Someone pressed me to respond to the binding breasts thread. So I'm
dropping in again, and should introduce myself to those I don't already
know: IBCLC, educator of health professionals, former ILCA Board
member, etc, author of Breastfeeding Matters and Food for Thought;
mother of three fantastic adults, and grandmother of one (Brigit),
make that two in early February, with a lovely amiable son-in-law who
really does his share of child/house work (there is hope for the world
if men can change that much in a generation). In the overloaded
sandwich generation, and currently moving house/office to be with my
mid-80s parents before there's a crisis that demands my presence
full-time. (Will be maintaining a bedsit/office in the communal St.
Kilda house that my husband and grown-up family all share: brilliant
huge 1880s Victorian vicarage: visiting them rather than visiting the
parents and worrying about the oldies from a distance.) Please note new
address from signature.
To pressure on breasts
The new realisation about autocrine control by the secretion of a
Lactation Inhibitory Factor that signals decreased production to
glandular tissue should not cause us to lose sight of the fact that
pressure also inhibits/prevents milk production, as the columnar cells
that make milk physically cannot do so when flattened. Mavis Gunther
highlighted the importance of intra-mammary pressure decades ago; it
remains true that it is the usual precursor to most mastitis. So
intra-mammary pressure is a factor that we need to be able to assess
and manipulate appropriately; when seeking to suppress lactation (or
conversely, prevent lactation from being suppressed.) I've discussed
this in chapter 2 of Breastfeeding Matters so will simply post that
section, to save time. Please don't cite this as blanket approval of
binders and rush off to use them in all cases of engorgement: like
everything else, they are a tool that needs to be used skilfully and
only when needed, and in the hands of the ignorant can do a great deal
of harm. However, as a 1970s mother who was in excruciating pain before
a Scottish midwife imobilised my 42DD (previously 34B) breasts, I can
vouch for the relief that they can bring when used wisely and
well-monitored. Others will no doubt have horror stories of the pain
they can cause when used badly. Bu that's true of compression anywhere
on the body: try sticking a firm bandage on a sprain that's till
swelling and refuse to re-wrap, and you will know about it!
excerpt from pp. 58-9 BF Matters
1. Engorgement
Extreme engorgement is now being seen as iatrogenic, as it
is rare when babies are fed ad libitum from birth. But some mothers
will suffer a degree of engorgement even when fully demand feeding, as
milk production can proceed faster than the baby's ability to remove
milk. An excess of milk in the breast, combined with the vascular and
lymphatic congestion usual as the breast switches on to lactation, can
create pressures that prevent milk outflow or lymphatic drainage. This
can lead to a degree of oedema needing assistance for prompt
resolution. The most important thing to remember is that milk can flow
out of the breast, while oedema must be resolved by getting lymph back
into the circulation. The basic principles for the resolution of oedema
can be adopted: rest, ice, compression and elevation. Treatments
include the following:
… 'Binders'. These would seem to work on the principle of persuading
the breast to slow or stop milk production by mimicking the feedback
pressure effect of total breast distension. They do cause pain to
subside more rapidly when lactation is being suppressed. This,
however, may not be a recommendation when lactation is to continue, as
it may merely indicate greater efficiency at suppressing milk
production. Before dismissing the idea of binders as unhelpful, we
should listen to the reports of mothers who have found them to increase
comfort when applied by skilled midwives willing to adjust
them as often as needed: as in all other cases of oedema,
compression relieved as often as necessary is found to be useful. But
unadjusted binders on breasts are as cruel as unadjusted plaster casts
put on broken bones before the swelling has reached its maximum. Just
as we break open casts that are too tight, we need to monitor and
adjust binders to deal with breasts still increasing in size.
… Hand expression. this needs to be very gentle to avoid bruising an
overdistended gland. Such expression has caused mastitis and bleeding
when too vigorous. Nurses often have no idea how exquisitely painful
engorged breasts can be. If it hurts, don't do it! The hot jar
technique discussed in the mastitis chapter can be used initially. So
too can gentle massage and expression by the mother herself in a warm
bath or under a warm shower.
… An electric breast pump can be used to 'empty' the breast at the end
of the day, after the last feed. Following this, cold packs can be
applied to help reduce the lymphatic congestion in the breasts, and
often with this done, the breasts settle down as drainage is possible.
Milk expressed can be frozen for later use.
… Borrowing a hungry baby with more vigorous and efficient sucking
techniques can also be useful.
… Drugs (see ch. 4)
Unless this initial engorgement is adequately dealt with, it can
progress[via increasing pressure buildup] to obstructive mastitis and
even infectious mastitis. Badly managed, this may bring about lactation
failure. It can certainly cause a temporary supply problem. Mothers
should be taught to look for lumps or painful spots in the breast or
under the armpits and to ensure that these clear away with massage
during feeds, etc. They should also be taught that much of the fullness
of their breasts is vascular and lymphatic congestion, not milk; that
when this subsides they may find their supply is just a little low and
be prepared to feed more often. Mothers who think that they have been
bursting with milk tend to assume that when the congestion resolves
they have lost their milk altogether, and some try to 'save it up' by
going longer between feeds.
It is worth noting that engorgement is a general term that means
overfullness or distension; it is a phase the breast can go through in
the weaning process, or preceding mastitis, and the two fronts to work
on remain: moving milk and ending oedema. "
***********************************************
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