Deb from Texas writes:
< She was pumping her breasts before bedtime and noticed that=
she had a firm lump directly behind her right nipple. Pumping was even
more painful in this breast, and she noticed she only expressed about a
teaspoon from the affected breast. . . . . . . .By dawn when she called me,
the pressure and pain was even more excruciating in the breast, and mom
received little more than a trickle from the affected breast. I explained
RPS, hoping it might shift the swelling slightly, especially since she had
been using such high suction and for nearly an hour at a time. She wasn't
able to press on the areola without going through the roof.>
Even in cases with no suggestion of infection, if RPS is tried for moving
swelling out of the areolar area, it should never cause any pain. In such a
case, less pressure held for a longer time will do the job comfortably, if
patience is used.
However, this appears to be another type of situation. I will copy what I
wrote on Sept 6 in answer to another post by another Debbie in Texas:
:
<She has no other symptoms that explain the fever and WBCs. The PA started
her on antibiotics with DX of Mastitis. She was sent home with nipple
sheilds (her request) Lansinoh (I asked her to discard what she had)
instructions for RPS and instructions to check with me by phone
tomorrow. She did give me permission to post. I'd be appreciative of any
ideas.>
In my JHL article and in my talks, I have specified that I recommend reverse
pressure softening for only two purposes:
1) for use before latching or pumping during the first two weeks, to
temporarily reverse the effect of engorgement on the areola. It seems to
move excess interstitial fluid and milk from the shallow subareolar location
to slightly deeper into the breast, in order to enable the areola to become
soft and pliable for long enough to latch or pump,
2) and for the purpose of triggering MER at any time during lactation.
I have stronglly advised against the use of RPS for mastitis or potential
abcess.
I have also cautioned against the use of RPS (by the professional), in
mothers with breast implants. While,these contraindications are my own
cautions, and I believe a mother with implants could certainly be given
instructions and allow her to make her own decision on whether to perform it
cautiously on herself, I once again strongly caution against the use of RPS
whenever the possibility of breast infection is involved, Since RPS is still
an empirical intervention, awaiting someone to confirm it by
research, I base my advice on the logic of erring on the side of caution to
avoid moving possible infectious material into adjacent breast tissue.
Cotterman KJ , Reverse Pressure Softening: A Simple Tool to Prepare Areola
for Easier Latching During Engorgement, *Journal of Human Lactation *, May
2004, vol. 20, iss. 2, pp. 227-237.
Better Latching Through Reverse Pressure Softening, 2004 ILCA convention,
Scottsdale, AZ
Reverse Pressure Softening, Skills Workshop, Clinical Day, July 12, 2006,
ILCA convention, Philadelphia, PA
Everyone, please help spread rthe word about mastits, and potential abcess,
as a contraincation to the use of RPS.
Jean
*************************
K. Jean Cotterman RNC, IBCLC
Dayton, OH USA
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