Kathy
I see this fairly often. The areola feel very thick and "meaty" like a firm
piece of raw meat. There is no softness or 'give' there. I note that the mom
still has lower extremity edema and often her fingers are swollen too. I use
reverse pressure softening (RPS or the Cotterman technique) which helps alot
and I encourage the mom to drink lots of water and if possible eat some
watermelon or cucumbers which seems to help w/ diuresis. I think a
prescription diuretic might help in some cases. I think it would be worth a
try especially in situations where there is a little baby who might have to
get formula. Some moms get some colostrum and their babies seem ok so those
could wait a day or so more. I try to encourage moms to keep going in the
face of no to scant milk in the early days. I have had a few moms work 6 and
one 8 days w/ steady expressing etc before the milk came in. My neice (in
another state) very recently had a c/s birth and put baby to breast in
recovery room and also began expressing regularly with a pump in style when
her nipples got very abraded. She seems to have been keeping on with all the
right practices and had LCs assisting her but yet only drops of colostrum
until about the 5th day. Then she could pump 3 oz each side.

Laurie Wheeler, IBCLC, MN, RN
New Orleans Louisiana, s.e. USA

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