Ann writes:

< 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>

Crystal clear! Exactly what I have observed! In some moms, if the sinuses
are buried deeper, pressure must be focused out further - even 2-3 cm.
from the base of the nipple. Would that the whole lactation community
learn to be this observant. I think that may be part of the reason that
so few mothers are taught hand expression in prenatal and in-hospital
care-because the staff has not been this observant, and therefore does
not feel competent in teaching it. It is my contention that the
information "There are no lactiferous sinuses" needs to be refuted
clearly and scientifically for that very reason! If we allow ourselves to
be persuaded that there are no sinuses, then no one will bother focusing
the finger pressure at different distances from the base of the nipple,
and the success and maternal insight you cite in teaching hand
expression/improved latch will escape those who believe that there are no
sinuses! Mothers and babies will be the losers. Then ask yourself just
which commercial entities may then become winners because of this
perception.

Jean
**********************
K. Jean Cotterman RNC, IBCLC
Dayton, OH USA


Jean

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