Keleigh,

I have been cogitating your post, and at first didn't really feel I had much that was pertinent to a lot of the things you said in your post. But I will comment anyway.


First and foremost, this happened during a notoriously suspect calendar period for lactation complications that may be associated with the possible changes in routine due to the seasonal celebrations themselves. In order to assure that the milk ejection reflex is able to overcome any extra stress hormones, I recommend the frequent use of Reverse Pressure Softening a minute before latching, and also before and several times during pumping, because the milk ejection reflex is the strongest force in milk transfer.


Next, I do find myself wondering whether a prepregnancy breast diagnosis of very fibrocystic breasts is automatically continued on through to this stage of reproduction. I remember hearing somewhere that pregnancy improved the condition. Perhaps a pathologist, the specialist probably most familiar with the normal cellular changes, might supply some answers on how pregnancy affects fibrocystic breasts. I am assuming that natural changes take place during pregnancy within any first time mother's breast tissue, fibrocystic or otherwise, for one thing, changing the acini themselves from type 3 to type 4 in the TDLU (terminal ductal-bular units).  


Here is an excellent reference by a histologist, (with some of the notes copied from my own bibliography),  easily available in any university library:


<Russo J, Russo IH Development of the Human Mammary Gland in: The Mammary Gland, Development, Regulation, and Function ed. by Neville MC, Daniels CW 1987 Plenum Press, NY. pp 67-93.
Pie chart of differing amounts of tissue depending on age/parity. “Dabelow (1987) made the most complete systematic description of the mammary gland development, dividing this process into the following 10 different stages: (p. 69-71.) Very detailed explanation of development with a few excellent diagrams (p, 87). One very important Russo Quote:

<Describing the breast as a whole: “This complex organ therefore has to be described in its anatomy, histology, ultrastructure, physiology, or response to hormones not as a static picture, but as a dynamic phenomenon in which each phase is transitory and heavily dependent on the age at which it is studied, and the specific conditions of the host . . . the development of the mammary gland has to be evaluated based on the architecture of the organ at each given period of time for each individual woman.” >


However, I would also like to call your attention to my post of Dec. 21 on Mechanics of Suckling. I am hoping the entire post is available to you by clicking on the archives for that 3rd week of December. If not, let me know and I will copy it for you.


I described what seems to be an alternate understanding of the action of a mechanical breast pump, and the fact that vacuum does not pull, contrary to the impression of many professionals and parents. I give the alternate explanations in the post, but the essence is that while vacuum does not pull (500 years of scientific evidence base), other forces push. I go on with more, including this paragraph:


<And of course, it's a great time to add in teaching the usefulness of alternate breast compression if the baby snoozes too often at breast. For even though we probably won't tell moms this, we are providing her a skill to supply some of those "other forces to push milk forward", (because at least, we ourselves fully realize, that neither baby's vacuum nor pump vacuum is actually PULLING!)>  


Dr. Jack Newman has an excellent handout on breast compression available from his website. Essentially, it involves putting gentle pressure/massage on many of the upper ductal areas whenever the baby stops swallowing. I often tell moms to pretend their breast is like a giant toothpaste tube, put their thumb on the breastbone and their 4 fingers near the axilla, and gently compress and hold for a few minutes, watching baby's sucking pattern change.


So whatever else may be going on in her breasts, it will help milk transfer to do RPS before latching, and gently massage/compress all areas of the breast being drained while nursing or while pumping. I do hope you are able to read, and perhaps supply her a copy of the entire post.


Best wishes to her first as a mother, and from our viewpoint, also quite as important, as a pediatrician, because her experiences will come to have a strong effect on the experiences of so many mothers and babies in the future, and on all the professional colleagues whom she contacts from here on in.


Best wishes also to you, in helping her. Keep us posted as it is possible to learn so much from the experiences of others.


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

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