Heather writes:

<Using a pump has some (hypothetical) drawbacks, I think

* you lose some drops in the equipment
* it's an extra 'thing' that has to be specially obtained, sterilised
and fitted together
* it could be an added stress as you suggest>

It also has the potential to increase the sequestering of extracellular
fluid in the interstitial tissue in the area beneath the flange,
especially if maximum or medium pressure settings are used. Some staff
and parents conclude that increasing the setting is the obvious solution
if the pump isn't "pulling enough to yield milk."

A vacuum doesn't "pull" on anything, let alone milk. By lowering the air
pressure inside the flange in a negative direction, the atmospheric air
pressure (at whatever altitude) pressing on the surrounding breast tissue
tends to push the tissue within the flange inward, because "Nature abhors
a vacuum."

Unfortunately, the tissues (sinuses/ducts) containing the small amount of
milk at that time actually receive much less pressure against the innner
ring of the flange if more and more extracellular fluid has been pushed
forward, because an "extra ring or pad" of edema is then often formed
over the sinuses.

<Some hand expression of colostrum would be encouraged to help tempt
the baby, and to offer the baby if he is still not latching on over a
couple of days.>

I agree with Heather that the positive pressure of efficient fingertip
expression demonstrated correctly to the mother would have the effects
she mentioned, minus the side effects she and I mentioned.

It is "portable knowledge", easy for the mother to keep on using at home
without equipment as she continues on to an even more difficult phase of
engorgement when she goes home at 2-3 days.

Jean
***********
K. Jean Cotterman RNC, IBCLC
Dayton, Ohio USA

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