5 Massaging her back To do this the mother sits down leans forward folds her

5 massaging her back to do this the mother sits down

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5 Massaging her back. To do this the mother sits down, leans forward, folds her arms on a table in front of her, and rests her head on her arms. The top part of her body may be clothed or unclothed, but it is best if her breasts can hang loosely. The helper uses her closed fist with her thumbs pointing forwards. She places her thumbs on either side of the vertebral column, at the base of the neck, at the top of the back. She presses firmly making small circular movements with her thumbs. She works down both sides of the upper spine, from the neck to the bottom of the shoulder blades, at the same time, for two or three minutes. This can be repeated according to the wishes of the mother. Milk may begin to drip spontaneously after this has been repeated a few times. If the woman’s husband or partner gives this help the psychological benefits to her are increased. Methods of milk expression There are three main methods of expressing breast milk: Hand expression. A hand pump. An electric pump. A mother often finds that one of these methods suits her best. Some mothers develop their own technique of hand expression. Providing this works for her, she should be encouraged to continue with it. When a mother is having difficulty expressing enough milk, she should be taught a more effective technique and be encouraged to experiment with different techniques. To establish and maintain lactation The information given to a mother if she needs to establish and maintain lactation by milk expression (e.g. for a sick or very preterm newborn baby) is the same for all the methods. She should start to express milk on the first day, as soon after delivery as she feels able to. At this stage only a few drops of colostrum may be produced but early expression helps breastmilk production to begin, in the same way that a baby suckling stimulates production. At this time the breasts are still soft, making the initial expressions, particularly by hand, easier than when the breasts are full or tender which occurs at approximately 48 to 72 hours after delivery. She should express as much colostrum or milk as she can, as often as her baby would breastfeed. This should be at least every three hours, including during the night. If she expresses only a few times, or if there are long intervals between expressions, she may not be able to produce enough milk. More prolactin is produced at night. (Prolactin is the hormone which makes the milk secreting cells produce milk. This milk is then available for the next expression.) If breastmilk is not removed regularly from the breast, the inhibitor reduces the milk production. Milk can only be continually expressed from one breast for 3 or 4 minutes before the supply slows down or appears to stop. Milk should then be expressed from the other breast. The mother should then go back to the first breast and start again. This procedure of changing from one breast to the other should be continued until the milk ceases or drips very slowly from the nipple. (A baby suckling has frequent pauses during feeding. This allows the lactiferous sinuses to refill with milk.)
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