Karyn-grace-

As many know, during the first two weeks postpartum, RPS consistently stimulates the MER. Its main value at that time is probably in temporarily, but totally reversing engorgement in the nipple-areolar complex. (This lasts just for minutes, but will last for a few minutes longer when done in an anti-gravity position, and so prolongs the opportunity for effective latching or pumping.) 


It is also very helpful to repeat RPS at least once or twice during early pumpings as edema, even small amounts of invisible edema, easily pushes forward toward the vacuum and thereby often crowds the ducts in the nipple-areolar complex, preventing them from draining efficiently. (This may be responsible for little or no results from the pump, especially after the first one or two pumpings.) Edema is usually no longer present after about 7-10+ days, depending on how much IV fluid and pitocin the mother received. 


But, some good news is that you will also find that throughout the course of lactation, RPS remains useful in eliciting the MER. This is because it stimulates the nerves that pass through the tissue of the areola on their anatomical pathway from all parts of the breast to enter from the deep areola up into the center of the nipple (not the outside of the nipple!). RPS is a wonderful tool to teach a pumping mom for times whenever she might be under stress during any stage of lactation!


Once edema/engorgment has passed sufficiently to permit easy fingertip expression, gentle, steady firm pressure of HE on the deep areola will also elicit MER.  But with RPS, it's "less messy" than HE since RPS tends to keep those few drops of milk inside the breast till the baby or the pump is ready to remove them in the next few minutes! (Similarly, this is why MER happens with fancy pump cycles, and sometimes even ordinary pumps.) 


RPS can also be used to elicit an MER during a feeding if desired. Mom can do RPS on the opposite breast as an alternative or companion activity with breast compression, if desired, though alternate breast compression is a more  unobtrusive way to stimulate MER in public. 


Remember there is an obligatory "refractory" period between MER's due to the body's "rules" about oxytocin release in a pulsatile (not continuous) fashion. So if baby is falling asleep or otherwise waiting for milk flow to stimulate nursing activity, if mom wants, she can "fool" the baby into continuing to swallow solely from just the pressure she can apply to the milk in the ducts by breast compression alone, even if its not quite time for a natural (oxytocin pulsed) MER to happen. 


Let us know how things work out for this mom.


K. Jean Cotterman RNC-E, IBCLC
WIC Volunteer LC, Dayton OH 

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