I might suggest:
- RPS for several minutes (not just 30 seconds) to "pit" the areolas; try
all versions: finger tip pressure, finger pad pressure; double finger pad
pressure; 2-3 fingers below and thumb on opposite side of areola pressure;
whatever works for her breast structure
- Use the largest available (30mm?) of the Custom Breast Flanges; standard
is probably too small for her and that can create sore nipples because of
the gripping and dragging within the flange tunnel
- Use a touch of Lansinoh or PureLan on the angle edge of the flange; that
is the point of greatest skin stress during pumping and the cream can help
the skin stretch or move a bit
- Use a gentle vacuum for an extended time: 20-30 minutes; 10 min is often
not long enough for serious engorgement; increase vacuum slowly when milk
begins to flow
- Interrupt regularly for more RPS
- Lean her back slightly so the breast edema is less likely to be pulled
forward by the vacuum which makes milk removal more difficult because of
fluid pressure on the ducts
- Ice packs 20 min on, 20 min off; use the pliable, wrapable "blue ice"
soft pack made for athletic injuries or very large bags of frozen peas or
corn (throw out after use as they aren't good to eat when defrosted and
refrozen several times; protect skin from frost bite with a cloth or towel
- consider clean green cabbage on the skin but not on the areolas; replace
when wilted
- avoid hot shower water beating directly on her breasts; it will
exacerbate the edema or swelling
- she should turn her back to the shower spray and let it flow over her
shoulders; good time for gentle massage or hand expressing; if milk wants
to flow, lean over & let it go
- pump again after the short 5-10 min shower (no long hot soaks during
engorgement)
- use anti-inflammatories as appropriate for her, per directions
- pump again; maybe hourly until relief is achieved
- once milk starts to flow, baby MAY be able to feed well with a nipple
shield until mom's nipples become more pliable &/or baby's mouth grows more
- if hand expressing works better for her than a mechanical pump, that's
fine; objective is to move the milk out, relieve the breasts, and
facilitate feeding
Two schools of thought:
1. pump as thoroughly as possible to "empty" the breasts, then have baby
regulate the infilling, with/without nipple shield because of size of
nipples
2. pump just to relieve engorgement pressure; then feed baby directly
with/without nipple shield so baby can regulate the milk supply
OK, I lied:
3. pump full supply and feed EBM by alternative means until baby can get
his mouth around the large nipple
As always: the objective is to eventually get rid of the nipple shield.
It's just a tool to facilitate BFing in various circumstances, or to
control a strong MER so babe doesn't "drown"
If any of this is now out of date, please let me know.
I always want to keep current on the most effective techniques.
Phyllis Adamson, IBCLC, RLC
Glendale, AZ
[log in to unmask]
Subject: engorged breasts and sore nipples
Hi Everyone,
I am working with a mom that is 3 days post cesarean birth, wide-flat
nipples and engorged. The baby is not able to maintain a latch to the
breast even after softening the areola by hand expression. I gave her a
ameda elite pump to use and after 3minutes no milk let-down so I taught her
hand expression.
I have had this issue with mothers before. Engorged breasts and no relief
from the pump. Any suggestions?
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