This is my observation and theory, concluded only from my own years of clinical experience and much reading:


To my knowledge, no one has yet formally researched the effects on a mother's serial colloid osmotic pressures daily for the first 2 weeks after birth. Such research would need to consider the comparative volume of intravenous fluids, and perhaps other medications administered to a mother and when she had them in relation to the birth of the placenta. these results would need to be compared with the serial colloid osmotic pressures (daily for 2 weeks) of mothers in a control group who had: 1) no IV's, and 2) no more than one dose of pitocin intramuscularly.


It has been my general observation that about 24-48 hours or less after a mother receives more than "2 bags" (per mother' memory), i.e. 2000-2500 cc. of IV fluid in any 24 hour period, edema can quite often be detected in the interstitial tissue of the breast. This edema is not "contained" in vessels or ducts, as are the fluids in the circulatory system or glandular/ductal tissue. Therefore, any vacuum applied needs to done judiciously if at all, with close observation to see if the excess interstitial fluid is in fact pushing its way forward toward the nipple-areolar complex/flange with the potential to crowd the subareolar ducts. This can soon reach the point where colostrum, even if assisted by MER) may not be able to "push" through the compressed nipple ducts to neutralize the vacuum (because if you are not yet familiar with my"mantra": Vacuum does not pull; other forces push." Evidence based for 3 centuries. Hospital OB personnel need to look up "vacuum" in Wikipedia if this is new info to them.


That having been said, I am not intending to disagree with Jan (one of my initial mentors;-) or any others who are using the system she described. I am suggesting that the mother's intrapartum history be considered before instituting pumping versus fingertip expression (or latching) within the first hours/days after birth. 


If a mother with premature labor, especially if she is also treated for pre-eclampsia, has had hours of tocolysis to allow medications to help her premature baby's lung maturation before birth, or for prolonged ROM, or perhaps she may also receive IV's to give antibiotics for GBS, or any mother who receives subsequent induction or augmentation with IV pitocin for long hours, or any such set of circumstances her doctors find necessary for management of complications/labor/anesthesia, my observation has been that formation of edema (theoretically from a lower than normal colloid osmotic pressure) has had time to result in some degree of edema in the interstitial tissue of the anterior portion of the breast before or by the time the delivery of the placenta occurs. This edema can be present already before the beginning of the resulting hormonal cascade meant to trigger lactogenesis II. Edema can be present without being visible by pitting, even before the excess interstitial fluid in the tissue has reached at least 30% more than normal. 


These are some of the situations for which I have discovered the value of early applications of reverse pressure softening (RPS) just before and if needed, several times during pumping, or before attempts to hand express with the fingertips. I invite you to try the test I often suggest to new mothers in their initial phone call when they report their baby's birth (and answer briefly some questions about IV's, anesthetics and type of birth) to our WIC LC office: Use your thumb and forefinger to press together on the tissue on each side of your chin, and feel the firmness; then move those fingers up and compress the sides of your lower lip, to see how soft the areola needs to feel when it's ready to be compressed to do its job. A soft areola not only makes any latching easier, and more vcomfortable, but also allows the areola the freedom to push the subareolar ducts and their contents forward toward a pump flange more easily. There is an extra plus in that RPS done to soften the areola triggers the MER within 60-90 seconds after application.


http://kellymom.com/bf/concerns/mother/rev_pressure_soft_cotterman/


If you e-mail me privately, I will be glad to forward even further information about RPS (including some references for the above statements) to those unfamiliar with it.


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

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