<The milk pores
are located approximately at 1 1/2 cm off the areola-skin junction, and
despite the infant is attaching beautifully, there is a questionable milk
transfer.>
I am trying to visualize where you are describing. Are you saying the
milk pores are about 1 1/2 cm. inside the areolar/skin junction?
If so, these are probably glands of Montgomery. If I look hard enough, I
could find the embryology reference that says that those Montgomery
glands closer to the nipple are capable of manufacturing small quantities
of milk, while those further from the nipple (closer to the areolar/skin
junction) produce a more sebaceous type fluid.
Understanding the embryological development of the breast and nipple,
unless the mother has what appear to be a double nipple tip (I have seen
one), it is hard to imagine that the milk from the interior ducts could
exit anywhere but from very near the central 1-1 1/2 cm of the nipple
itself. If there are supernumerary nipples, that should be obvious, and
even, then, any milk exiting should exit from the central portion of that
nipple.
<there is a questionable milk
transfer.>
<The nipples are very sore because of bilateral top cracks>
<pumping seems ineffective>
This speaks to me of the milk sinuses not being compressed. Despite our
recent discussions on LN about evidence for the theoretical existence of
milk sinuses, while I agree that they are certainly not distributed like
the spokes of a bicycle wheel as most diagrams would have us believe,
they do exist as separate entities and are visible to the histologists
under a microscope. I urge you to palpate for them yourself.
You can find them by standing in front of or slightly behind and to the
side of the mother. I prefer the latter as this puts my thumb and fingers
in the same plane as hers, which makes for good demonstration of
fingertip expression.
Curve the first joints of your thumb and fore and middle fingers (those
last 2 placed together), forming a "C" (left hand) or a reverse "C"(right
hand).
Imagining the areola to be a clock, place the thumbtip at 12 o'clock, and
the touching fingertips directly at 6 o'clock, about 2-3 cm. (both top
and bottom) away from the base of the nipple, . (This is where I can
palpate them in most mothers. Some few mothers may have them as close to
the base of the nipple as 1 cm, and a few others as far away from the
base of the nipple as 4 cm.)
Press the areola directly inward perpendicularly to the chest wall so as
to "trap" the tissue to be palpated. (Maintain the "C" shape and the
inward pressure throughout).
Gently begin to roll the thumb (as if taking a thumbprint) against the
opposition of the stationary fingers at the 6 o'clock position.
Deep within the nipple-areolar complex you will feel what I describe to
mothers as "small lumps in tapioca" or "tiny balloons". When you find
them, if you can imagine them to be like tiny toothpaste tubes, you want
to start compression from the proximal end, rolling toward the distal
end, just as you would try to get the last of the toothpaste out of a
toothpaste tube starting from the far end.
During the postpartum period, they often become somewhat "overfull",
distended, very firm and tight and tender if compressed directly over the
central "belly" of the sinus area.
I am convinced this accounts for a great deal of what we call "initial
latch pain". The tenderness resolves after 10 drops or so of milk are
removed from those particular sinuses, so that they are no longer
over-distended.
If you move 90 degrees around to the opposite quadrants, those sinuses
will often be distended too, unless this area is where the baby has been
using the same nursing position and habitually pressing there with the
jaw/tongue.
They are not tender if compressed at either end, which is what the
infant's upper jaw (compressing the distal end) and tongue (compressing
from the proximal end) do in an off-center latch (voile- no pain!).
They can comfortably be "decompressed" before palpation, fingertip
expression, latching, or pumping by moving some milk back up into
contributing ducts. This can be done by pushing inward close around the
base of the nipple for 60+ seconds, thus using Reverse Pressure Softening
first. (See archives or ask me more about this if you need to.)
This also seems to produce a strong MER when it is done. The MER is the
most iimportant force active in moving milk within the breast. In order
to expect good milk transfer, it is important that the MER be elicited
(one way or another), expecting the double neurohormonal arc to take up
to 3-5 minutes before attempting to pump, (or nurse).
I would be interested to hear feedback from any and all.
Jean
*******************
K. Jean Cotterman RNC, IBCLC
Dayton, Ohio USA
***********************************************
The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(TM)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html
|
