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Subject:
From:
"K. Jean Cotterman" <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Fri, 22 Feb 2013 20:10:57 -0500
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Anne asks:

<Usually a mom in this scenario has very firm tissue which is hard for baby to draw into his mouth. >

I read all today's comments on nipple shields. Research was called for. Do any of us question "Why is the tissue so firm (today)?"

That's where I think the research is really sparse. I wish someone would do research that follows the colloid osmotic pressure at least daily for 10-14 days for mothers who get peripartum IV fluids, with factors including the total amount of fluids before and after birth, how long the fluids were given before and after birth, was IV Pitocin used for induction, augmentation or for "fourth stage" management for how many hours after birth? How much Pitocin total? Pitocin's natural effects include an anti-diuretic action, so some of the fluid re-enters the circulation during it's procesing by the kidney.

Is the firmness being palpated due to fluid in the interstitial spaces of the areolar tissue, or is the firmness due to fullness of the subareolar ducts (aka  lactiferous sinuses), or is it due to a combination of both?

Are the mom's breasts pendulous? Gravity effects the movement of edema. Is there edema crowding the subareolar ducts, preventing the exit of milk?

How about vacuum? If vacuum is used on an edematous breast, edema moves forward both by the force of gravity, and pushing toward the vacuum to try to balance the negative pressure. 

Vacuum does not pull; other forces push, evidence based for centuries. Do all IBCLC's and NICU nurses understand this? I'm sure the breast pump employees do.


Are we using enough "laid back" positioning to help mothers with pendulous (C-cup and over) breasts, especially before attempting reverse pressure softening (RPS)? 


Is any one using and teaching RPS for just before latching, just before trying fingertip expression, just before deciding to use a nipple shield, just before and during any necessary use of a breast pump in the early days and weeks?? 


Edema must be suspected in so many of the situations described today, and as Susan said, the firmness of the breast changes so much from day to day in the early weeks, because the formation of edema and the rate of its resolution, the physics of gravity and vacuum on the behavior of fluids , even prenatal edema in the pendulous breast, needs to be considered when the need for a nipple shield is being assessed.

Am I the only one asking questions like this?


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

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