Hello,

I am thinking about introducing Reverse Pressure Softening, a technique I learned on LACTNET from Jean Cotterman, to a patient with edemetous areolar tissue and difficulty latching. For those who don't know what this is, this is how the technique was described to me:

"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."

My question: Since this method 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), would this actually be contraindicated in a woman who is simultaneously experiencing severe engorgement in the axillary region? My client is up to her armpits in engorgement, and I don't want to make it worse.

Thanks!
Brenda Phipps, BS, IBCLC

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