Allison posted about coaching her daughter in successfully using RPS on their 24+ hours postpartum goat because the twin kids were unable to latch on one side. My first reaction was "Lucky for mamma goat!!" and my second was "I wonder just how Allison explained to her what to do? And since 12 ounces was mentioned, I am presuming that the RPS made the teat comfortable enough for her (no doubt dairy care experienced) daughter to milk or pump the 12 ounces out before it was OK to let the "kids" have at it!! 


I too would have been interested to have seen pictures so the appearance of the two sides could be compared. All this set me to thinking, so just for the heck of it, let me think out loud, and see what Allison might be able to add to the fascinating tale she has told.


Since mamma goat went into spontaneous labor, with no IV fluids or pitocin at any stage, and had immediate "mouth to skin" contact and vigorous demand feeding attempts from both her kids, and so, probably prompt onset of L-2 (whenever it happens in goats), my assessment is that in that swollen side she probably did NOT have what I call 


1) "pre-L-2 edema" which is mostly what I have been seeing in human moms in my locale for 3-4 decades since the dawn of perinatal medicine,


2) "post-L-2 edema" seems a more likely explanation.
 

 
This corresponds to the "old-fashioned kind" described by Newton and Newton and others 5 decades ago, (and copied mostly verbatim many times since without clear re-definition correlating with continued changes in peripartum OB and anesthesia management.) This was explained as edema collecting because of "backed up venous and lymphatic circulation secondary to over-full ducts and lobules." 


Newton's definition was back in the days of few natural childbirth experiences, few if any IV's or pitocin inductions, but most moms were NPO during labor, probably somewhat dehydrated in many cases. Most had twilight sleep and general anesthetics, long delays in initiating feedings, short, time-limited feedings on one breast only, at widely separated intervals, skipped night feedings for several nights, etc. etc. Those moms did in fact develop a back up of milk so that the lactocytes could accept few of the new raw materials, and there soon did actually develop full glands and ducts which crowded circulatory vessels which then tended to obstruct lymphatic drainage and thus lead to edema.


Fortunately, RPS will soften the human areola if done gently but firmly for a sufficient amount of time, using anti-gravity positioning if appropriate


1) whether the swelling and firmness is due to pre-L2 edema, often made worse by pumping, 
2) even if superimposed on the actual filling of the subareolar ducts soon after the onset of L-2, or 
3) whether there is an element of post-L2 edema if there was a total late start to milk removal, or 
4) whether several types of swelling were superimposed on each other. 


Such a scenario can certainly happen if a mom gets off to an unsatisfactory start, and gets her IV pitocin for 24-36 hours after birth of the placenta, which delays the antidiuretic effect later than seen with moms who get hours of IV pitocin for induction or augmentation before the placenta is born.


So much for my thoughts on the goat's type of swelling itself. My own questions were more about the differences in anatomy.


While the milk making tissue is said to be apparently the same under the microscope in all mammals, there are individual designs for the exit pathways. I at first thought of a cow's udder, but decided to google it. I found that the goat' udder has two separate glands which are completely separate within the one udder. Each gland contains it's own completely separate set of milk making tissue with the new milk collecting in it's own gland cistern and exiting through its one teat, and each teat has a single smaller teat cistern with a single opening. 


This is in contrast to the human breast having 5-9 or so very narrow galactophores which directly exit the ducts, with no such formation as an actual cistern.  


So, Allison, I'd like to hear more about just what you instructed your daughter (over the phone?? which I often do for explaining RPS to moms), and whether doing it slowly enough kept mamma goat from experiencing pain from it, etc.etc. And then, confirming that she probably hand-milked that 12 ounces out before comfortable latching could happen.


This is "one for the books"!!

K. Jean Cotterman RNC-E, IBCLC
WIC Volunteer    Dayton OH

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