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Subject:
From:
Kermaline Cotterman <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Sat, 3 Sep 2005 14:31:15 -0400
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Martha Johnson and I have been having a discussion about the use of heat
and cold. She recently wrote me:

<I know, most people frown on the use of heat for relief of engorgement. 
But is the current 'taboo' on heat evidence-based?  Are there studies
dealing not just with lymphatic drainage in general, but with the BREAST
specifically, which show that heat worsens engorgement?  If you know
about any research, please direct me to it, for I too am eager to further
my understanding on this topic.  And what about all the moms who are
suffering and finally get relief when they hop into a hot shower and
their milk lets down?  I have seen this happen SO many times that I
cannot discount the value of heat in this situation.... haven't we all? 
I would hazard a guess that most all of our new moms are heating their
breasts in a shower every day.  Anyhow, I guess I am going on what has
worked for me, and the moms I help, rather than on what 'everybody' says.
>


Oh Martha, I think there is just so much our profession still needs to
research about the use of heat and cold, and about how arterial, venous
and lymphatic capillaries differ in their anatomical features and
physiological responses, to help us to better understand the process of
tissue exchange more thoroughly. I think we also need to develop greater
insight into assessment of breast swelling. We need to learn to
differentiate what part of the current swelling can be attributed to
increases in circulatory, interstitial or glandular compartments, in
order to choose the most appropriate intervention for that specific
moment in time. 


I agree with your point about MER and warm showers, even if directed
mostly on the mother's back. That is a function of both physical
stimulation of the chest nerves and of the arterioles delivering oxytocin
rapidly to the area. However, it still has to traverse the interstitial
fluid to get to the myoepithelial cells. ( I still don't know what
accounts for what seems like coordinated, sequential back-to-front nature
of the contractions! I read that it doesn't work like the synchronized
contractions of the healthy heart.) But once it reaches myoepithelial
cells, their contractions around the alveoli and spirally/longitudinally
around the ducts can of course relieve pressure, especially in the upper
part of the glandular/ductal tree. I also want to go back and learn more
about dual layers of lymphatic drainage, both surface, and deep. 


My curiosity about all this has recently had a boost. I now suspect that
the persistent posture problem and low back discomfort I've had in my
70's may be a gift from the Good Lord, because I finally arrived early
this year into the competent hands of a young physical therapy assistant
whose wife was expecting. Between my learning more about principles of
muscle rehab, and he, about new parenthood, we had many an interesting
discussion (courtesy of Medicare!)  I, of course, proactively supplied
him with RPS information, touted the wonders of skin to skin, the MER,
off-center latch, breast compression and hindmilk, and posed some of my
questions about swelling. 


Last month, I returned for a second, longer, more intensive course of
therapy, and caught up to date with the birth and the early
breastfeeding, and the progress of the plans for his RN wife to return to
work. Because he will be caring for the baby while she is at work, it was
an excellent opportunity to provide some of Diane W.'s excellent handouts
on insights about rubber nipples/flow rate habituation/ breast refusal,
and several others, including Working and Breastfeeding, and What if I
want to Wean (along with some of my brand of advocacy re: pumping vs.
AIM, and experiences with working moms through WIC).


I've read that there is further PT research being done on cryotherapy
(cold), so I asked him for leads in learning more about tissue swelling
and the use of heat and cold. He recommended I try www.dogpile.com and
search for 'modalities', and specifically, for 'contrast baths'. Of
course, much of this is specific to muscle and injuries, but even my
first few hits have been thought provoking. I share this with the list so
that anyone else who is curious might check these out.


As for me, I will soon be over a thousand miles away from my computer for
a month, hoping there's no snow in September in Montana, continuing my
stretching and exercises, vacationing at the Lewis and Clark museum, and
being doula/LC for my granddaughter in the Air Force. I'm enjoying my
improved flexibility, and looking forward to a great adventure. Wouldn't
it be exciting if my great-grandson were to arrive on  my 'Diamond
Birthday'!? 


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

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