Leah,  I'm not sure I understand: < Mom states she pumps regularly, and feels milk (I feel decent mammary development)- got engorged with baby #1 -  but never gets it to come out even with direct breastfeeding. >


Pumps regularly, but gets nothing out??? How often? What size pump flanges does she use? Does fingertip expression  (done properly about 1 inch or so behind base of nipple) yield anything at all? Does let-down reflex ever occur, accompanied by even one drop of milk leakage??

3 days old?? What is her bra cup size? Did she have C.S.? spinal or epidural? How many sacks IV fluid total?? It is very common by day 3 for moms who got 2000 cc. or more of IV fluid, especially if they may have gotten IV pitocin for induction, augmentation of hours worth for third stage management, to begin to develop enough edema in the breast that edema pushes forward toward the flange tunnel to try to balance the negative pressure of the vacuum, thus crowding the milk ducts behind the nipple so that milk cannot flow through them unless the edema is pushed back up an inch or so from the subareolar tissue. I developed reverse pressure softening for just such situations. If she is C-cup or beyond, having her lie at least 3/4 of the way down will prevent gravity from returning the edema to the areola too quickly for deep latching, or for at least 5 minutes of pumping. If she does this sequence and repeats it 2-3 times, it helps get more milk out.
1) reverse pressure softening for at least 60 seconds, longer if very edematous, to soften the areola and trigger the MER  2) pump for just 5-7 minutes 3) Pause to gently massage some milk forward from back areas of breast. 4) Repeat the whole sequence once or twice more for a total pumping time of about 15 minutes. Better to do 15 minute sessions more often rather than long pumping sessions.

In my experience, let-down reflex always occurs within 30-60 seconds after doing reverse pressure softening (RPS). If you are not familiar with this, you can google a good instruction sheet by putting the term and my last name and kellymom.com in together in your search. Or you can email me privately at [log in to unmask] and I will send attachments, if you want.

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

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