This is not evidence based, but my experience with each of two experienced nursing mothers, each one of whom came to WIC with a breast problem with a newborn. I remember one very clearly.

She came in at about 1 week with a problem with the baby latching on one side. She had had a swelling of the areola during pregnancy and the OB told her that if it was still there postpartum, it would be time to ultrasound to discover the problem. 


As I palpated that side, it dawned on me why the baby couldn't seem to get a good latch. I had the impression that there seemed to be a stretched, undrained lactiferous sinus and after finding it was not painful, I reduced it's size slowly with RPS. I taught her to take time to do RPS for 2-3 minute bouts each time it was that way enough to interfere with the baby's latch. This slowly moved the milk back upward out of what I took to be a galactocele. The baby was then able to latch on and drain the breast effectively, just as on the other side. I followed up on the phone, and she reported it came back, off and on for the first week, but was reducible with RPS so the baby could latch and nurse. By the time of her 6 week check up her OB said there no longer seemed to be any irregularity, so no US was done. The other mother's situation was much the same.

Reducing the galactocele before the feeding seemed to allow the baby to then compress the sinus effectively so as to be able to roll the tongue to move the milk through the nipple. I would not expect the pump to solve the problem, at least as well as RPS did, because vacuum doesn't pull; other forces push. Evidence based for 3 centuries, (ya-da, ya-da;-) 

Some force behind would need to push, which is what always causes milk to move toward the flange. The "blob" of milk in the galactophore would not have enough of the force of the MER transmitted through it, nor would hand massage from behind, due to the "blob's" inability to transmit hydrostatic pressure very effectively.


K. Jean Cotterman RNC-E, IBCLC
Dayton OH
 

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