Wow! What a can of worms my question opened!!! Now I am all the more certain of my previous statement:


<If this term needs defining when I use it, I will have to re-think my use of it. Maybe I'll need to use a different term or describe more clearly the effect I'm trying to gain?? I do describe and explain the effects I'm trying to gain when I talk to mothers, but talking to other HCP's, might they be interpreting the term differently from me??>


The first time I remember hearing "anti-gravity" was years ago, from some LLL literature source, I believe, in how a mo with OAMER could help her baby avoid the need to protect his airway during feeding, especially early in the feeding. 


In other words, ask such a mother if she has a recliner chair, or would lie at least part way back with baby's head/mouth physically above or lying more on top of mom's nipple. Then, milk would exit the nipple uphill, delivering the milk to baby a little more slowly, because milk was flowing against gravity, thereby slowing the flow rate, or at least making the milk exit more like water from a drinking fountain. Or at least, the baby's throat was "uphill" from the milk so that there was no gravity involved in speeding the milk to the throat, and therefore, baby could coordinate breathing and swallowing much more easily.


Actually, my current fascination with the term "anti-gravity" has little or nothing to do with the baby. I keep thinking more and more deeply about RPS, and why some folks report that "it doesn't work" or "it doesn't work long enough for the baby to latch!" 


Although each of my articles and the 2005 version on Kellymom.com and other sites does in fact mention having mom lie back if her breasts are very firm or very swollen, that often seems to go straight under the radar, and RPS is often applied with the mother sitting upright. Indeed, the You-tube video showing a mom applying RPS while in a sitting position has now gone viral. I was not asked for input when this video was made.


My latest conclusion is that if a mother's bra cup size is C or beyond, the breast, even prenatally, is pendulous enough to place the nipple-areolar complex "downhill" from the main bulk of the breast. I explain to moms by using the words "spongy, protective tissue" around the milk making cells and ducts (or tubes, if I want to simplify it more). I tell her this "protective" tissue has other jobs, especially one of storing extra fluids temporarily. 


The moms I get to counsel on the phone or see for consults of this nature at WIC are typically from 3-6 days postpartum, when their breasts are far different from what the L & D and postpartum and nursery nurses saw (or palpated) on days 1 & 2. 


I ask the mom about her hospital experience, partly to encourage her to ventilate and "tell her story". As she proceeds, I ask a little question here and there to elicit the information I am looking for. I then ask her to try to remember about how many sacks of IV fluid she may have received in the hospital, or for how many hours before birth, and especially if she received IV fluid for hours (12-48) AFTER birth (not shouting, just emphasizing), and if she ever heard the term "pitocin" or "pit" in regard to medication in any of the IV fluid. I tell her that one of pitocin's effects is to tell her kidneys not to be in a hurry to get rid of the extra fluid too soon.  (BTW. the answers given by mothers who received little or no IV fluids seem markedly different from the answers of the moms who received >2000 cc. in any one or more 24 hour periods.)



(I'll have to read up more, as there have been distinct changes in "3rd stage management" since I left direct inpatient OB nursing decades ago. But I would like confirmation or rebuttal from anyone on the list who is very familiar with current L&D, postpartum and anesthesia practices (especially Sarah Reece-Stremtan). I assume (and I know that old joke/truism about ass-u-me!!) that if a mother says she was eating and drinking whatever she pleased soon after the birth, that the long period of postpartum IV fluid was obviously not for hydration purposes, but probably as a vehicle for pitocin because she was considered at increased risk for postpartum hemorrhage.)


Then, if she has swollen ankles, I show her this is a sign that her body is still storing some of the IV fluld. I recently have begun asking her to imagine an ordinary rectangular dish sponge, moistened even a small amount. I ask her where would the most of the fluid go if she held the sponge up by one corner??? She "gets it" right away that fluid would move toward the lower corner, and she can see right away that that corresponds to the nipple-areolar area of her breast, and why lying back (45 degrees or more) to position the breast higher than the heart (or sometimes I say "on top of the chest-wall"), will help RPS soften the areola more easily and allow it to stay soft for a longer time for latching purposes. 


It occurs to me that using this principle of (what I've been calling "antigravity" positioning;-) to temporarily elevate the breast over the surface of the chest wall, and teaching RPS first, then teaching HE while in the same "anti-gravity" position, might be a good way to teach HE in the early postpartum period with more success. Moms who deliver at some our local hospitals seem to be learning these skills in the first two days, but moms who deliver at others don't seem to have been taught either RPS or HE. I think it's worth thinking over for the NICU nurses who want the moms to have more success when they sit back upright to pump, too. It would be interesting to find whether repeating the "antigravity RPS" once or twice during pumping might help the pump yield more as well.


We are all taking care of the same mother and baby, but in different rooms, and especially, at different periods in time in relation to IV fluids and meds received and their longer-range effects, the type of birth, the number of days after the D.O.B., and r/t the successive hormonal and circulatory shifts in her breasts, plus situations that may have been worsened by pumping. We will probably never all be on the "same page" with our instructions, but I hope we can improve our understanding so as to do some better anticipatory guidance, prenatally, and in the hospital, for the typical changes her breasts are likely to go through during the 7-10 days shortly after the mother goes home.


I have also begun thinking of an analogy for moms to replace the mantra I feel it's important to use for professionals: "Vacuum doesn't pull; other forces push." That's definitely evidence based, for 500 years. But from what so many moms have told me, I don't see evidence that it's clearly understood by many of the folks who are teaching new postpartum mothers how to use a pump, be it a single hand pump or a double electric. So many moms report getting a little colostrum out in the early pumpings, and then less and less, or none at all, even though they can feel their breasts getting fuller. But the milk won't seem to come out with pumping for a certain time period! All too often, it seems to me, that someone, either a professional, or a family member or a friend tells her to simply "turn up the vacuum number!", which often ends up compounding the situation in one way or another.


I have begun having moms recall the TV weather reports that demonstrate that "areas of high pressure will move toward areas of low pressure" and that this works the same for fluids as for winds. After the dish sponge analogy, she can usually make the connection I am trying to make. When she visualizes the tissue swelling I have demonstrated to her as the "high pressure area" (meaning both the "downhill pressure" (e.g. gravity acting on weight of the stored fluid) she gets it that it will flow toward the low pressure vacuum area in the pump flange. She can then follow my reasoning that this may soon cause a "traffic jam" behind the nipple that can interfere with the milk flow through the ducts. 


I know it sounds technical, and I struggle with simplifying my explanations, but when I have taken it one step at a time, observng for feedback that she is "getting it" before I move to the next step, I am convinced that I have given her some new tools to use at home in the first 1-2 weeks. I feel sure that those who give totally "hands-off" care may have a markedly different reaction. 


Be that as it may, I'll never use the words "antigravity position" to professionals again without clarifying what I mean in that specific example!!


K. Jean Cotterman RNC-E, IBCLC
WIC Volunteer LC  (which I find to be a very interesting retirement experience;-)
Dayton. OH

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