Fourth day postpartum? Did she have any intrapartum IV's, totalling > 2000-2500 cc's in 24 hours, and/or especially hours of IV pitocin drip for induction, augmentation or third stage management (IV pitocin for 12-48+ hours post birth if at risk for postpartum hemorrhage?) 


If so, this suggests the potential for what I now call "pre-L-2 edema", which has the capability of pushing forward through the interstitial tissue, to crowd the ducts in and behind the flange area (especially if any pendulousness, C-cup or larger) is helping gravity push edema forward as nature tries to balance the negative pressure of the vacuum by pushing other fluids forward. (Again, 500 years of evidence exist that vacuum does not pull; other forces push.)

In addition, it has been my observation the RPS held for 30-60 seconds reliably elicits an MER within an additional 60 seconds. (Remember that oxytocin release is in a pulsatile form, with about a 5-7 mnute refractory period between releases.)

I would suggest that  (especially if she has "pre-L-2 edema"):
1) she lay back in an antigravity position so that the breast(s) is/are above the heart.
2) RPS be applied on at least one side as above, to stimulate MER. (Both sides needed if edema need
     to be moved backward out of the flange area before use of double pump
3) (Lying on one side to utilize antigravity while pumping one side), or sitting up if more comfortable) Pump for 5-7 minutes or till milk begins slowing down
4) Pause 1+ minutes to massage milk forward from back areas
5) Repeat the above sequence 1-2 more times with a maximum of pumping time of 10-15 minutes.

Using Diane W's excellent handout "How we make milk", I help moms understand that milk is made more rapidly 
in the first hour after removal. More frequent removals of whatever smaller amounts possible will still add up to
a larger total quantity removed in a 24 hour day.

I reassure moms about this, and recommend a session of nursing or pumping every 1 1/2 to 2 hours during their
waking hours, and whenever breasts or baby wake them up at night.

K. Jean Cotterman RNC-E, IBCLC
WIC Volunteer LC    Dayton OH (currently in AZ for the winter;-)

             ***********************************************

Archives: http://community.lsoft.com/archives/LACTNET.html
To reach list owners: [log in to unmask]
Mail all list management commands to: [log in to unmask]
COMMANDS:
1. To temporarily stop your subscription write in the body of an email: set lactnet nomail
2. To start it again: set lactnet mail
3. To unsubscribe: unsubscribe lactnet
4. To get a comprehensive list of rules and directions: get lactnet welcome