Felicia had a pumping question. 

My first thought was to compare the diameter of the tunnel of the single pump flange with the diameter of the double pump flanges. Perhaps more of the subareolar tissue needs to push its way into the flange tunnel to "tap" the appropriate part of the subareolar ducts (known to histologists and breast surgeons as the lactiferous sinuses.) 


http://www.lab.anhb.uwa.edu.au/mb140/big/nip02he.jpg


The solution may be as simple as getting a similar flange tunnel size for the side that the mother says is not "releasing" milk (or as she perceives it, not getting "pulled in".) No need to stress her with the science, but translate this in your own mind: "Vacuum does not pull; other forces push", evidence based for centuries. We need to spread the word in our profession, which is so heavily influenced by pump advertising and our common experience of "suction", which is really "siphoning" fluid through a straw, the liquid being forced through the straw by atmospheric pressure. This is much different from removing milk from under the surface of the skin. Wikipedia is a wonderful source of clear and interesting information on subjects like this;-)


The massaging could definitely have caused an MER. But MER happens on both sides, the first phase of the reflex stimulated by the neural trigger(s), be it physical stimulation or emotional stimulation, because the second phase of the MER causes oxytocin release into the circulation, which reaches all tissues in the body.


I am of course glad that so many have found that reverse pressure softening (RPS) has been helpful with latching problems during engorgement. I hope that everyone realizes, tests it for themselves with the permission of mothers, and spreads the word that RPS is useful in stimulating an MER within 60-90 seconds at any stage of lactation. The key is constant, gentle, steady pressure. (This length of time the pressure is steadily applied has been inaccurately illustrated in a video that has gone viral.)


If there is ever any pain, the pressure is too firm. Use less pressure, held steadily for a few extra minutes.


Although referred to as an engorgement treatment on Kellymom.com, these directions used at any time during lactation will trigger MER.


kellymom.com/bf/concerns/mother/rev_pressure_soft_cotterman/


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

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