Nicola wrote:

<This is something I wonder about all the time! Why do the mothers not
follow
on with the tools I give them? An example is Reverse Pressure Softening-
I teach it to virtually all my new mums who have engorged , full areolas. It

works. They say ...wow , thats amazing, a pain free latch! I give them the
handout. Then they don't do it because its too much hassle?? I just don't
get
this >

I observe this same scenario myself and continue to get this comment from
other HCP's and breastfeeding helpers.


Few mothers, or for that matter, HCP's seem to appreciate the vital
importance of the function of the areola.
The areola absolutely must be pliable to effectively and comfortably do its
job of

   1. extending the nipple toward the soft palate and
   2. permitting efficient extrusion of milk.


In the U.S., OB interventions are so common that very few mothers have a
pliable areola for the majority of the feedings in the first 7-14 days. I
know things must be much better in places where there is early,
prolonged skin to skin contact and no IV fluids, pitocin induction and/or
injudicious pumping, but these conditions seem very scarce to me in Dayton,
Ohio USA.


Some tell me that many new moms are just plain reticent to use any "hands
on" skills on their own breasts (a la the "Main trial????").


I figure that this may also mean that my instruction sheet with very few
3-syllable words is still too long (and involved?) for sleep-deprived,
prolactin saturated, new postpartum moms. It was originally conceived for
prenatal/anticipatory guidance, for significant others as well as moms. They
will be her 24-hour support after hospital discharge, and I think they need
an accurate overview of how certain interventions may cause latching
problems, and how to help moms and babies if this happens. I would like to
urge more MD's, nutritionists, nurses, childbirth educators, doulas, and
peer helpers to provide anticipatory guidance on this frequent situation.


I have often been told that I need to devise something extremely, extremely
simple for postpartum use. I have been shown several "dumbed down" versions,
but they quickly lost the principle or mixed it up with hand expression.


I am not asking to take up valuable Lactnet space with discussion of my
concerns, but I would be most grateful for personal communications on your
experiences in teaching moms RPS. I welcome even negative comments, for I
can even get ideas from them. Feedback has thus far helped me improve
the usefulness of RPS to more HCP's and parents all around the world.


Some of my U.S. friends who think that mothers they see are reticent to
handle their own breasts are encouraging me to "invent some kind of a
'gizmo' before someone else does so, while using a different terminology to
avoid any possible infraction on rights." (I don't think the principle of
"pitting edema" is the intellectual property of anyone. I don't think there
is any right way or wrong way to do RPS-just more effective ways for certain
situations.) If I were to make rules, Cotterman's rules would be:


   1. No "hands on" without an explanation and mom's permission.
   2. No pain.
   3. No pinching.
   4. No pulling.
   5. No stretching.
   6. Empower mom to do RPS for herself whenever possible.


I have studiously avoided trying to invent a "gizmo" for RPS myself because
I absolutely don't want to add anything else that someone needs to leave the
bedside to obtain, charge for and eventually get restocked. Nor do I want
significant others to be sent out at all hours of the night to hope to buy
it in an all night grocery, drugstore, or discount department store, nor
that people in other countries might have even more difficulty in obtaining.



My thinking was, and still is, that fingers are free, and always instantly
available, and I want to remove "roadblocks" for parents.  There are already
"gizmos' that are commonly available that can be used to help the fingers if
desired:

   1. Gravity itself, is one of the best "gizmos" to use when swelling is
   extreme or breasts quite pendulous.
   2. Almost any brand of flexible silicone nipple shield can be easily
   used to exert pressure of well placed fingers to trigger MER as well
   as reduce tissue resistance of the central areola, to help latching or
   gentle pumping.
   3. A standard latex or silicone bottle nipple, with the nipple
   portion trimmed down, (or not), is the perfect fit for a mother with a small
   to medium nipple to use as "a soft ring method" of doing RPS. This allows
   her to exert reverse pressure for longer periods even if her fingers have
   long nails or are uncoordinated, or if there is a language barrier,
   communication problem or disability such as blindness or deafness.
   4. Different brands may have slightly larger size openings more
   suitable to the mother with a larger nipple. The important thing is that a
   flat area with a radius of 1/2 to 1 cm is needed to focus the pressure on
   the central areola directly at the base of the nipple to be most effective.
   (No pump flange or insert that I have yet seen meets this specification.)
   5. I have been inspecting different brands of artificial
   bottles/nipples, and find that some may have smoother surfaces than others,
   to place around the base of the mother's nipple to do RPS.
   6. For that matter, if care is taken, the actual plastic screw-on ring
   that holds the bottle nipple can be placed upside down on the areola, for
   slightly larger maternal nipples, providing they fit freely, so as not to
   "trap" mom.
   7. Add to that the convenience of using it while attached to the
   bottle, either the bare plastic ring, or with the silicone nipple inserted
   upside-down from the outside, and the bottle itself becomes a handy handle
   to help provide leverage, making it more convenient for the mother to
   maintain pressure for 10-15 minutes if needed.
   8. The flexible "petal" cover of the Avent pump can be removed from
   the pump flange and placed over the nipple for use with one or both hands.
   If one finger is placed in each of the 5 "petals" and pressure focused
   directly at the base of the nipple, it works fine. (It will not work for RPS
   if left on the pump flange, as one rep was recently overheard to say.)
   9. Perhaps the appropriate size opening in the actual nipple-measuring
   ruler put out my Medela might work????
   10. I have even wildly imagined plastic gaskets made for garden
   hoses, perhaps teething rings, and/or bread slices with precut holes, or
   sugar cookies with holes, placed in separate "baggies", saturated with water
   and frozen, etc. in readiness for the first few days at home??? (Goofy ideas
   are allowable in "brainstorming"!)


I would welcome private feedback from any Lactnetters about their
impressions. Please note my new e-mail address [log in to unmask]  I make no
profit from my RPS information.

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

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