i, too, went to the lymphatic breast care workshop. it's not a conference,
it's training. lymphatic techniques apparently are taught by different
schools, and this is dr. chikly's version of it, refined into a class
specifically for use in treating the breast. the class was exactly what i had
in mind, although some of the massage therapists and other health
professionals there may have been surprised.

i undertook to learn this for the same reasons i learned cranial-sacral
therapy. there were certain situations with mothers and babies in which i
felt i had woefully inadequate tools with which to fix problems. c/s for
instance - as an accredited lay bf counselor, i saw a fairly large number of
"arching babies." the BAB tells how to handle arching babies, but doesn't
give the cause or a cure, just gives management techniques. wolf and glass,
and marjorie meyer palmer are pretty darn sure that a baby who is hypertonic
and expresses it in sucking (or doesn't express it at all, i.e., won't suck
on anything, ok, i hear the groans even now about the puns) is neurologically
damaged and that's it..

but how to explain that some of these arching babies "grow out" of their
problem? or at least improve and are never diagnosed with a neurological
problem? i saw too many of them to consider that a true answer unless there
are an awful lot of people running around with permanent neurological
problems they just haven't noticed, or perhaps the answer was that this was a
temporary neurological problem.

when you excluded all the other possible problems and cures, and there were
still babies left who could not be "fixed," i decided that the descriptions
of c/s work were a pretty good answer. so far, the cases in which i have
either referred or have worked on myself, have shown this to often be the
case.

lymphatic work: when i see mothers who often can't get any milk out at all. i
interpret this to be due to general edema. i really hate saying "well, call
your doctor and get a diuretic and take it and THEN we will get the baby
latched on, etc.," since that causes so many problems, usually solved by not
breastfeeding. some people are not interested in an herbal diuretic tincture.
anyway, if you can't get breastfeeding going, you have to set up an
alternative feeding plan as well. sometimes that's the end of breastfeeding.
sometimes a pump works, but i don't like having to get women to get a pump
just for a day. a pump is in intervention, too.

which brings me to jean's description of treating 'nipple edema' by moving
the water out of the nipple. i thought this was really good approach to
solving the problem, but now that i have just had all this info about the
lymphatic system, i would like to point out that i think that simply moving
the excess fluid out of the nipple into the surrounding tissues might either
not work or only work temporarily. of course, temporarily might be enough.
but why does this work or how?

if the edema were only in the nipple (not likely, but it could happen as a
result of trauma, usually from a pump or perhaps the baby), and the fluid
level is reduced, the baby could then theoretically get on and nurse and get
milk out and things would be fine.  i think usually generalized edema is
caused by epidurals or hormones, and that's not local to the nipple. so,
getting the nipple to a shape and size that the baby can latch on to might
not be the entire solution. why?

if the edema in the breast itself is bad enough, it could still prevent the
milk being moving out of the breast, and the baby could be latched on but not
transferring milk. so, the techniques i learned have a few things to tell us
about this. first, the edema shows that the lymphatic system is not moving
the fluid out fast enough (if the epidural is gone, then the excess is not
still being delivered, its just a question of getting the overload out of the
body and then it should not reoccur). if you just move the interstitial fluid
around the nipple back into the breast tissue, it ain't going anywhere. it
will just move back to the nipple after a while as you wait for a general
lowering of the fluid level.

if, however, you start moving excess fluid out of the tissues at the point
closest to the lymph nodes that serve that area (back towards the axilla),
then eventually you can move the fluid from the nipple into the lymphatic
system as well, and get it to stay out.

i enjoyed the class and wasn't quite as overwhelmed as andrea, probably
because of my previous classes in c/s. it's too bad more lactation
professionals didn't attend. you're missing a bet here. we use our hands to
get babies latched on and other things; there isn't any reason why an LC
can't learn to do these techniques. they are short and won't add a lot of
time to a consult. they work beautifully. we know that engorgement can
negatively impact milk supply; we don't know how long it takes to do it, so i
think maybe we don't have much time to lose when it needs to be fixed.

also, it appears that these techniques will be very useful with plugged
ducts, mastitis (especially recurrent) and a lot of the other chronic
problems that are hard to fix.

sorry you all missed it, all 9,990 of you that got a mailing and didn't go.
it was the most useful thing i have learned lately. i got my money's worth,
and that doesn't always happen at conferences. also, i have tried to find a
description of "breast stripping" but even the name is so awful that i can't
imagine trying to do it. this is much gentler.

carol brussel IBCLC

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