Mary writes:

<I have worked in immediate postpartum lactation for 10 years and have always wanted the secret about how to express colostrum from women who seem to either have no oxytocin surge or something that prevents any drops 
from being expressed during the first few days. . . . . .I work in a large US hospital which does pitocin inductions, unnecessary c sections and all the rest that go along with iatrogenic breastfeeding difficulties. > 

Are you familiar with reverse pressure softening? "Reverse" is the operative word. RPS totally reverses engorgement in the nipple-areolar complex (NAC) itself, but only temporily. This reversal of engorgement permits the NAC to do it's primary job (milk transfer) efficiently for several minutes or longer. If the nipple-areolar complex is free to do its primary job, the physiology of the rest of the breast is empowered to get on with Lactogenisis 2 more comfortably.  (To be most effective, RPS must be properly done, in conjunction with antigravity positioning if the breast is pendulous and/or very swollen.) 


IME, worrying about oxytocin release is sort of putting the cart before the horse. Oxytocin release is a 2 arc process. Even if the neural arc is stimulated and works quickly, the hormonal arc must travel through the circulation to reach myepithelial cells. 


Think of the breast as being made up of 3 compartments suspended within an envelope of skin. Each compartment has a different fluid within it. (of course every cubic inch of breast tissue has the 3 compartmental composition) 


1) The circulatory compartment expands its vessels after birth of the placenta to bring in raw materials and hormones and take out metabolic waste. 


2) The glandular/ductal compartment, already containing colostrum before birth, requires raw materials, hormones etc. for Lactogenesis 2 to proceed speedily and efficiently.


3) The interstitial compartment (extracellular space without walls) fills most of the spaces between circulatory vessels and glandular/ductal walls. Its main function is to be a medium to transfer raw materials, hormones and wastes between these other two compartments.


Iatrogenic factors (primarily excess IV fluids, antidiuretic action of pitocin, and vacuum itself) slowly result in overfilling this interstitial compartment. This excess of interstitial fluid then slows the exchange between the other two compartments. One result seems to be eventual crowding of one compartment against the other. This often results in directly impeding milk transfer and causing back up of return circulation. Another result may be to delay oxytocin from reaching it's target area within the glandular compartment, the myoepithelial cells. Thus, my impression that worrying about oxytocin release is putting the cart before the milk transfer horse.


The primary job of the nipple-areolar complex (NAC) is to transfer colostrum/milk. (I view participating in oxytocin stimulation as its secondary job.) Most people have it correct in our day and age, that early, efficient milk transfer is the key to a good start, for the sake of both the baby and the mother. 


However, too many are fooled into believing that vacuum will surely help. A basic principle of physics is that vacuum does not pull. Other forces push.  When excess interstitial fluid (unrecognizable as edema just yet) is pushing into the subareolar area because "nature abhors a vacuum", it interferes with the function of the NAC. Therefore, using any degree of mechanical vacuum at this stage has the potential to make colostrum/milk transfer less likely, or less efficient. Gravity compounds the problem in a pendulous and/or very swollen breast.


Using and teaching RPS early and using it often (before offering latch, before expression and before and several times during any necessary pumping) temporarily reverses multiple iatrogenic effects on the NAC. Using RPS repeatedly throughout the first 7-10 days thereby permits the NAC to do its primary job early, consistently and more effectively. All else follows more efficiently. 


Oxytocin will then be all the freer to do its job on the myoepithelial cells. 


This has been my clinical experience, and the experience of many, many Lactnet friends around the globe. Thank you to all of them for their feedback which has encouraged me to continue development of this concept, until someone can finally figure out how to do formal research on RPS.


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

Cotterman KJ, Reverse Pressure Softening: A Simple Tool to Prepare Areola for Easier Latching During Engorgement, Journal of Human Lactation, May 2004, vol. 20, iss. 2, pp. 227-237. 

Cotterman, KJ, Too swollen to latch on?: try Reverse Pressure Softening first, Leaven Apr. May 2003, pp. 38-40.



 

             ***********************************************

Archives: http://community.lsoft.com/archives/LACTNET.html
To reach list owners: [log in to unmask]
Mail all list management commands to: [log in to unmask]
COMMANDS:
1. To temporarily stop your subscription write in the body of an email: set lactnet nomail
2. To start it again: set lactnet mail
3. To unsubscribe: unsubscribe lactnet
4. To get a comprehensive list of rules and directions: get lactnet welcome