I learn something new every day! Like I have often said, reverse pressure
softening is primarily based on the principle of pitting edema and the
variety
of possible technique(s) are still a work in progress.

Jan Wenk writes:

<I'm behind in posts, but you mention a mom with sore nipples and severe
engorgement who was unable to let down to a pump. . . . . . Sometimes
when all else fails, I will resort to nipple shields, inverted to
place on breast well enough to draw a good amount of breast into the dome,
then place pump over shields and pump with nipple shields in place.

This works well with a woman who is large breasted with severe areolar
edema associated with engorgement and retention of extra IV labor fluids. It
provides simultaneous reverse pressure softening while pumping. I then try
to get the baby on the breast with, or preferably, without the shield, with
the end intention of getting baby on directly.

I remind you that I use this as a last resort, but it has sometimes proved
just the trick to enable mom to get through extreme engorgement (provided
she has a sense of humor, or a certain tenacity.)>

Actually, I'm not so sure about the "last resort" part of it, in large part
because
so many technology-minded people are so quick to "jump to the pump" as a
"first resort".  Too often, the "vacuum cleaner-like" action tends to
attract excess
interstitial fluid to the entire flange area.

Can't wait to try this out to test how beneficial this method is compared
with
the various other methods for applying reverse pressure softening. I would
certainly like to hear your impressions from anyone else who tries it, also.

I am still working on ways to increase the number of ways to disperse
edema from the nipple-reolar complex long enough to permit better latching

Jan's observations remind me of what I probably overlooked in the prenatal
breast, in some of my early observations in attempting to evert inverted
nipple
prenatally by using a manual breast pump over a combination of two types
of nipple shields then on the market.

Cotterman KJ, Intensive Preparation for Inverted or Retracting Nipples,
*Keeping Abreast Journal, Oct-Dec. 1976. *pp. 331-333


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

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