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Subject:
From:
Chris Mulford RN IBCLC <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Fri, 10 Oct 1997 07:49:40 -0400
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Noreen,
You asked about pointing the baby's chin towards the affected area when a mom
has a plugged duct, as you say: "due to increased suction that results from
this position."  I think it's not the *suction* we want (which I would guess
is applied pretty equally all around the nipple "clock") so much as the
increased "stripping" from the massaging action of the tongue and lower jaw
on *their* quadrant of the breast.  I also agree with Riordan and Auerbach's
recommendation to point the nose toward the sore area, since the *nose's*
quadrant would also benefit from being opposite the stripping of the tongue
and lower jaw.  Thus, for a plug at "2:00," the first choice would be to
point the chin at "2:00," second choice to point the nose at "2:00."

I don't know whether anyone has published work on differential emptying of
areas of the breast related to baby's position.  I remember that Peter
Hartman, in his talk at the ILCA Conference in 1990, said that his group was
working on developing a way to photograph the breasts with two cameras to
yield a stereo image, which they hoped would give information more
information about changes in the surface of the breast and thus about which
lobes had been drained by feeding.

Of course, a mother might develop a pretty good ability to estimate which
lobes are drained just by palpating her breasts before and after feeds for
awhile.  Not as quantifiable for Scientific Research, but eminently
practical!

The other usual approaches to plugged ducts are moist heat---to dilate blood
vessels and possibly milk ducts---and massage---to break up the plug
mechanically.  I would suggest that, since some degree of swelling is
probably involved, cabbage leaves or even ice after feeds might help, too.
 Picture that little duct, smaller than the veins in your wrist, with a
little plug of cottage cheese stuck in it.  The milk piles up behind the plug
like water behind a dam of leaves in a creek, increasing pressure on all the
adjacent tissues.  Applying heat should increase blood flow to the area,
which will help if that extra blood flow brings extra oxytocin and makes a
stronger MER, popping the plug out of the way like a surge of water behind
the dam.  Massaging may help break up the plug by opening some cracks in it,
the way you might take a stick and poke at the leaves that make up the dam.
 But if these things don't work, then you'd like to reduce the pressure in
the whole area by decreasing the tissue fluids and slowing blood flow for
awhile. That's like waiting for things to get better in your dammed creek
when the rain stops and the banks get less saturated with water.

That's my image of what's going on.  To carry the alanolgy even further (if
you're not sick of it!), pointing the baby's chin at the plug is like
installing a powerful "wave machine" downstream of the dam, which would help
break up the plug.  Pointing the baby's nose at the plug is like putting the
"wave machine" upstream to send stronger surges of milk down the pipe and
push harder at the plug.

Well, it looks like the weather's clearing.  So long!

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