I see this type of edema present also in moms with mastitis and nipple infections with severely damaged nipples. Pumping can only be sustained for 3-4 minutes, no matter how great the pump, then gentle hand expression and compression of the tissues, then more pumping if needed. It is like blowing up a rubber collar around the nipple ducts which gradually squeezes the soft ducts shut. Like sucking from a drink box and biting the straw shut, while at the squeezing the bottom to push the fluid into the straw. Doesn't work.
-----Original Message-----
From: Lactation Information and Discussion [mailto:[log in to unmask]] On Behalf Of K. Jean Cotterman
Sent: Friday, July 19, 2013 8:07 AM
Subject: Re: "VACUUM DOES NOT PULL: OTHER FORCES PUSH."
That is not a "paradigm held dear". Sadly, it's the opposite. It's physics, proven by 300+ years of science. Very interesting to look up, just by googling the phrase.
Engineers of all types know this, including breast pump engineers. The present "paradigm held dear" seems to be the "automatic", "knee-jerk" response for hospital personnel to start early applying vacuum to the breast of a new mother whose baby is not able to nurse .
This idea seems to have built up over the last 5 decades or more, not only in response to better understanding of lactational physiology, but in great part because of all the advertising and availability of expensive pumps.
While vacuum may free a direction for the force of the milk to "aim" to push into, when edema is present, the excess fluid in the interstitial spaces around the ducts under the areola pushes its own way forward to try to neutralize the vacuum. This is very common in many of today's maternity inpatients, especially in the early postpartum period when a mom has had a lot of IV fluid, especially hours of IV pitocin. The fluid in the interstitial tissue then pushes forward toward the vacuum, ending up crowding around the outside of the subareolar ducts more and more. This results in less and less milk getting through to the outside of the nipple surface where it can directly move into the vacuum area.
Spread the word about displacing the interstitial fluid back away from the subareolar ducts with RPS before and several times during the pumping, whenever the flow slows noticeably. The resultant removal of pressure on the outside of the ducts, allowing them to drain more freely, plus the MER stimulated by RPS, will yield more of the stored milk in far less time, and certainly with less chance of trauma to the nipple by extended time being exposed to vacuum.
K. Jean Cotterman RNC-E, IBCLC
WIC Volunteer LC Dayton OH
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