Hi Jean,
I agree that it's wise to be cautious when writing, esp for publication, so we keep our terminology straight. But I wouldn't want LCs or staff nurses to shy away from trying this for fear of practicing outside their scope of practice. It's very simple, based on physiologic principles, and it makes SUCH a huge difference that I would not want an engorged mom to miss out on the benefits, for lack of a licensed massage therapist on staff (something few hospitals have).
My previous post which came thru in computer-greek just said that I feel a little chagrined for having just integrated this concept after 10 years + of practice. And that I just helped another mom with a Breast Spa, day 4, very young mom of a NICU baby she had slept thru the night and skipped 2 pumpings, we got out 155cc (over double any previous pumping)
that's it, it is great to keep up the dialogue on this.
OXO
Martha J
-----Original Message-----
From: Kermaline J. Cotterman [mailto:[log in to unmask]]
Sent: Friday, March 25, 2005 8:14 PM
To: [log in to unmask]
Cc: Johnson, Martha (Lactation-SHMC)
Subject: Martha's post on RPS and the Breast Spa
Martha Johnson writes: <I have recently run across another technique in Sheila Humphrey's Nursing Mother's Herbal, which is a FANTASTIC treatment adjunct to RPS for edema. I don't have her book with me right now, but I think she calls it something like "lymphatic drainage breast massage." Lots of us do breast massage and encourage moms to do it, especially while breasts are engorged. In my hospital we always did massage from the outer breast DOWN towards the nipple/areola. Sheila wisely points out that the lymphatic drainage for the breast is in the armpit. This means we need to massage the breast UPWARDS and outwards, towards the armpit, to mobilize lymphatic fluid. I've had amazing success with this technique on very congested breasts, in the following order: 1. Mom lies on her back in bed. Apply moist heat for 5-10 minutes. 2. Have her lift her arm above her head and let it rest on her pillow. Do lymphatic massage as described above. 3. Now do RPS 4. Pump, or bring baby to breast. The pumping moms get SO much more milk out after this treatment, it's amazing. I've started calling it the "Breast Spa Treatment," and the nurses are all asking me to show them how to do it. >
It is good to know there is an easily accessible book for those wishing to know more about this. It's important to be careful with the term "lymphatic drainage breast massage" as this rightly seems to fall into the professional domain of the licensed massage therapist, who has a more in-depth knowledge of lymphatic physiology.. A French physician Dr. Bruno Chikli gave a presentation on it at ILCA a few years back, and I have read an article by him in a newsletter for massage therapists. He has a whole course on it through the Upledger Institute (with which I have no connection). I personally know of at least 2 IBCLC's who have taken the course, and there are probably quite a few more.
I was careful to avoid using this specific terminology in writing my May 2004 JHL article "Reverse Pressure Softening: A Simple Tool to Prepare Areola for Easier Latching during Engorgement". Lymphatic drainage terminology would have been out my depth, but I attempted to strongly suggest some of the principles Martha comments on when I wrote:
"Under normal conditions, 90% of interstitial fluid re-enters the venous end of circulatory capillaries, while the remaining 10%, including protein molecules, re-enters lymphatic capillaries. Glandular tissue is most heavily concentrated in the upper outer quadrant of the breast, the same general area where 75% of lymphatic drainage moves toward the axilla. Other lymphatic vessels pass between the pectoral muscles, the intercostal muscles, and under the clavicle, all ultimately emptying into the large veins leading back to the heart.. While fluids enter the breast through the arterial system, they must exit in two opposing directions. (1) Milk advances through the glandular compartment in an anterior and central direction, converging toward the nipple, the only exit. Thus, ineffective milk flow through the nipple-areolar complex automatically impedes milk flow from the rest of the breast. (2) Interstitial fluid leaves the breast in the opposite direction, moving posteriorly and superiorly, utilizing numerous venous and lymphatic capillaries to re-enter the circulatory system.
Understanding these physiological principles and natural directional patterns of fluids leaving the breast during engorgement may be helpful in choosing interventions: (1) whether and how to use positive or negative pressure, (2) the appropriate direction for any massage depending on whether the immediate goal is to move milk or edema, (3) the possible therapeutic value of gravity in helping resolve severe breast edema, and (4) the possible therapeutic value of assisting lymphatic flow by active/ passive motion of arm and chest muscles.. . . "A traffic jam at rush hour" provides a simple analogy for teaching mothers about the changing course of engorgement. "
Martha has been a wonderful support to me as I have been developing my concepts, so I know she will not be insulted if chide her about "missing some of the fine print" on the first reading of my article. From some of the other questions I sometimes receive, I know she is not the only one (LOL).
While writing it, I myself had to reread many of my references multiple times before I could move beyond a surface understanding of the anatomy and physiology of the breast. This was the only way I could explain my observations in terms that other disciplines might respect. One of my goals was to challenge researchers to consider intravenous fluids and edema as variables in future engorgement research, and stimulate more appropriate choices in nursing interventions. A secondary goal was to prepare LC's and nurses to dialog with physicians about increased edema of the breast as a side-effect of medical interventions. I realize that made for a somewhat complicated article. So be it. It is a complicated subject about which there is still much to learn, for the sake of the mothers and babies in our care. Thank you to all who have been so supportive.
Jean
************
K. Jean Cotterman RNC, IBCLC
Dayton, Ohio USA
--------------------------------------------------------
This message is intended solely for the use of the individual and entity to whom it is addressed, and may contain information that is privileged, confidential, and exempt from disclosure under applicable state and federal laws. If you are not the addressee, or are not authorized to receive for the intended addressee, you are hereby notified that you may not use, copy, distribute, or disclose to anyone this message or the information contained herein. If you have received this message in error, immediately advise the sender by reply email and destroy this message.
--------------------------------------------------------
***********************************************
To temporarily stop your subscription: set lactnet nomail
To start it again: set lactnet mail (or digest)
To unsubscribe: unsubscribe lactnet
All commands go to [log in to unmask]
The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(R)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html
|
