SUCCESSFUL NURSING TECHNIQUES
Copyright 2005 by mlklvr@…
When I wrote Successful Adult Nursing I felt there was more to be said, but I still had much to learn and couldn’t add anything more meaningful at that time. It was written to increase awareness among nursing partners, allowing each of them to see and understand the various physical responses she will experience as lactation is induced. It included 10 lactation indicators to use as a progress guide, in addition to any milk produced. These indicators allow the partners to experience the success of their efforts as it happens, even before any measurable milk is seen. Successful Adult Nursing stressed the importance of a regular nursing schedule and identified the regular nursing schedule as the most important variable to successful induction of lactation. I still believe all of this to be true, but there is more.
Today I can say that I have additional information that can help you and your partner refine your techniques and become more successful as a nursing couple. These methods should provide more positive results faster, with fewer negatives, allowing you to better induce and maintain lactation sooner. It may even be possible to start from scratch and bring about full lactation in as little as six weeks. These techniques and methods do not use drugs or artificial pumps so put them away, you don’t need them.
What you are about to learn may not agree with what you have learned about breast anatomy. I am not a medical person, just a guy in a nursing relationship who can pay attention, observe, and reason. I believe adult nursing is very old, dating back to the Stone Age and the early development of the human species. If you look at the differences between men and women it will become clear that they are by design, not by coincidence. The differences compliment each other’s weaknesses, making the man-woman team much stronger. Human females are also the only mammals that can lactate indefinitely throughout their adult life. This is not an accident of nature. Adult nursing is another tool in our biological toolbox to help bond men and women together and insure their survival under extreme conditions. With a little bit of time and applied effort, your success as an adult nursing couple is almost guaranteed.
Lets get started with the right foundation for success. Every day you need to know what you are doing right and what you are doing wrong, then make corrections as necessary. Print a copy of Successful Adult Nursing (SAN) and Successful Nursing Techniques (SNT) and put them on your bedside table. Try to read one of them every day and compare what you are reading to your own nursing experiences. You will find that as your nursing experience changes, so does your interpretation of what you read. After I wrote SAN I kept a copy at my bedside and re-read it several times a week for almost a year. Every time I read it, something new would click with a recent nursing experience. There is a lot of imbedded information that your brain will tend to glaze over unless the experience is close at hand. Periodically re-reading the material will help you stay focused and on track.
Success at adult nursing depends on a successful suckling technique. Stimulate the breast properly and it will “let go” of the milk it is holding and release it, allowing room to make more. Stimulate the breast improperly and it will not release its milk but hold on to it, causing the breast to lock up, tight! Why? Because the breast not only makes milk, it also makes butter. Milk production is the pro-lactation process and butter production is the anti-lactation process. If the breast is not suckled properly, the butter will build-up and stop the lactation process before it can get off to a good start.
Milk is produced in milk sacs within the breast mound and is made up of liquid and dissolved solids. The milk travels from the sacs through tube-like ducts to sinuses in the areola. The sinuses are flexible cavities, or bladders, that collect milk from the sacs and funnel it toward the nipple. The nipple contains many very small capillary tubes that connect from the sinuses to the outside world. The nipple is a sort of valve that stops the flow of milk, holding it within the breast, until it is needed. After nursing, milk left in the breast ducts, sinuses, and capillaries is re-absorbed over time by osmosis through the tube walls. This process reduces the liquid part of the milk, leaving the solids behind in the tubes. As more milk is made some of it trickles into the tubes bringing more dissolved solids and liquid to be absorbed. The process causes the solids to concentrate within the tubes, forming butter. This butter can eventually build up and block the capillaries and ducts, stopping the lactation process because the breast can no longer get rid of the milk it is making and has no room to make more.
The more milk the breast can make and get rid of, the less the production of butter will affect it. If she is fully lactated and nursing regularly, there will be so much liquid passing through the breast that the solids will remain dissolved and very little or no butter will be formed. However, the less milk the breast can get rid of, and the more time it sits in the tubes, the more butter it will produce. In the early stages of inducing lactation the breast produces only small amounts of milk, much of which stays in the tubes, the ideal situation for making butter. The first time new milk is made, it can easily flow through the empty tubes of the breast. When he stops nursing the flow stops at the nipple, but the sacs still ooze milk for a few minutes, until they can transition from releasing milk to storing it. Once the flow stops the milk sits in the tubes and is subjected to osmosis thickening. As time approaches the next nursing session, the milk sacs become nearly full and again begin to ooze some milk into the tubes. This helps to dilute the thickened milk in the tubes in preparation for nursing, but the farther down the tubes away from the sacs the less effective this is. One of the goals during nursing is to remove all of the thickened milk from the breast. If all of the thickened milk cannot be brought out of the nipple at each nursing, the nipple will close on pre thickened milk, making it easier for butter to form before the next nursing session.
Butter can form anywhere in the breast, but it forms faster in the capillaries of the nipple than elsewhere. This is because the smaller the tube, the more wall area is exposed to a given quantity of milk and the milk near the end of the nipple is subjected to evaporation to the air which can hasten the process. The nipple is also farthest away from the milk sacs, with the sinuses in between, so it is unlikely to receive any new milk from the sacs to help dilute the butter. Add up all these factors it is very likely that there will be breast butter in the nipple when it is time to nurse. Once formed, the butter helps keep the nipple from leaking, enhancing its tightness, but it also makes it harder to start a new flow of milk when you nurse again. This means that in order to successfully induce lactation the nursing technique must be able to remove butter from the breast. If the butter cannot be removed, neither can the milk, and lactation cannot be sustained. This is probably why so many couples bounce back to zero right after they see their first drops. The suckling technique he is using cannot remove the butter from the breast.
He can remove the butter by rhythmically squeezing the nipple around its circumference for the nipple’s entire length, followed by a short release, then repeat. He should purse his lips forward, placing the face of his lips on the areola, and use the inside of his upper and lower lips to squeeze the nipple. His jaw should open partly on the release and close on the squeeze, creating a chewing motion that is transmitted to the nipple. This technique mimics the size and action of a baby’s mouth. The nipple remains in front of his teeth and he can place the tip of his tongue between them to ensure against biting. He should start by gently and evenly squeezing for about 1 second, followed by a 1/4 second release, thus repeating every 1 1/4 seconds. The rhythmic action signals the nipple to loosen and the milk sacs to release new milk into the ducts. The squeezing compresses and stretches the butter, making it longer and narrower. Some of the butter will be forced out, into his mouth, and some will be pushed back toward the sinuses. As the nipple loosens and the butter narrows, liquid milk from the sinuses can surround and lubricate the butter in the capillaries of the nipple. Soon he will feel the butter flowing out of the nipple in strands.
The faces of his lips are also massaging the areola, mixing the milk and butter in the sinuses, making the butter softer and easier to flow. He can now pick up the tempo slightly and adjust the cadence by squeezing for about 1/2 second with a 1/4 second rest, thus repeating every 3/4 second. The cadence is now squeeze 2/3, rest 1/3, or 67/33. As the flow of milk increases he should adjust his rhythm and cadence to keep up, but not draw the milk too fast. If she is fully lactated with a strong letdown, he may receive a mouth-full of milk at a time, squeezing only briefly to swallow. However, in the earlier stages of inducing lactation he should stick to the 67/33 cadence and adjust his rhythm only. As her response level increases over time, he can move up to a 1/2 second rhythm and a 50/50 cadence. When she becomes fully lactated the cadence will vary widely to include 33/67, 25/75 20/80 or more. He should be constantly aware of the flow and learn to make adjustments automatically.
As new milk is released from the sacs and travels through the ducts to the areola, it dilutes and loosens the remaining butter and flushes it into the sinuses. This butter could suddenly cause the milk flow through the nipple to stop. A short rest of about 1/2 minute (10 breaths in and out) will close the nipple and allow more milk to accumulate behind the butter in the sinuses. You can actually see the sinuses swell as they fill with milk. Start nursing again slowly with an 80/20 cadence as before, thinning and reshaping the butter and purging it through the nipple. As the flow increases, adjust the rhythm and cadence to match. If she has butter deep in the breast, he may need to apply a short rest several times. When the flow of milk has slowed sufficiently, or if the breast will not release any milk at all, apply a long rest of about 10-15 minutes. This will allow new milk to trickle into the ducts, helping them to dilate, and soften the butter that has formed. As the ducts dilate some of the liquid milk will make its way into the sinuses, making it easier to remove butter from the nipple after the rest.
The long rest also gives the milk sacs a chance to relax and prepare for another release of milk. If you think of each milk sac as a small round ball of spongy tissue encased in a thin layer of muscle tissue, then it is easy to visualize what happens within the breast as milk is produced and released. Rhythmic stimulation of the nipple signals the milk sac muscles to contract thus pressing milk from the crevices of the spongy tissue, where the milk is synthesized and stored. The longer the nipple is stimulated the longer the sac muscles contract. This leads to the tiring of the sac muscles and a loss of compression on the spongy tissue. The long rest lets the tired sac muscles relax, improving their blood flow and re-supplying them with energy. The improved blood flow to the milk sacs stimulate the spongy tissue to produce milk and helps to re-hydrate the tissue that has been dried, causing expansion of the sac and dilution of the remaining milk left behind. This process is somewhat slow, but when nursing is resumed after the rest a new contraction of the milk sac muscles begin thus pressing the thinner milk from the crevices of the spongy tissue and again tiring the sac muscle as the milk is drained. Multiple contractions of the milk sacs during a single nursing session is very effective at improving blood flow, muscle strength, spongy tissue growth, and (of course) milk production. This means that nursing each breast for 10 minutes is less effective than nursing each breast for 5 minutes once, waiting 15 minutes, and then nursing each breast for 5 minutes again.
This model of a milk sac also sheds light on the ability of the breasts to supply milk as needed by demand and to induce lactation without pregnancy. Before lactation is induced the ball of spongy tissue is dormant and tiny, surrounded by a relatively thick layer of weak muscle. As the muscle is exercised it demands more blood flow, which passes through to the inner circumference to nourish the spongy tissue and provide raw materials to synthesize milk. The increased blood flow acts like a wakeup call, telling the spongy tissue to produce milk. As milk production increases milk storage needs also increase, stretching the sac muscle and making it thinner. As it stretches a little bit more each day, more room is opened up for the formation of blood vessels and more spongy tissue on the inner circumference. More milk, more room, more blood, more tissue, more milk. Gradually the milk sacs will thus grow in size and capacity.
Each day the milk sac muscle can easily stretch a little, but it will resist stretching a lot. After lactation or partial lactation is induced if a nursing session is skipped the continued milk production and added milk volume causes the milk sac muscle to stretch too much, thus overflowing milk into the breast and raising the pressure on the milk sac as the muscle resists. As the pressure rises and the sac muscle resists, the forced thinning of the muscle tissue restricts the flow of blood, thus starving the spongy tissue of nourishment and raw materials and slowing the production of milk. In the early stages of inducing lactation, this starvation process can halt the production of milk altogether in a relatively short period of time, but if she is fully lactated and nursing regularly the milk sacs are more powerful and have developed a plentiful blood supply that is much more difficult to cut off. Milk production will slow but it will be nearly impossible to stop. The milk sacs and the entire breast will eventually become very tight and painful as the pressure builds behind the nipple. The nipple will remain tight to contain the milk (or try to) until it receives the proper stimulation needed to signal a release.
The release of milk, or letdown, is triggered by physical stimulation of the nipple but can also be affected by mood, stress or anxiety. The ease of release is also partly tied to her lactation response level because the more milk she is producing the easier the release becomes. This is why some lactating women can trigger the release of milk easier than others. Some women can release with digital stimulation and some cannot. Some women can release with the use of a breast pump and some cannot. A few women can even signal the release spontaneously without physical stimulation on the nipple. While various nipple stimulation techniques produce varied results on different women, every woman will respond positively to the use of the proper suckling technique regardless of how much or how little milk she is producing. The other release methods may not get the job done, but her body is hard-wired to respond to a well-trained pair of lips. This is the best way to ensure the breast is properly stimulated and fully drained at each nursing session.
The long rest can be applied more than once during a nursing session, but overuse can lead to diminishing returns. In the early stages of inducing lactation, it is actually possible for the milk sac muscle to force out some of the spongy tissue and expel it from the sac. This can happen because the sac muscle quickly strengthens each time you nurse, but it takes more time to generate spongy tissue, stimulate the production of milk, and expand the milk sac, thus stretching and thinning the sac muscle tissue. As the spongy tissue grows and milk production increases over time, the sac muscle stretches, thinning it and reducing its overall strength relative to the ball of spongy tissue. If the sac muscle is strengthened too fast, before the ball of spongy tissue is large enough, the milk sac can squeeze out its own insides. If this happens it will feel similar to foamy toothpaste in your mouth and it will set back your lactation induction efforts at least a week. As time passes and her response level increases multiple use of the long rest can be very effective at totally draining the breast thus later resulting in an increase of her milk production. This technique can be handy to empty the breast right before a mammogram, but can also be used to “bump up” her milk production at a time of your choosing.
I have presented a lot of information up to this point. That is because, like many aspects of adult nursing, it is much easier to actually do it than it is to explain how and why. Everything we have learned can be restated simply as follows: The lactating breast makes milk in the milk sacs that will be converted to butter as it sits stagnant in the ducts and tubes. The nursing technique must remove the butter from the breast or the lactation process will be stopped! Butter must be reshaped and lubricated to pass through the capillaries of the nipple. Butter must be softened and diluted to be flushed from the breast ducts into the sinuses of the areola. Proper grip of the nipple, proper squeezing technique, use of rhythm, cadence, the short rest, and the long rest are the primary tools used to manipulate the milk and butter and remove it from the breast. Being aware of her responses is the best way to gauge the use of these tools so there is no substitute for an observant partner with a well-trained pair of lips!
Earlier I promised full lactation in six weeks. I think this is a realistic goal for a dedicated nursing couple on a strict twice a day +/- 10% schedule using the techniques I have outlined. It will require a plan, some patience, some discipline, some observation, and intelligent use of the primary tools. To start: Nurse 1 minute, 1 short rest, 1 minute, next breast, long rest, next breast, last breast for the first 2 weeks. This regime will take about 25 minutes, leaving five minutes to snuggle in a 1/2-hour allotment of time. Start using longer nursing intervals and more short rests as needed above response level 3 and allow a full hour for each nursing session. Begin using 2 long rests occasionally above level 4. You may add multiple long rests as her response level approaches level 6 and allow 1-2 hours of time. At this level don’t worry about how long you nurse at each session so long as you always begin nursing on schedule. If you have a lazy day and you want to “bump up” then nurse long in the morning, maybe a little short in the evening, and perhaps long again the next day. Always nurse on time every time! If she hasn’t fully recovered from a long session then nurse short, but do nurse. Don’t skip any sessions for the first six weeks. Get a calendar and mark off the schedule up front, so you both know what you are getting into.
Many couples cannot maintain a strict twice a day +/- 10% schedule. So start nursing once a day on schedule for 4 to 8 months or until she is stable and comfortable at level 6. Then take a 2-week vacation together and begin nursing three times a day. After 4 days begin “bump up” techniques to bring her up to level 10. At least 4 days before you return from vacation start using a good quality breast pump at the mid-day session. He is still with her every day and can help her get used to the pump. When you get back to your regular routine, he can nurse early each morning and late each evening, and she can pump in the afternoon. I don’t like a breast pump, but in this instance it makes good sense. Three times a day with full lactation means no butter in the breast! Don’t try this plan unless you both committed to see it through. If she bounces after the “bump up” it will be very bad.
Good luck, and good nursing!
TERMS OF LISCENCE FOR PERSONAL USE:
SUCCESSFUL ADULT NURSING
SUCCESSFUL NURSING TECHNIQUES
Anyone is free to print copies of SAN and SNT and keep them for personal use.
Anyone may post SAN and SNT on a web page and/or distribute them provided that:
1. SAN and SNT are available to everyone.
2. SAN and SNT are free.
3. SAN and SNT are complete and unaltered in any way.