I skipped half a day of Lactnet posts while traveling and missed Jean
Cotterman's grossly underpriced 'two cents worth'.
First I want to say that every phenomenon described by Jean in that
post is very familiar to me from working postpartum, and Jean's work
has made more difference in my daily life at work than any other
single theory or technique.  When you work mostly with women at the
time when postpartum edema is at its peak, understanding RPS is
invaluable - why it's needed and when, and what it does.

In this post, Jean writes, addressing me and another clinician:
'It has just dawned on me that when each of you, independently said
you had successfully done RPS on the nipple itself, I was presuming
you meant gently squeezing the nipple tissue from opposite sides.
Maybe you yourself were referring to pushing inward on the tip of the
nipple itself?'

Can't speak for the other clinician, but I can confirm that I have
guided women to exert reverse pressure directly on their nipples if
the nipples seem leathery and non-protractile.  In my experience the
leatheriness is a sign of tissue edema and RPS works to fix it.

I've had a couple of rather unpleasant exchanges with representatives
for Lansinoh at conferences when they were pushing their gizmo that
looks suspiciously like a re-packaged bicycle horn pump, claimed by
Lansinoh to be a superior way of getting a nipple, flattened by
engorgement, to protrude so a baby can attach to it.  The only force
this device can exert is suction.  The horn fits over the woman's
nipple and she applies it to the nipple after first squeezing the air
out of the balloon part, so it just sits there, stuck to the nipple by
the vacuum.  I have asked to see the research showing the safety and
efficacy of the device, and expressed my skepticism since it would
only accentuate any edema and could cause serious tissue damage the
same way a breast pump does in the same circumstances..   The hype for
the device included claims that women preferred it to 'other methods
for dealing with engorgement' including hand expression.  The
representatives were unable to provide me with research showing
anything at all about the device.  It is a mystery to me that anyone
with more than an extremely rudimentary knowledge of breastfeeding,
could be taken in by this sales pitch.  Of course, it would be good
for Lansinoh's business to get lots of women causing skin damage with
one of their products, because they could sell them salve for the
sores on their nipples too.
When a company behaves in this way, I would hope that serious
organizations for people who work with breastfeeding would see to it
that the company was not allowed to advertise in its publications nor
exhibit its products at their events, because of the disregard for
evidence-based practice they demonstrate.  Why is it OK to market a
product with no earthly justification for its existence, and with the
potential to jeopardize breastfeeding?

Rachel Myr
Kristiansand, Norway

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