Zena writes:
<I have been having a lot of moms with what appears to be insufficant
glandular tissue this last year. I have noticed something with some of
these moms that I wanted to see if others have noticed the same thing. 
These women's nipples dramatically change with just pumping. They will
sometimes mention to me that *pumping* is making their nipples too big
for the baby to latch. They think it's the suction of the pump. I have
another theory. I think it's the stimulation helping to develop the
tissue that didn't develop during pregnancy. Have others noticed the
same? What do you think? >
Vacuum can attract interstitial fluid to the flange area, temporarily
enlarging the nipple (teat). This has been measured in both humans and in
dairy animals. The greater the vacuum, the more the measurements change
during pumping. (Edema tends to recede between pumpings.)
Wilson-Clay B, Hoover K, The Breastfeeding Atlas, second edition, 2002,
LactNews Press, Austin TX pp.74-93.
Hamann J, Mein GA, Wetzel S, Teat tissue reactions to milking: effects of
vacuum level. J Dairy Sci 1993; 76(4):1040-6.

Developmental tissue changes in the nipples of laboratory rats have been
followed under the microscope at 5 day intervals from the virgin state
through the 10th day after weaning. Even in mammals with such a short
reproductive cycle, developmental tissue changes take days and weeks to
occur.

I suggest lowering the vacuum, and/or shortening the pumping periods to
prevent the attraction of edema that temporarily enlarges the diameter of
the nipple. Reverse pressure softening can be used directly on an
edematous nipple, as well as on the areola to displace edema and
facilitate latching.

Cotterman, KJ, Too swollen to latch on?: try Reverse Pressure Softening
first, Leaven Apr. May 2003, pp. 38-40.

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

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