Barb, you wrote:
<Does anyone have the magic wand that may have worked in this case?>
I have never seen a case as bad as you describe.
Since she was simply following what I believe is her ethnic tradition, I
am betting that she had some added iatrogenic factors: IV's intrapartum,
and possibly, a breastpump in the hospital.
I would opt for icepacks for 20-30 minute limit as often as every 2 hours
(effect lasts 90 minutes). Be very careful she understands about danger
frostbite so she doesn't leave them on "all night".
For it's anti-inflammatory effect, I would also add Ibuprofen to the
Tylenol, or have her substitute it regularly according to package
directions for several days.
Given that they did give her Rx for mastitis, I think I might have tried
RPS for immediate relief. From the archives:
<Simply place your thumbs or the flats of the mother's two fore fingers
(perhaps placing your thumbs on top of them) just opposite each other,
near the base of the nipple. Press the areola inward toward the chest
wall for a full 60 seconds by the clock, then repeat in the opposite
quadrants.
Or if the mother has short nails, I tell her to curve the 3 middle
fingertips of each hand and "plant them" at the base of the nipple with
the flat surface of the fingernails actually touching the sides of the
nipple.
I suggest that she sing a full lullaby, which occupies close to 60
seconds and sounds less worrisome than watching the clock. And as Diane
has so cleverly put it in one of her new papers, the object is simply to
make a ring of dimples at the base of the nipple.>
I am still in the process of developing this further, in that I have
found at least 2 mothers where it was helpful to hold the inward pressure
right at the base of the nipple for a constant 2-3+ minutes by the clock.
For the mother with short fingernails to do it in one step herself, it
might be easier to explain:
Encircle the nipple base, exerting inward pressure.
* Ring fingertips touching each other, placed just
below the nipple;
* Index fingertips touching each other, placed
just above the nipple;
* Middle fingertips one on each side of the
nipple, so close as to actually touch the nipple.
When held 1-3+ minutes by the clock, this will always trigger an MER,
painlessly push milk slightly back upward out of the overdistended milk
sinuses into the contributing ducts, and temporarily pit the edema enough
that fingertip extraction by Chele Marmet's method can soften the sinuses
even more.
This gives the baby a temporary fighting chance for a good latch. Or, a
few minutes of a pump on minimal suction, with gentle breast compression
may have a chance of removing more milk.
It is important that stronger or longer time of vacuum not be used,
because it would be likely to allow atmospheric pressure to force edema
from the surrounding breast tissue to move back inside the area of the
flange, again forming a "cushion of edema" over the sinuses.
Also, I hope others resist the temptation to invent some kind of
"mechanical pusher in-ner", because the soft flesh and the slight
separation of the fingertips and the short time involved do not interfere
with the circulation. And they are free, and always available.
I have seen cyanosis of the nipple in one light skinned mom who kept a
Hobbitt shield (with the small opening prenatal insert) in place between
feedings during engorgement.
Jean
***************
K. Jean Cotterman RNC, IBCLC
Dayton, Ohio USA
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