---- Tamara_Hawkins_RNC,_LCCE,_IBCLC  <[log in to unmask]> wrote: 

> I am working with a mom that is 3 days post cesarean birth, wide-flat
> nipples and engorged. The baby is not able to maintain a latch to the
> breast even after softening the areola by hand expression. I gave her a ameda elite pump to use and after 3 minutes no milk let-down so I taught her hand expression.
> 


At 3 days, especially post-c-section, I'm wondering if the area is engorged due to lactogenesis II or a dependent edema related to pregnancy/IV fluids or combo of both? Pumping/negative pressure can increase areolar edema, especially if breast shields/flanges are not sized correctly for a particular mother.

Has anyone instructed her re: Reverse Pressure Softening (RPS) prior to latch-on or milk expression whether manual or mechanical? Can help "displace" some of that fluid in the area, making the nipple-areolar structure more "latchable" or pumpable. Also enhances milk ejection. 

Also, when someone is lactogenesis II engorged, I've seen it take up to 10 minutes or so before the "dam breaks" and milk really starts flowing. If lactogenesis II related, are cold packs being applied for 20 minutes off and on between BF or pumping to help decrease edema?

Karen

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