Lori, You wrote:
<Winnie Mading <[log in to unmask]>> I find that Jean C's Reverse
> pressure Softening,which is much like the Hoffman's technique that has
been
> suggested for flat nipples, immediately effective. It pulls the fluid
away
>
Winnie- could you please describe this reverse pressure softening?
Thanks,
Lori Salisbury, RN, IBCLC
Winnie is absolutely correct. The Reverse Pressure Softening that I have
found so valuable is really a modification of the technique Dr. Hoffman
described in his one and only article that I have ever found.
(In that article, he made none of the claims that have since been
ascribed to it, especially those noted in the Main trial. His technique
consisted of inward pressure followed by sideways stretching. I believe
he advocated it both prenatally and in the postpartum period. I have
focused on the inward pressure just during engorgement.)
However, articles such as these have created such instant negative
reaction associated with his name in the LC community that I decided to
pick a name that simply describes what is being accomplished.
Here it is in a nutshell:
<Simply place your thumbs or the flats of the mother's two fore fingers
(perhaps placing your thumbs on top of them) just opposite each other,
near the base of the nipple. Press the areola gently but firmly straight
inward toward the chest wall for a full 60 seconds by the clock, then
repeat in the opposite quadrants.
Or if the mother has short nails, I tell her to curve the 3 middle
fingertips of each hand and "plant them" at the base of the nipple with
the flat surface of the fingernails actually touching the sides of the
nipple, then press straight inward on the areola.
I suggest that she sing a full lullaby, which occupies close to 60
seconds and sounds less worrisome than watching the clock. And as Diane
has so cleverly put it in one of her new papers, the object is simply to
make a ring of dimples at the base of the nipple.>
This maneuver accomplishes three things:
1) It temporarily moves excess interstitial fluid toward the inner lymph
channels and temporarily removes it from the areolar and subareolar area,
to give the baby a fighting chance of a better latch.
2) It presses on the anterior openings of the milk sinuses, relieving any
overfullness by temporarily pushing milk back up into the contributing
ducts. (When sinuses are overly full, direct compression of them causes
distinct pain. When they are less full, fingertip expression is painless
and much easier, and provides further softening of the areola)
3) Stimulation of the nerves deep beneath the nipple never seems to fail
to elicit MER.
I hope many of you find this helpful. Edema does not have to be severe
for this to help. In fact, in cases with severe edema, it may be
necessary to do it more than once before the feeding to accomplish enough
softening to help milk transfer.
I saw a young mother last week on postpartum day 4 who was so engorged
that when I did the RPS, I could see 0.5 cm deep "pits" for maybe 15
seconds till the interstitial fluid filled them back up again.
But after repeating it 3 times in a row, there was sufficient tissue
elasticity and MER to entice the baby to nurse very efficiently with a
silicone shield. What "manna to the ears" the steady swallowing was for
the mother, the grandmother (a LLLL) and me!
I would appreciate any feedback, positive or negative from anyone who
tries it.
Jean
************
K. Jean Cotterman RNC, IBCLC
Dayton, Ohio USA
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