Janet writes:
<When mom pumps, and she has been pumping now for about 4 days, she gets 3-8 cc of milk from each breast in about 5 minutes. Milk starts immediately, is fairly fast dripping or spraying for about 3-4 minutes, slows, she adds hands/ massage. Get a little more. Then nothing. 20 minutes later she can get same amounts. 3-8 cc, And again 20 minutes later. Yesterday we tried pumping 5 minutes after 1st pumping, she got some more, repeated 2 more times. Each time she got some milk, quickly and briefly. Then again after 20 minutes she was back up to original amounts. We were trying to see if we could coax her body to have more frequent let-downs as it is clear from baby behavior and test weighs that what we are seeing with pump is happening for baby.
I think what's confounding me is the quick and brief. Mom tells me that at 3 am the milk is dripping before she can get to the pump, and she gets more milk. But when it stops it STOPS.>
Case in point: What forces are acting on this mother's lactiferous sinuses?
Remember: Vacuum does not pull; other forces push. (Evidence based for 3+ centuries.) Increased strength of vacuum seems to cause other forces (such as excess tissue fluid) to move forward faster, thereby crowding around the lactiferous sinuses more quickly.
Have you tried different size flanges to see if there is a difference? I have been surprised to find that smaller flanges, sometimes change the angle of the forces of compression on the lactiferous sinuses as the nipple-areolar complex pushes forward to try to neutralize the vacuum. However, many times, a mom really needs larger flanges, or a different size on each breast, as the internal anatomy may differ somewhat between breasts.
Are her breasts C cup or more? How many days postpartum is she? Does she have edema in her ankles (or hands)? if she is within the first 7-10 days postpartum, did she have >2000 cc. (2 large bags) of IV fluid in any one 24 hours? If so, was this before the birth (of the placenta) or after it? Or both? Was intravenous pitocin used for hours? Before or after birth? Both gravity and vacuum may be causing any excess interstitial fluid to move forward into the flange area, crowding the lactiferous sinuses so they are "buried" inside the edematous tissue, unable to move forward into the flange to compress themselves against the inside of the flange tunnel, or be compressed through the edema.
Reverse pressure softening (RPS) used right before attempting to pump (or nurse) will
1) displace any edema upward in the breast away from the lactiferous sinuses temporarily,
2) plus it will trigger the MER within 60-90 seconds or less, IME. Nature will not allow another surge of oxytocin for a few minutes. Breast compression or massage during the interval can speed up the progress of the milk from the back of the breast (faster than edema moves back into the subareolar tissue.)
3) If RPS is applied every 5-7 minutes (when the milk flow slows/stops, total 2-3 times) during pumping, repeated MER's and more efficient compression of lactiferous sinuses may give a better yield. (better to have 10-15 minute sessions more often right now, maybe very 1 1/2 to 2 hours, than longer sessions every 3-4 hours)
4) if mom's breast is C-cup or beyond, have her lie back and elevate the breast above the chest wall while doing RPS.
5) if the breast is large, have mom lie on her side to pump one side at a time, so that gravitational force is the same all along the level of the ducts and nipple-areolar complex, so the weight of any edema is not helping it move forward.
Hope a few of these suggestions help. Let us know her progress so we can all learn from what you find.
K. Jean Cotterman RNC-E, IBCLC
WIC Volunteer LC Dayton OH
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