Donna writes:
<Reverse pressure softening...
I have not heard this term before. Is this a name for something we all
do,
or is this a new technique?>
A little bit of both, I suspect. The name is new, chosen to describe
precisely what this tool is for. I fully recognize that it is really a
modification of the Hoffman technique, the first part of which I often
found useful in the early postpartum period.
Unfortunately, any mention of the name "Hoffman" proved to be an
albatross around my neck in trying to spread my insights, hence my
decision to select RPS as a name. (I have discouraged anyone attaching my
name to it in favor of the descriptive name.)
My clinical experience began back in the baby boom when hospital stays
were 4-5 days for vaginal deliveries, 7-8 days for CS. (Fortunately, not
many IV's, but plenty of twilight sleep and general anesthesia and sleepy
babies!) 24 hour delay in starting breastfeeding, on one breast only per
feeding, starting with five minutes, and progressing to 7-10 minutes by
the 4th day, and lots of supplementing and feeding twice in the nursery
at night. Lots of opportunity to observe engorgement!
The "bicycle horn" pump was all that was available to us, and in our
institution, even that required a doctor's permission, under pain of
"professional death" at the hands of my supervisor.
(In retrospect, I am glad there were no electric pumps available to us
then, or I would have been one of the first to use them, and probably
overdo it, and miss all that valuable observation opportunity! Vacuum
used indiscriminately has the potential to increase areolar edema, IME)
So "under cover of darkness", on the night shift, in the early '60's, I
learned to do hand expression when a problem arose. Sometimes, a few
minutes of simple fingertip expression solved the problem. Other times, I
couldn't get much out for love nor money, and still other times, when I
could finally get a few drops out, I recognized that in the process, I
had "pitted" the edema on that particular areola.
I also noted that when mothers consistently used the same position to
nurse in the first 3-4 days, there was noticeably more edema in the
quadrants 90 degrees away from the infant's jaws and tongue.
Many of those infants, (the ones with strong, coordinated jaw/tongue
action) had actually accomplished some dispersion of edema by their
efforts.
When I began to realize, bit by bit over the years, why different things
seemed to happen with different areolas, I felt compelled to find out
"why" whatever it was, was happening. Fortunately, I love to read about
embryology, anatomy, physiology, etc.
The archives contain many posts that helped me begin to articulate my
insights after I retired. A very short article on it appeared in the
final BSC newsletter published several years ago (thanks for the
opportunity, Jan!). Denise Fisher has posted it on her website
http://www.health-e-learning.com/
Or, you may also contact me personally for it, and I also now have some
sketches available to illustrate a few ways to perform the technique.
Thanks for your interest, and for any feedback, especially if it would
happen to be negative. I would certainly want to know about that as I
continue preparing a longer manuscript to submit for publication.
Jean
**************
K. Jean Cotterman RNC, IBCLC
Dayton, Ohio USA
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