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Subject:
From:
"Kermaline J. Cotterman" <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Thu, 12 Jul 2001 21:57:50 -0400
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text/plain
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<She says she was pumping on low speed, initially releasing
the suction every 3 minutes, then going to every 2 seconds.>

Low speed? Or low suction? Perhaps even low suction on the Nurture III
might be more than from the hand-held Ameda? Or the large electric
Ameda?? Others can probably answer this better.

At any rate, I think the initial holding of the suction for 3 minutes is
the problem. By the time blood spreads into capillaries, the the blood
pressure in both the arterioles and venules is much lower than our
systemic BP (taken in our arm, etc.)

The negative pressure from the pump may have held the flesh against the
flange tightly enough to resist the low pressure entry of fresh, red
blood and trapped the blood already there.

If that is the case, the trapped blood changes from bright red to
cyanotic as the oxygen is used up and carbon dioxide is absorbed to
replace it, but the "cyanotic" blood cannot exit through the venules.
This is the "purple" she is seeing. The impaired tissue respiration
cannot help but traumatize the affected cells and result in some degree
of inflammation and eventual discomfort.

I suspect that the reason she used this timing has to do with when she
saw milk first exit from the nipple. She did not understand:
  1) Vacuum does not pull on milk; it pulls on flesh.
  2) The most powerful force in milk transfer is the
       milk ejection reflex.
  3) The MER is a 2 part reflex:
           * the neural arc from nipple, chest wall,
             emotion, etc. travels rapidly to the brain.
           * the hormonal arc (by logic and
             observation), takes longer, about 3 or
             more minutes to result in the exit of milk:
                 * release of stored oxytocin from the
                    posterior pituitary into the circulation
                 * travel of that blood to the right heart,
                   through the lungs, into the left heart,
                   off the aorta into the mammary arteries
                   into the alveolar and ductal capillaries,
                   in quantities enough to stimulate
                   contraction of myoepithelial cells,
                   to shorten and dilate ducts finally
                   forcing actual travel of the milk itself to
                   the nipple exit.

With all the other serious medical complications this dear devoted mom
has, I certainly would not want to see Raynaud's spasms in the nipple end
up being added to them! I would have her trigger the MER by hand first,
and then wait 3-4 minutes to start the manually controlled short cycles
of vacuum and release.

Jean
************
K. Jean Cotterman RNC, IBCLC
Dayton, Ohio USA

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