Hi Jean and Lactnet,
I just observed something I've theorized about for years but never seen so clearly demonstrated clinically.
DOL 3, mom's milk came in during the night, she has had a significant degree of breast edema even before the milk came in. Nipple/areolar tissue now so swollen it cannot be compressed to fit in baby's mouth, and pitting edema is noted on areola when RPS is applied. I put moist heat on her breasts and used the electric breast pump to try and soften the tissue enough to allow baby to latch.
this worked well on the left breast, and after 5 minutes of pumping, we got baby on and he gulped for 15-20 minutes before falling asleep completely satiated.
the right breast stayed full and painful. We applied the moist heat again, and then began pumping. Her milk sprayed into the pump flange for about 3 minutes, then stopped. The mom said, "why don't you put the heat on it again?' When I checked her breast, I could feel a hard knot of edematous tissue that corresponded exactly to the shape of the pump cylinder at the center of the flange. We re-applied the heat until her nipple/areola was soft, then began pumping again. Sure enough, her milk sprayed out, but only for about 5 minutes. When we checked her breast, we could feel the same firm circle of tissue that had been pulled into the pump flange. The hot towel went back on again.
I believe the pump is pulling edema down from surrounding tissue into the pump flange, which then occludes the milk ducts. The tissue softens with application of heat, and then the milk can flow again, but only until the pump pulls that edema back down.
The take-home message here is that pumping can exacerbate edema, to the extent that milk flow is impeded or even occluded. We should all watch what is flowing when an engorged mother is pumping, and take action when needed to keep the breast flowing.
Warmly-
Martha Johnson RN IBCLC
Eugene OR
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