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The first article in this series provided a general introduction to breast-feeding and to the views of La Leche League, a support group that provides free counseling and holds regular meetings on issues related to breast-feeding. This article focuses on the Oketani massage method, which helps breast-feeding women gain confidence and overcome difficulties throughout the breast-feeding experience.

Although her massage method is little known in the West, Sotomi Oketani’s books and the clinics using her techniques have been a major influence on breast-feeding practices in Japan since the end of World War II. Now in her 80s, Oketani has retired, leaving a legacy of midwives and a school that certifies people in her pioneering methods.

While working as a midwife in war-torn Manchuria during World War II, the death of countless babies she’d brought into the world forced Oketani to recognize that having quality breast milk to feed newborns was no luxury — it was a life-saving measure.

She devised an effective and relatively painless massage technique to help stimulate milk production, and also used massage to help women cope with overproduction of milk. Her technique worked for more serious conditions too, such as clogged milk ducts, which commonly occur when breast-feeding mothers are separated from their babies for a long period or must suddenly stop breast-feeding.

Oketani observed that women 50 years ago, and even today, often feel uncomfortable about expressing their own milk. Her method included easy instruction to teach a mother how to hand-express her own milk with confidence. She held firmly to the belief that even after a mother stopped breast-feeding, she must hand-express unconsumed milk, stopping gradually, and ideally make regular visits to a trained therapist so that the weaning process could be monitored.

Oketani-trained massage therapists almost always start out as midwives. Yukiko Yoshioka, who runs her busy practice in Narita City and Tokyo, gave up delivering babies in order to devote herself full-time to breast massage. She had 12 years experience as a midwife at the Red Cross Hospital before leaving for Osaka to train directly with Oketani.

“My children are 21 and 19 now. When they were born I had trouble breast-feeding and it was Oketani’s method that allowed me to breast-feed,” she says. “I realized that this was very important work so it became my goal to open a clinic for breast massage.”

Today, there are some 283 Oketani-trained midwives practicing in Japan. Of these, 203 have opened private clinics and the rest work in hospitals. Wherever these midwives work, there is consistency in technique. An Oketani midwife uses her fingers in motions that simulate the baby’s suckling of the nipple, with a hot towel placed over the breast to create a zone of comfort and privacy between mother and midwife. The towel is frequently dipped in a bowl of hot water to discharge expressed milk. A massage may take up to 30 minutes, during which time the midwife will give dietary recommendations, such as eliminating oily foods when the problem is clogged milk ducts, and suggestions for reducing any stress that may be contributing to difficulties in breast-feeding.

After the war, Oketani returned to her home in Toyama Prefecture to open a private clinic, but, as she wrote in the introduction of her seminal book, “Bonyu Ikuji (Raising Children Through Mother’s Milk),” a life-threatening illness and her unexpected recovery gave her new confidence to expand her mission to teaching these techniques nationwide.

“My idea was very far away from the medical community so doctors and midwives at first couldn’t listen. I was telling them that breast milk is real nutrition and as important for new life as blood itself,” she said.

Reading this book led one young mother, Kazuko Sato, to Yoshioka’s clinic. “My first experience with breast massage was after the birth of my baby. I wasn’t producing enough milk and the massage my midwife gave me was very painful,” she says. “I thought Yoshioka’s would be that way but her massage felt good. Yoshioka later told me that if it is painful, it’s not being done the right way.”

Yoko Kitazawa, a Tokyo mother of three, confides that she was told that her breasts were too small to breast-feed when her first child was born. At the urging of her first midwife, she started to give formula while still attempting to breast-feed, but the results were not encouraging.

“I produced less and less milk,” she explains. “My second child didn’t like formula. She threw it up a lot and looked bloated so I suddenly decided at six weeks to stop.”

Having heard of the Bonyu Sodanshitsu, a clinic in Ochanomizu based on Oketani’s method, Kitazawa decided to try this approach, and went for massages every week for about a month. “I could feel the milk coming in, and that helped me become more confident that I could feed without formula. I watched my daughter’s bloating go away as she became beautiful,” she says.

“Why didn’t you come to me earlier?” is a common refrain at Yoshioka’s clinic, where she sees many breast-feeding problems that could have easily been avoided.

In Oketani’s method, a mother who wishes to stop breast-feeding is advised to go to see a certified Oketani midwife with her baby. Abrupt weaning may cause mastitis (painful swollen breasts accompanied by a high fever), and to help avoid this, she devised a ritual for mothers to perform on the day they decide to stop breast-feeding.

In this ritual, a mother will paint bright faces on her breasts to help discourage the child from feeding. Rather than the traditional Japanese practice of putting hot wasabi or pepper (togarashi) on the nipples to end the breast-feeding relationship, Oketani’s approach, as she explained in her book, “makes kids feel a bit scared and at the same time impresses on them a mysterious feeling, like watching a drama.”

The method works for some children, but not all. Kitazawa’s second daughter, at 16 months, was neither scared nor impressed by the painted faces and went back to feeding at the next opportunity. However, Yuki Fujii, the mother of an older child, a 2-year-old boy, was able to bring her breast-feeding days to an end with no resistance from her son.

“I had been explaining to him from months earlier that when he reached the age of 2 we would stop, so he was ready,” she says.

Sometimes she sees mothers who claim they want to stop breast-feeding, but she senses the ambivalence in both mother and baby. In this case, she may urge a mother to continue.

“A mother with an 18-month daughter came to the clinic after having decided to stop. She hadn’t breast-fed in a week, and because she didn’t have the confidence to express her milk, she was in pain,” Yoshioka recalls. “I noticed in the waiting room that her daughter had crawled onto the lap of another nursing mother. Clearly, this baby wasn’t ready to quit. I expressed this mother’s milk, then told her to go home and continue nursing. The best way to heal a mother who has clogged milk ducts is let her baby suckle as much as possible. I told her next time that she should come see me before she stops.”

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