Thanks, Rachel. Once again, I gratefully acknowledge, as I first did in JHL, that you were the "wind beneath my wings" as I was finally conceptualizing RPS clearly enough to write some "real" articles for "real publications". Not only do I remember you "talking it up" in European meetings, but as the first to translate one of the original short articles and print it in the journal of which you were then editor, but you helped me see the light that "a picture is worth a thousand words" (How many centuries ago did the Chinese philosopher(s) start saying this???) (Duh!! And me with a then-soon-to-be-world-famous-tattoo-artist for a grandson!-) Once you "planted the idea" of illustrations, his diagrams began to make a world of difference in the instruction sheets.
And you also pointed out that a mother with a crying baby was not about to put the baby down in order to use two hands to do RPS, and you summarily invented the Flower Hold to add to the other choices!
So now you have given me this podium, I want to use it.
I think more moms could feel empowered by having the let-down reflex explained very simply to them as a great tool nature has for them to use. Then, let mom in on the secret that RPS held steady for 20-30 seconds will always trigger MER within a minute, whether she's "under stress", etc. etc. etc. without recordings, pictures, mom's used undergarments, etc. etc. if mom desires. This is especially helpful when EBM is needed in NICU or to be quickly "stashed" for returning to work.
The one thng that I want to emphasize more strongly than I ever have before in any of my wrting, is: "If mom's breast is the least bit pendulous, be sure to utilize the power of gravity, especially when first performing or teaching RPS!!"
If the mother, especially one with a C-cup size bra or beyond, assumes a position lying back, where her nipple-areolar complex is lying stable, (not being held up), higher than the level of her heart, the power of gravity is then harnessed for 2 jobs during RPS, and can be continued during the feeding if she desires:
1) to help move some of the loose interstitial fluid temporarily inward 1-2" during RPS, toward the unidirectional "blind" lymphatic capillaries under the areola, and
2) to keep any loose interstitial fluid from returning to the area till the baby has finished using the nipple- areolar complex for that feeding.
3) If this same set of principles is used before and several times during early pumping, it allows the milk ducts to drain without interference from pressure or crowding of the NAC from edema.
I would actually go so far to say that I observe:
"RPS can TEMPORARILY, TOTALLY reverse engorgement in the nipple-areolar complex itself, and as often as desired. " (sorry, no other way to accent).
That is, long enough for the baby to "do it's thing" to latch, (very often without a shield) and then, with the jaw action s/he can continue to keep edema at bay from the NAC tissues, while making continuous progress at the milk-removing process, even if mom may decide to sit more upright. Later on, perhaps add a little breast compression as needed, and relative comfort ensues for mom and for baby. No heat. No ice. No cabbage, etc. etc.! Repeat as needed by mom and babe!
Yeah, I know! Sounds good, but it may take a little longer in complicated cases. But recognizing and showing mom that "gravity helps keep the swelling away from the circle, and makes it easier for baby and you" might just be the extra insight she needs to get off to an easier start!
Down off podium, thank you all;-)
K. Jean Cotterman RNC-E, IBCLC
WIC Volunteer LC Dayton, OH
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