> it is hard to imagine that the milk from the interior ducts could
> exit anywhere but from very near the central 1-1 1/2 cm of the nipple
> itself. If there are supernumerary nipples, that should be obvious, and
> even, then, any milk exiting should exit from the central portion of that
> nipple.

I have seen on more than several occasions milk exuding from 'spots' around
the  areolar  "probably glands of Montgomery" and have read and understood
that it happens with some women and is on no major concern. On the ocasions
where mums have called me in alarm at a little milk oozing out of those
places i have simply reassured them likewise and there have not been any
problems with feeding as milk also transfered through the nipple to the baby
no worries. (NB no supernumerary nipples involved)

> This speaks to me of the milk sinuses not being compressed. Despite our
> recent discussions on LN about evidence for the theoretical existence of
> milk sinuses, while I agree that they are certainly not distributed like
> the spokes of a bicycle wheel as most diagrams would have us believe,
> they do exist as separate entities and are visible to the histologists
> under a microscope. I urge you to palpate for them yourself.

thank you for that confirmation that what we see and feel and others have
seen on histology exists and isn't a myth.


> I am convinced this accounts for a great deal of what we call "initial
> latch pain". The tenderness resolves after 10 drops or so of milk are
> removed from those particular sinuses, so that they are no longer
> over-distended.

that is interesting and quite in line with what I often see. In fact when a
women experience this type of pain I always help her through it by
encouraging her to count to ten and then wait at least a full minute or two
before unlatching the baby to reattach (if necessary). Invariably, nothing
else is wrong, the pain subsides and the feed progresses. On the other hand
if baby is removed the instant the mother feels pain  - the baby can develop
frustration and eventually breast refusal.


> This also seems to produce a strong MER when it is done. The MER is the
> most iimportant force active in moving milk within the breast. In order
> to expect good milk transfer,

so, tell me Jean and others. What would you say the important factors are in
being able to tell the baby is getting milk (ie confirming milk transfer -
note "confirming") while you watch baby feed? And do you see any one factor
being  more important than another? I find this is a major problem in the
hospital HCP are very focused on positioning and attachment but not always
able to recognise good milk transfer and thus problems occur that could have
otherwise been avoided.

Ruth
-------------------------------
Ruth Cantrill RN, RM, IBCLC
Breast Worx
Redland Bay QLD AU

             ***********************************************
The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(TM)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html