For Liz Brooks,
 
I understand you are giving a talk tomorrow (Thursday).

Re: <USBC Clinical Care Quality   
 Action 10: 

Include basic support for breastfeeding as a standard of care for midwives, obstetricians, family physicians, nurse practitioners, and pediatricians.  
Define standards for clinical practice that will ensure continuity of care for pregnant women and mother-baby pairs in the first four weeks of life. 

Conduct analyses and disseminate their findings regarding the comparative effectiveness of different models for integrating skilled lactation support into settings where midwives, obstetricians, family physicians, nurse practitioners, and pediatricians practice. >

 
I hope you see eye to eye with me that the "edematous elephant in the postpartum living room" needs to be anticipated, recognized and addressed, at least by postpartum day 2, and certainly before the mother leaves the hospital! Not by spoken or printed words or pictures alone, but by utilizing the mother's own kinesthetic sense. (It helps to have her compare the pliability of her earlobe with the non-pliability of her chin to demonstrate the goal for the areola before latching or pumping.)


IME, all the better if RPS is taught prenatally as a problem preventative postpartum skill. Understanding how to use RPS before latching or before and during pauses in pumping, is a very useful skill during the whole first 7-10 days, especially if a mother gets lots of IV fluid or if either mom or babe has complications requiring pumping. 


I wholeheartedly wish that some of the academically qualified would take it on as a research project so it could be trumpeted as "evidence based" for those, especially in other professions, who insist on such before they will try it! No one can get a patent for pitting edema, and wonderful as fingertip expression is, it is sometimes impossible to make it work, by itself, in the postpartum period, due to edema collected in the dependent area of the nipple-areolar complex (pump flange area) . But understanding how to present baby momentarily with a pliable areola (neither edematous, nor overfull, at least for long enough to latch) will help so very many mothers "make it" through the first two weeks!


Anyone desiring the most recent, simplified, English or Spanish, "laid back" RPS direction sheet, adding emphasis on gravity, may find it where Jeanette Panchula has made it available on the California WIC website. Or you are welcome to contact me privately.


K. Jean Cotterman RNC-E, IBCLC
WIC Volunteer LC, Dayton OH
 
 

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