Thanks, Jessica for adding that observation about gravity. That's always important to figure into the particular mom's equation, along with the relative pendulousness of her breast plus the likelihood that she had more than 2000-2500 cc. of IV fluid in any one 24 hours, especially if there were long hours of constant pitocin. The pitocin molecule has a lot of similarity to the anti-diuretic hormone molecule so that it can attach to the ADH binding sites in the kidney. This seems to give the kidney a message to "recycle" much of the H2O on the first pass through the kidney rather than excrete it, so the occurrence of edema in the lower part of the breast is almost predictable in such cases.


Many folks don't start RPS early enough in the edema process, and the more tightly packed the edema is, the longer that RPS, used gently, as it always should be to be painless and not chance causing pain and/or doing tissue damage, takes that much longer both to trigger MER and to soften the areola. And it really does allow gravity to help if the mom is laying back at least halfway.


I had such a mom on the phone at WIC recently and had her do the one-handed version while I was watching the clock on my end of the line while explaining some things to her. It was a full 10 minutes before she sort of let out a squeal of delight and said that "fluid of several colors had started to leak out of the nipple, and she wanted to go get her baby quickly to let her try latching. I simply told her to gently press her fingertip over the holes in the nipple for 1-2 minutes and all that colostrum would be saved for the baby, who would find it much easier to latch now that the circle was soft for a few minutes.


I could of course, be prejudiced about RPS;-) I would like very much to hear from anyone who finds that the MER takes over 2 minutes to happen, along with the particulars about time postpartum, the fluid history and the edema in that particular breast.


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

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