jean Cotterman RNc, IBCLC
Dayton, Ohio USA
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