< The baby latches on on one breast
after reverse pressure but doesn't at the other.>

Maria,

I would suggest holding the fingertips in reverse pressure longer then.
At least 3 full minutes by the clock was what it took in some terrible
cases I have used it on. Longer won't harm a thing. And remember to
massage out a niche for the chin.

I also think we have to consider which fluid compartment is the most
problematic at the moment, and direct our efforts to the compartment are
we trying to relieve at the moment. Often a little like "Which came
first, the chicken or the egg?"

The ductal pathways downward and outward can of course be emptied much
more quickly than the interstitial fluid pathways to the lymphatic
vessels themselves. But to get free access for the exit of the ducts, it
has been my experience that speeding the excess interstitial fluid in the
appropriate direction needs to some first.

If edema is the worst component, the direction of relief is upward toward
the chest wall, armpit and clavicle. The pump won't help that, and
depending on the strength of the vacuum, might even be allowing
atmospheric pressure to push excess interstitial fluid into the area
within the flange.

This then buries the lactiferous sinuses even deeper so that the baby
finds more subareolar resistance, not less. Of course, that will keep the
ductal compartments from emptying efficiently, and they will keep
compressing on the lymphatic pathways that surround them. A viscious
circle that needs quick interruption.

Considering this mother is alone with only the baby to help, these are
some of the other thoughts that come to me today after having been
reading up on the lymphatic system recently.

Would consuming a lot of protein for the next few days help to normalize
the colloid osmotic pressure from all the IV's that lowered it so far, so
that that powerful force could draw more interstitial fluid back into the
venous and lymphatic capillaries?

After sufficient RPS frees up the latching area, would Australian
position (baby prone on top) allow gravity to help drain the lymph inward
at the same time the baby and the MER are draining the ducts outward?
This, with a pillow supporting the upper arm on the side she is nursing
on, once she can find a way to manage it, is a very relaxing position in
which she can safely doze off and let gravity and the baby do all the
work.

So many of the lymphatic pathways from the breast go through the axilla
and the pectoral muscle areas. Everywhere else in the body, muscular
action helps pump lymph along. Would a few moments of arm exercises many
times in the next few days help? I am remembering the
"heartburn/lactation exercise" that was taught in CBE classes decades
ago.

Are you able to make a one time housecall on her?
I remember hearing once that Japanese and other nationality LC's use
massage a great deal more than we have heard about in the US.

I wonder what would happen if she were to lie on her back and you, with
some lubrication on your hands, were to start near the upper part of the
breast gently massaging circularly, toward the axillary and clavicular
areas. Then gradually move further down on that breast and massage that
area to encourage lymph to move into the areas you may have just cleared
up a little. And lastly, move further toward the areola.

Please keep us posted on her progress.

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

             ***********************************************
The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(TM)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html