I can't answer all of Andrea's study questions (due to lack of time) but
wanted to let her know that a philtrum is the little groove beneath the nose
and above the upper lip. If it is well-defined, it is a good indication
(along with a nice bow to the upper lip) that the baby has good lip tone.
Good lip tone is important because without it, a baby may not be able to
adequately seal around the breast. Lack of good lip seal will create vacuum
leaks. If the lip seal is poor or the baby can't sustain it for long, this
impacts the suction component of infant suck. Babies use suction to hold
the breast in the mouth and to help start the milk flow and to maintain a
pressure differential to keep the milk flowing after letdown subsides. So
observation of a baby's philtrum is a marker of sorts.
Engorgement is discussed in an important series of two articles that
appeared in Journal of Human Lactation,
Humenick S and Hill P: The occurrence of breast engorgement, JHL 1994,
10(2):79-86.
and
Hill P and Humenick S: Breast engorgement: patterns and selected outcomes,
JHL 1994, 10(2):87-93.
These articles describe 4 variant patterns of engorgement that are common in
lactating women. Two of the patterns are somewhat predictive of lactation
problems: low level engorgement (often connected with low primary milk
supplies) and extremely intense engorgement (connected with oversupply and
often with early weaning due to discomfort, mastitis, etc). The intense
engorgement they studied lasted for several weeks, and altho annoying and
requiring special management, is actually a normal pattern for some women.
They also identified the standard type of engorgement our books tend to
focus on, which is a single peak of breast fullness that lasts a day or two,
and another type that has multiple peaks. They make the point that
engorgement tends to get more intense with each lactation, and that it is a
normal event. Kay Hoover and I review Hill and Humenick's work in The
Breastfeeding Atlas.
For more information about engorgement that progresses to inflammatory
symptoms, read Sally Inch's work and Cathy Fetherston's wonderful new
article (Breastfeeding Review, 2001).
Barbara Wilson-Clay BSEd, IBCLC
Austin Lactation Associates
http://www.lactnews.com
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