Lori, You wrote: <Winnie Mading <[log in to unmask]>> I find that Jean C's Reverse > pressure Softening,which is much like the Hoffman's technique that has been > suggested for flat nipples, immediately effective. It pulls the fluid away > Winnie- could you please describe this reverse pressure softening? Thanks, Lori Salisbury, RN, IBCLC Winnie is absolutely correct. The Reverse Pressure Softening that I have found so valuable is really a modification of the technique Dr. Hoffman described in his one and only article that I have ever found. (In that article, he made none of the claims that have since been ascribed to it, especially those noted in the Main trial. His technique consisted of inward pressure followed by sideways stretching. I believe he advocated it both prenatally and in the postpartum period. I have focused on the inward pressure just during engorgement.) However, articles such as these have created such instant negative reaction associated with his name in the LC community that I decided to pick a name that simply describes what is being accomplished. Here it is in a nutshell: <Simply place your thumbs or the flats of the mother's two fore fingers (perhaps placing your thumbs on top of them) just opposite each other, near the base of the nipple. Press the areola gently but firmly straight inward toward the chest wall for a full 60 seconds by the clock, then repeat in the opposite quadrants. Or if the mother has short nails, I tell her to curve the 3 middle fingertips of each hand and "plant them" at the base of the nipple with the flat surface of the fingernails actually touching the sides of the nipple, then press straight inward on the areola. I suggest that she sing a full lullaby, which occupies close to 60 seconds and sounds less worrisome than watching the clock. And as Diane has so cleverly put it in one of her new papers, the object is simply to make a ring of dimples at the base of the nipple.> This maneuver accomplishes three things: 1) It temporarily moves excess interstitial fluid toward the inner lymph channels and temporarily removes it from the areolar and subareolar area, to give the baby a fighting chance of a better latch. 2) It presses on the anterior openings of the milk sinuses, relieving any overfullness by temporarily pushing milk back up into the contributing ducts. (When sinuses are overly full, direct compression of them causes distinct pain. When they are less full, fingertip expression is painless and much easier, and provides further softening of the areola) 3) Stimulation of the nerves deep beneath the nipple never seems to fail to elicit MER. I hope many of you find this helpful. Edema does not have to be severe for this to help. In fact, in cases with severe edema, it may be necessary to do it more than once before the feeding to accomplish enough softening to help milk transfer. I saw a young mother last week on postpartum day 4 who was so engorged that when I did the RPS, I could see 0.5 cm deep "pits" for maybe 15 seconds till the interstitial fluid filled them back up again. But after repeating it 3 times in a row, there was sufficient tissue elasticity and MER to entice the baby to nurse very efficiently with a silicone shield. What "manna to the ears" the steady swallowing was for the mother, the grandmother (a LLLL) and me! I would appreciate any feedback, positive or negative from anyone who tries it. Jean ************ K. Jean Cotterman RNC, IBCLC Dayton, Ohio USA *********************************************** The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(TM) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html