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Date: | Thu, 16 Sep 2010 09:14:35 -0400 |
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Pressure in the breast induces apoptosis in any overfull lactocytes.
(They release their attachment to the basement membrane through an
integrin protein, and no longer get a survival signal, and then
apoptose). Pressure also reduces immediate milk production by
interfering with the geometric arrangement of organelles, especially
ribosomes, so protein production ceases. (Think hammering a machine so
the parts no longer line up - it no longer functions.) Milk production
is decreased over time when fewer lactocytes survive than are
regenerated by proliferation based on milk removal and prolactin
spiking. Therefore, I recommend pumping if RPS and getting the baby to
feed more often don't clear engorgement. We see really reduced milk
production if a mom doesn't get the engorgement cleared out, and pumping
to relieve engorgement doesn't seem to increase supply overmuch. In any
event, oversupply can be managed by block feeding later, but undersupply
means exposing the baby to artificial milk. Engorgement is not normal,
babies should feed very often, and engorgement should not occur. It's a
non-physiologic response to our non-physiologic breastfeeding management.
I want to make it clear I'm not talking about breast fullness here that
moms experience when lactogenesis II kicks in, but uncomfortable
engorgement that makes it more difficult to get milk out. I also
recommend ice or cool compresses right before pumping, feeding, or
manually expressing to reduce some of the surface edema and allow milk
to flow more readily.
Catherine Watson Genna, BS, IBCLC NYC
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