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Subject:
From:
"K. Jean Cotterman" <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Tue, 18 Sep 2012 10:29:09 -0400
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Thank you, Jane. Aptly put: "RPS is the 'Two-Buck Chuck' of lactation". That sent me straight to google to understand the metaphor, and I feel even more grateful for your support now than I have been for all these years you have been encouraging me in your occasional private e-mails.


http://westernfarmpress.com/two-buck-chuck-helps-drain-wine-tanks-overflow 


I saw a mom at WIC earlier his year for a short 1-on-1 prenatal infant feeding class. I was terrifically impressed by her exclusive pumping history with her first child, despite the difficulties she faced. She is hoping for a better experience with this child, and had asked her OB about her "flat nipples". (not really flat, but short-shanked and relatively large, and her breast pendulous enough that there was already some edema collected in the NAC prenatally.) He told her they were "normal", and I was glad that the routine referral by the nutritionist fell to me. 


In that 10 minutes time, in answer to her concerns, I was able to use a demo breast plus some hands-on teaching (with her permission) and some illustrated instruction sheets. I encouraged her to ask permission from her doc to be able to practice RPS in a well laid back position once a day during her 39th week of pregnancy. This will allow her to be familiar with how soft the areola can become under the prenatal circumstances, and to become experienced enough to start using it early, for both direct nursing, or for any possible pumping. (I also suggested that she request in advance to have skin to skin time during her CS, if possible.) 


The Main trial conclusions about prenatal preparation of the nipples (conclusions which, by the way, have always sounded very paternalistic to me) seemed to result in giving 'cart blanche' permission to prenatal care providers to completely dispense with any meaningful prenatal examination of the breast and nipple form and function. OTOH, I don't believe that the preparation methods they used in their research are ones that I would want to teach today, knowing what I now know. 


I have found that offering a mother a 3rd trimester breast examination and prenatal teaching about laid-back position, areolar aroma and self-latching capabilities of the newborn and demonstration of the effect of RPS has great potential to help mothers get off to a better start. If the mother is willing, it can be done, probably by a nurse, right in the privacy of the OB or pediatric or FP medical or clinic office, a prenatal home visit by a nurse or LC, and perhaps even some WIC offices. IME, kinesthetic teaching offers definite value, prenatal as well as post-natal, in the hospital and by pediatric personnel at the early newborn visit, if the mom desires.  Asking her is of course, absolutely necessary. Many mothers are very accepting, willing and desirous of such help.


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

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