<My question: Since this method temporarily moves excess interstitial
fluid =
toward the inner lymph channels and temporarily removes it from the =
areolar and subareolar area (to give the baby a fighting chance of a =
better latch), would this actually be contraindicated in a woman who is =
simultaneously experiencing severe engorgement in the axillary region? My
=
client is up to her armpits in engorgement, and I don't want to make it =
worse.>
Brenda,
Thanks for asking the question for the sake of discussion and further
understanding.
The short answer: No. The right amount of pressure is gentle enough to be
painless, yet firm enough to temporarily "pit" the fluid out of the
subareolar area. Watch the mother's body language to guide you.
I find it to be an excellent first step in helping relieve severe
engorgement. In my experience, RPS moves the fluid only an inch or two
back and only temporarily, 5-10 minutes at the most, to provide a "window
of latching time" for the baby. The baby's correctly placed jaws then
continue to keep the edema at bay by rhythmic compressions during that
suckling session.
In fact, I have found several mothers who were so engorged that by the
time I had released the pressure from the second 2 quadrants, the first
two seemed partially "re-edematized".
These mothers responded to repetition of RPS, one after another 3 times
in a row. I am presuming this was enough to move more of the fluid a
little deeper inward so it would not refill the tissue quite so quickly.
Working quickly then, I was easily able to express 5-10 cc, by fingertip
expression on an area which would not yield to this technique previously.
(I performed the expression where I intended the baby's upper and lower
jaw/tongue to go, with perhaps some attention to softening a place for
the chin to nestle easily.)
The thorough deep stimulation of the nerves in this area triggered the
MER, and one baby was able to get a good latch with a shield, the other,
directly on the nipple-areolar complex.
Loud swallowing ensued, and when it slowed, a little breast compression
in the axillary quadrant (where over 50% of the milk making tissue is
supposedly located) promptly began to transfer the stored milk forward.
This reduced the generalized swelling near the axilla, thereby lessening
discomfort in that area till natural resolution of the edema there.
As an aside, gentle UPWARD massage of that area after a good feeding,
TOWARD the axillary lymph nodes might well help the physiologic
progression of the excess fluid to its destination.
I have wondered if gentle exercise of the arms/pectoral muscles might
also help, since we know that movement of the skeletal muscles of the
lower extremities act as an auxiliary circulatory pumping force.
I would be delighted to hear of anyone else's experience, pro or con. I
want to emphasize I have only used this in the initiation of
breastfeeding (up to 10-14 days). I would hesitate to use it under tissue
conditions suggestive of mastitis, in part due to possible pain.
Jean
******************
K. Jean Cotterman RNC, IBCLC
Dayton, Ohio USA
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