Barb wrote:

< Nipples have horizontal compression stripe and are slightly
compressed when baby comes off breast.>

<The last "wave" at the back of the mouth, just before swallowing, was
very
large and a prominent "bump" in the tongue.  I think that this is what is
compressing mom's nipple.

Any way to fix this?  Is it just a long tongue?  Positioning doesn't seem
to
affect it.>

I have a slightly different view of the cause of a "compression stripe".
I believe that the "stripe" is the only part of the nipple skin receiving
the full negative pressure of direct vacuum.

I do not believe it is necessarily the tongue that is the problem in the
situation you described. Nor do I find that it is the compression stripe
per se that is causing the greatest part of the mother's discomfort.

I have found there is actually more discomfort in the "meat" of the
nipple button (the mammilla) itself, and even much more discomfort yet in
the overdistended walls of the milk sinuses when they are vigorously
compressed on the "belly" of the sinus (like squeezing a toothpaste tube
in the mddle).

The stripe always runs in the plane of the hard palate, and the
compression of the nipple against the hard palate by the tongue coverage
is keeping the rest of the nipple surface from receiving vacuum, while it
may be interfering with incoming circulation and outgoing capillary and
lymphatic circulation.

The momentary whiteness of the stripe I believe is due not only to
temporary blanching from this circulatory interference, but to edema of
that tiny segment of skin due to the attraction of the full force of that
vacuum on the interstitial fluid behind that small stripe of tissue.

In other mothers without so much actual compression, the stripe is red,
and the vacuum can easily break down the skin capillaries and integrity,
which produces what Mavis Gunther called "positional sore nipples".

My view is that if we can temporarily free up some of the elastic
potential of the nippleareolar complex, we can facilitate a better and
more comfortable latch which will tend to draw more of the surface of the
tip of the nipple 1/4" further back into the soft palate area.

This reduces the amount of nipple tissue that is being compressed against
the hard palate. The soft palate also undulates, moderating the force of
the vacuum, which is now also distributed over a larger surface This
reduces the relative psi (pounds per square inch) of skin.

It would be interesting to know if this mother had IV's in labor. If this
is present on her 2nd postpartum day, worse is yet to come if there is no
intervention. By this, I mean at the very LEAST, more frequent "temporary
circulation breaks" whenever the baby stops actually drinking, and
rotation of at least 2 positions, or else more frequent switching back
and forth between sides to allow more time for unrestricted circulation
in the nipple.

(No flames, please. This is only my well thought out opinion. You are
welcome to yours. I know that painful nipples are no fun, and I believe
the mother deserves a chance to make this choice if she so desires. [The
Kalihari desert mothers' method??] Plenty of time later when pain and
skin symptoms are gone to let the baby have 100% of the choice of how
long to stay attached.)

Reverse Pressure Softening of the areola by 1 full minute of digital
pressure at the base of the nipple inward toward the chest wall can help
in three ways. 1) It temporarily moves excess tissue fluid out of the
way, 2) it pushes on the anterior end of the milk sinuses in a
longitudinal direction, temporarily pushing some milk back up further in
the ducts, and 3) it usually stimulates the MER.

Relieving the overdistention of the walls of the sinuses and removing the
obstruction of tissues edema makes it virtually painless to express 15 or
so drops of colostrum as in the Marmet method. (It doesn't have to go to
waste! It can be saved and given by cup or teaspoon, etc.)

When thorough softening of the areola by evacuation of excess tissue
fluid and milk from the deep subareolar areas has taken place, the
elastic potential that has been freed up temporarily will allow a deeper,
and much more comfortable latch, especially if an asymetric latch can be
achieved. With the MER triggered, the baby will get more milk in a
shorter time, allowing for more frequent circulation breaks.

Just felt like reiterating my point of view in answer to Barb's question.

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

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