Ann asks:

<My question to you Jean: how does the reverse pressure work if the baby
cannot nurse?>

My experience is that RPS uses positive pressure to help solve at least 3
different problems at the same time, whether or not the baby is able to
go to breast.

1) It disperses excess extracellular fluid away from the subareolar area,
thereby reducing subareolar tissue resistance over the sinuses (and to
the baby's jaw and tongue efforts).

2) It also painlessly reverses overdistention of the walls of the sinuses
by longitudinal  movement of some milk back up into contributing ducts;
then, direct "latitudinal" compression (over the "belly" of the sinus)
will no longer cause pain, and will transfer milk more efficiently,

3) It is very, very effective in starting the neural arc of the MER, so
that the hormonal arc can bring free-flowing milk down to the vicinity of
the sinuses within 5  minutes or less.

<Do you recommend this prior to pumping?>

I am hypothesizing here. I myself would probably try the positive
pressure of the Marmet method of fingertip expression first to see what
could be obtained. IF the MER has in fact already caused milk to be
free-flowing through the sinuses, and IF only minimum vacuum is used for
a very short time immediately after RPS, and IF the correct size flange
to allow the sinuses to compress themselves against the pump is used, I
would imagine the pump would promptly yield at least a small amount of
milk, depending on the amount thus far produced.

When the milk flow slows, I would probably take a break in the action to
observe the nipple-areolar complex and palpate to check for the amount of
subareolar tissue resistance that might be reaccumulating.

I believe that if stronger vacuum is used for a longer time, atmospheric
pressure outside the flange could simply start extracellular fluid moving
right back into the subareolar area, re-creating a thick layer of edema
over the sinuses.

If the pump is used, I would recommend single pumping with the hand of
the same side of the breast being pumped, so that the opposite hand could
apply opposing compression to the upper outer quadrant of the breast
where 50% of the glandular tissue lies, to help move the milk quickly
before edema could again be produced under the flange.

By opposing compression, I mean thumb on the breastbone, fingers near the
axilla, gently squeezing the both the inner and outer aspects of the
upper breast steadily for several minutes at a time, as if extruding from
a large toothpaste tube.

I think this is more effective than just intermittently pressing and/or
massaging the glandular tissue against the ribs, which often just results
in the breast being mostly pushed in different directions. with inner
ducts escaping much compression,

In my mind's eye, I envision that during the height of engorgement, we
could well be looking at it as a race between the expression of the milk
and the reaccumulation of edema. I see milk with extra hand pressure
traveling faster through larger tubings than extracellular fluid under
atmospheric pressure would move between cells.

Till edema is no longer a  problem, RPS just before each milk removal
session can be helpful before removal by any means, but especially by the
baby, for it gives a fleeting window of opportunity for the strength of
the baby's jaws/tongue to be greater than subareolar tissue resistance.

I am very interested in anyone else's hypothesizing and/or experience.

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

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