I would like to brazenly hop right on the soapbox (as Karen Gromada vacates it), to "piggy-back" a personal request for feedback, positive or negative.
My own practice no longer consists of hospitalized mothers. My contention is therefore, more theoretical now. You can be my "on-site" researchers. I believe that breast edema (in mothers who have had hours of IV's and hours of IV pitocin drip) is in fact, an ELEPHANT (sorry) in the postpartum living room that must be considered
1) in the quest for early and most effective milk removal for the NICU baby, and for
2) in facilitating the increased production of new milk by better evacuation of colostrum.
In addition to interfering with milk removal itself, marked edema may interfere with transfer of raw materials from the plasma to the milk-making cells as well, perhaps partially further explaining any delay in Lactogenesis II.
I encourage you to think about this in relation to the mother's peripartum IV/oxytocin drip history. Visible edema often takes (IME) about 24-36 hours after initiation of IV's> than 2000-2500 cc. in any one 24 hour period, to begin to become apparent in the NAC, and may increase for a day or more before it begins to resolve. Correlation with observation of edema of feet, legs and/or hand edema may be helpful in regard to this timing. Others have noted some correlation. (The Breastfeeding Atlas- B. Wilson-Clay, K. Hoover)
I would like for those in the actual observational/hands-on situations to make mental notes re: the relationship of the success of fingertip expression, and/or mechanical pumping and "hands-on" pumping after mechanical pumping, in relation to a particular mother's peripartum history of:
1) Total amount and time length of IV fluid both before birth and after birth. (obtained form a mom's self report of "how many bags) if searching mom's records is too time-consuming)
2) Amount of (# of hours of) oxytocin given in any IV's both before birth and after birth, for 3rd stage management, since singleton births of 9# or more technically put the mother at risk for postpartum hemorrhage, and therefore multiples, with total of the same weight or close may also be more likely call for management with postpartum OT.
3) Pendulousness of that particular mother's breast.
I'd welcome any kind of feedback about whether others find that RPS, used before and whenever flow slows, will free the ducts of that one breast on which it was used, to yield (in a shorter time period) more of the colostrum/milk it contains. (MER will happen in both breasts, but please observe whether milk removal is more effective on the side on which RPS was done, compared to the side where there was no attempt to displace edema with RPS. This would be especially interesting in using RPS on one side and not the other, before any pumping, as well as in cases of fingertip expression.)
Your observation may be helpful to general clinical practice if my theories "hold water". I am requesting feedback from NICU practitioners, to observe for edema not even yet visible, before use of fingertip expression, and before and during any pumping in the early days.
I want to encourage those working "where the rubber meets the road" to give feedback for all of us, about whether breast edema from IV fluids does in fact (or not) appear within 24-36 hours after large amounts of IV fluid, and whether it makes hand expression more difficult and time-consuming and/or less productive in the first 2-3+ days. Worse yet, theoretically, might be the effects of vacuum on a breast with visible edema and especially if that breast is pendulous. Vacuum itself may sometimes be the culprit in the early days by "inviting" other forces (like edema, or edema under the effect of gravity) to push forward to crowd the nipple-areolar ducts so that colostrum/milk cannot get through the "traffic-jam" in the anterior breast.
If you are not familiar with RPS,
kellymom.com/bf/concerns/mother/rev_pressure_soft_cotterman/
I welcome any negative feedback also, to my personal e-mail if you wish.
K. Jean Cotterman RNC-E, IBCLC
WIC Volunteer LC Dayton OH
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