<. I feel pretty silly saying this with Jean Cotterman watching so I'll
stop now. Hi Jean, I've been using your paper! >

That's all right Elaine. Thanks for your feedback. The more people who
recognize the physiology of edema of the breast in early lactation, the
better. The more they share their experiences, the more light will shine
on the phenomena of "pitting" and the effect of vacuum on it.

It is the responsibility of the physican(s) to decide on whether and how
much crystalloid IV solution to administer to the mother for various
medical reasons, (and the right of mothers to be informed and discuss
possible alternative management.)  The effects of IV's on the initiation
of lactation needs further dialogue and research.

In the meantime, we lactation folk should certainly be careful not to
make an unfortunate situation worse with the injudicious use of vacuum.
We need to understand more about the A&P of the lymphatic system.

A drinking straw directly immersed in a beverage, or a syringe/needle
immersed in a vial of medicine do not provide an accurate model for the
action of a breast pump on milk in the breast. Perhaps an analogy with a
vacuum sweeper is closer.

Jean
************
K. Jean Cotterman RNC, IBCLC
Dayton, Ohio USA

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