Labor Repose

Labor Repose
LaborPayne during her 6th homebirth (9th baby) at age 44

Sunday, September 20, 2009

Hand Expression and Breast Massage

Thanks to everyone for your comments. I'm glad to get some dialog on this issue. Here is a video recommended by Dr. Smillie for the proper technique of hand expression and breast massage for building milk supply.

The thing that I liked best about Dr. Smillie's approach to lactation assistance, was that the whole thing was mother and baby-led. Of course the name of the conference was, "Baby-Led Breastfeeding." But I always felt uncomfortable being overly dictatorial when helping moms in the hospital. Like so many other things that went on there, it left the patients feeling like we were the experts and they couldn't be successful without us. That's great for making nurses feel good, but not so great for empowering women as mothers. Dr. Smillie (a pediatrician) was all about allowing mom and baby discover one another without the interference of 'professionals.' I loved her videos of babies discovering the breast for themselves, crawling up the belly towards the smell of milk, or making jerking movements down toward the nipple. Babies are so smart- we give them so little credit. I remember (with horror) the time I stood by and witnessed a nurse 'help' a mom and baby by grabbing the mom's breast, and the baby's head, and 'milking' them both for 15 minutes to 'facilitate' a feeding. I stood there somewhat in shock that this very invasive procedure would pass as assisting with breastfeeding (I always had a no touch policy about lactation assistance- but I would still verbally direct and frustrate the mothers). The mother of course learned nothing from this except that she would need the nurse the next time she wanted to feed her baby to hold her breast and her baby's head to 'make' them nurse. Dr. Smillie's approach centered more on asking questions, to help the mother discover for her self was should be done. She also advocated for time for the infant skin to skin with mother to discover the breast on their own. It's been a week now since the conference, and the more I think about the information, the more excited I get. I'm adding significant information to my lactation seminar for my students on practical nursing care, with more emphasis on patient-led dialog and less on nursing interventions. I can see very clearly that there are times when being the 'expert' can interfere with a new mother embracing her own power and autonomy. We don't want to create a patient who is dependent on our expertise, we want to support a mom who can go home and care for her infant with confidence.

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