Michele says <That's because it all matters, and really, its all related to lactation on some level.>


Amen, Michelle. My kids laugh at me because I love to read A&P for recreation!!


I notice a double check beside lymphatics and immune system. I couldn't agree more. Without even proceeding into the immune function, I have found so much "pregnant" information by reviewing the basic A&P of lymphatic vessels themselves. Lymph doesn't "circulate", as hazily suggested in so many of the most well-known breastfeeding texts. Lymph drains. In one direction. Toward the right and left junctions of the jugular and subclavian veins, and thus to the heart. Gravity is but one factor that can help or hinder the speed at which it drains.


IME, IV fluids in excess of 2000-2500 cc. within any 24 hour period, especially with hours of pitocin involved, complicate initiation of lactation as well as initiation of breastfeeding in the postpartum period. (There is a connection but a significant difference between the two!) I do so wish those with the capability of formal research would include that in their variables! (Or at least do it to try to disprove my hypothesis;-)


http://pediatrics.aappublications.org/content/127/6/1177/reply


Here are but a few facts I have learned over the years here and there by re-reading various references on A&P. Under NORMAL (again, not shouting, just emphasizing) conditions, the return of 90% of the interstitial fluid to the heart is by way of the venous capillaries, while 10% of that return is via lymphatic capillaries, which can receive large proteins and protein fragments that cannot enter venous capillaries. 


Return of fluids into venous capillaries, as I understand it, is a combination of chemical processes and the hydraulics of blood pressure, understood for over 100 years. In contrast, return of fluids into lymphatic capillaries (which are a part of the interstitial fluid compartment, not the circulation) works not by chemistry but by physics only. It works by a process of intermittent positive pressures, and by some references, could increase absorption of interstitial fluid up to 20 times more if the right conditions exist.   I recently reviewed the basic A&P of blind lymphatic capillaries in preparing a presentation, and to my surprise, found so much that I didn't pick up the first time around, or had forgotten. I recommend it. 


Feldman JF, Winchester DJ, Lymphedema in Breast cancer, 2006, pp. 551-553
Breast cancer - Google Books Result
Accessed 3/28/11


Within the sphere of our practice, we cannot do anything directly about the effect on the postpartum breast of administration of excess IV fluids (and the antidiuretic action of pitocin) that are admittedly, in many cases, life saving. (Sadly, in most other cases, routine, and excessive.) Indirectly, before and after the administration, we can attempt to educate the parents and willing professionals. 


OTOH, by understanding the microscopic anatomy and the physiology of the lymphatic system, the lactation community could do so much more to encourage lymphatic drainage of excess IV fluids to relieve postpartum breast swelling (starting with Pre-L-2 edema). The swelling in the interstitial compartment often interferes with the function of the glandular/ductal compartment, especially when the effects of vacuum are so misunderstood. If we engage some experts in the field of lymphatic drainage, especially the lymphatic drainage of the breast, they have much to teach us if we would but recognize the need to learn. Though touched on lightly in the past, there is so much more we could address in our continuing education that could ultimately benefit moms and babies.


Chikly B, Lymph Drainage Therapy: Treatment for Engorgement. Presented at International Lactation Consultant Association Conference, Aug. 2, 1999, Scottsdale, AZ. Audio tape: Repeat Performance 219-465-1234


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

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