Phyllis writes:
<The larger flanges are especially useful in combo with RPS for a
mom who has become engorged.>
Thanks for the reminder, Phyllis. Remember that RPS can just as easily
and effectively be used on nipples themselves, especially if
overhydration and/or injudicious pumping (at too high a vacuum or for too
long) has already attracted extra interstitial fluid into the connective
tissue and dermal layers of the nipple itself. (or if shells have blocked
free drainage of dermal lymphatics.) Interstitial fluid in the connective
tissue compartment is responsible for apparent nipple enlargement
(Veterinary research on goats has measured this effect (Haman et al.).
This size change also been measured in non-engorged, lactating
woman.(Wilson-Clay, Hoover).
OTOH, functional retraction (often mistakenly labeled "inversion") seems
to result more from the inward tug on galactophores from overdistention
of the lactiferous sinuses. RPS often relieves this too by temporarily
displacing some of the milk backward an inch or so, "magically" seeming
to restore some eversion to the nipple again. This is great to remember
if finger-tip expression to relieve fullness in the lactiferous sinuses
is impossible due to a barrier of edema having formed over them.
Also important, remember to utilize gravity by positioning a mother with
obvious nipple/areolar edema flat on her back during RPS to prevent the
rapid re-entry of interstitial fluid when pressure is released. It might
be worth trying to reduce the swelling in the nipple with a full (timed)
3-5 minutes or more of RPS directly on the nipple itself, and then,
following that, another 3-5 minutes or more on the areola surrounding the
base of the nipple, at least for the first application. There are ways to
exert pressure on the full circumference at once to save time. (If you
have questions or need more info, contact me privately.)
I have had many confirm my experience that it may tax one's patience to
continue pressure for sufficient time to permit painless movement of
fluid during RPS. Start it first, then use the time for instruction and
explanation, and you may be able to get by without charging for the
larger sized flanges. Then, again, if larger sized flanges were used in
the beginning, with less vacuum and shorter pumping sessions, along with
alternating RPS and breast massage, more efficient milk transfer might
occur without attracting much edema. Many have found it worth a try.
Hamann J, Mein GA, Wetzel S, Teat tissue reactions to milking: effects of
vacuum level. J Dairy Sci 1993 Apr;76(4): 1040-6.
Wilson-Clay B, Hoover K, The Breastfeeding Atlas, second edition, 2002,
LactNews Press, Austin TX pp.74
Jean
***************
K. Jean Cotterman RNC, IBCLC
Dayton, OH USA
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