Having had the pleasure of rooming with Jean in Scottsdale two years ago, I
was privileged to have the chance to ask her many of the questions that had
been bothering me in my work.  One of the most difficult challenges was the
mom with aereolar edema...I work in a hospital with 95% epidural rates.  ( I
could have filled pages and pages of epidural horror stories in the epdural
thread, but for lack of time and aggrivation at just thinking of it, I chose
not to! Including the 5month post partum mom who is just learning to re-walk
with a walker because of the epi in her birth...she still has not gone home
with her baby....refuses until she can negotiate the 5 flights of stairs to
her flat......)
The phemomenon of edematous tire-like nipples on day 2 was baffling and
difficult.  Jean explained to me how to perform her RPS technique and it has
become the most useful tool I have learned in my 15 years of experience.
The scenario is that you have a mom reporting a fussy baby at breast and
lack of milk on day 1 or 2.  Palpation reveals a rubbery thick aereola and
an indefinable nipple.  Normal pressure will not produce even a drop of milk
and the tissue is very sensitive due to overextension.....if the baby has
happenened to latch, it is usually very painful.  This mom usually had a
very long birth and an epi early on.....her ankles are very swollen, as are
fingers, hands, etc.  She may have been given a few zaps of pitocin to speed
up her birth.  For sure she had several liters of liquids during the birth.
I explain the reason and show her the RPS.  Short strokes at first, then
longer ones.  It is quite painful, but you feel results immediately.  You
will be able to express a few drops of colostrum....be ready with a spoon!!
You will be able to form a nipple and eventually get the baby to latch!!
Show the mom the difference in the other nipple which you have not massaged,
and she will begin to understand the reason her baby was not able to latch.
Husbands like to do this massage!!
The next step is to suggest that the mom start eating lots of pee producing
foods, like watermelon, cucumbers, coffee, tea, etc.  If she was a
c-section, you will have her breastfeeding by the time she goes home, if
not, you will have to refer her on or have her come back for follow-up.
Often I see these mothers after one or two weeks. They come in to show me
that they are fully breastfeeding.....and I do not recognize them!! They
have lost kilos of water weight and the swelling has gone down in their
faces as well......
Jean, in the next conference you should demonstrate your technique!!  I
bless you every time I use it!! Or come over here and we will do a study!!
Esther Grunis, IBCLC
Lis Maternity Hospital
Tel Aviv, Israel
mailto:[log in to unmask]
http://www2.iol.co.il/communities/breastfeed

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