I too thank the list mothers for this wonderful "venue" where we can share, and if need be ventilate among trusted colleagues.


6 weeks ago, I posted a request for names of TT experts in N. Carolina, in case my expected great grandson might have one. I got prompt answers and in fact met some wonderful local LC's when I visited NC in mid-May.


He was born at term last week, and is being treated at a major medical center because he has far more serious problems, which I will not detail here. I have not and do not plan to ask permission. That having been said, I think it's fair game to comment on the general subject of maternal postpartum edema in the ankles/lower legs (and in the breasts, too, to make it applicable to breastfeeding.) 


My granddaughter did call her own obstetrician with questions in regard to her marked leg swelling. She was of course told "It's normal, and will go away." Other than encouraging her to limit her sodium and elevate her feet whenever she has the chance, I bit my lip and said nothing that might confuse or discourage her. She has enough on her mind, and we are all helping keep her spirits up.


Common, certainly, but NORMAL??? He/she has probably seldom SEEN normal-sized postpartum ankles!!(Well, yes, I guess I was yelling there for a minute.) I would like comments from those experienced in other maternity cultures


Before that obstetrician of hers was born, and possibly before the obstetrician's own mother was born, I was taking care of postpartum women. My first experience was a month of solo night duty on postpartum in 1948 as a freshman student nurse back when we were used to actually help staff the hospital on evenings and nights. I started my R.N. career in the nurseries and then for several years, in labor and delivery, and was working full time night duty on postpartum for 5 years during the height of the U.S. WW II baby boom when mothers with vaginal deliveries stayed 4-5 days. (I had my first 4 children of my own during this time period as well.) We were having 3600 births a year in a community hospital, one of 3 in our city. Most of our doctors were family physicians.


Granted, having moms NPO in labor, giving them twilight sleep and general anesthesia was not normal either! But very, very few of them ever received any IV fluids. Many multiparas had short labors, (and an occasional precipitate delivery), so NPO didn't really effect them much. And mothers with C.S. and complications requiring IV's were on another postpartum floor, so seldom part of my nightly clinical experiences. And there were no IV pitocin inductions (Occasionally, someone was induced with a swab dipped in an ampule of pitocin and inserted in the mom's nose till she was having adequate contractions!). Or there was a time when buccal pitocin was use for induction before the FDA removed it from the market in the 1970's.


Most moms (without complications) did not begin to experience ankle edema (or what I now call "pre-L-2 breast edema") till the mid 1970's when perinatal medicine began to "arrive", and more and more labors were managed, and regional anesthetics became preferred. 


Oh how I wish someone with the appropriate research skills would think it worthy to compare the postpartum course, including formation of edema in legs and breasts, by including colloid osmotic pressures, or at least albumin levels, daily for 14 days. 


Engorgement references from 3-5+ decades ago, from various parts of the world, (and therefore, probably during different stages of the 'one-obstetrician-at-a-time' introduction of perinatal medicine in different settings, with possible changes in midwifery care too), that are still the only ones commonly cited in lactation texts today, never included any of these hydration factors of the mother's intrapartum care as variables. So we really have absolutely no real idea whether this factored into the various "patterns" that were described in those references, still the most-used to this day. If this research were to be replicated but designed to include variables of specific amounts of IV fluids and IV pitocin at various stages, I am convinced there would be far different conclusions.


Comparisons would be needed on mothers with NCB for control normals, others on mothers with IV's for hydration and BP control, and thirdly, especially others on mothers with amounts, dosages of pitocin and time periods when IV pitocin is also running for induction, augmentation or third stage management, where it seems the anti-diuretic action of pitocin causes much of the water to re-enter the circulation and re-lower the COP for an extra day or two. 


I strongly encourage anyone who is academically qualified, to consider doing this research, and I hope I live long enough to be able to read that research, even if I am wrong in my observations.


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

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