Ann Perry writes,
<The mom with edema is definitely more challenging but I still can get
them to see some wetness. The more the mother does this the easier it
gets for her.>
On that particular day perhaps, but I always wonder about the next few
days if the swelling is in the process steadily increasing (e.g. 48-96
hours) and she is soon to go home. I have often seen edema of the areola
increase enough to make hand expression that was easy one day, absolutely
impossible the following day, often when it would have been most
beneficial. This is especially true if more tissue fluid has been (or
will be, at home) attracted forward by injudicious pumping,
Do you ever use RPS prior to hand expressing in these cases? Not only
does it usually permit more effective hand expressing when the edema has
been re-located deeper within the nipple-areolar complex, but it is sure
to trigger the MER, which increases the amount of colostrum that moves
far enough forward to be available to the fingertips or the baby. If she
is due to go home soon, it prepares her to deal with her pre-latch
preparation at home till the swelling, especially the edema portion,
begins to subside substantially. This may often take until the 7th-10th
day or later, especially if she has had multiple IV's, long
administration of pitocin, etc. (One mother told me recently she had 15
sacks of fluid!)
I also got a private post from a lactnetter who, in the 1980's, used to
work in the hospital where I had worked, done maternity inservice and
updated a lot of policies in the 1970's. She gave me a little historical
insight, stating that I and a co-worker had apparently started to
introduce an early version of RPS way back then!. She gave me some
feedback that has added a useful new piece of "RPS trivia" that goes
beyond what my experience has allowed me to write about, since I don't
help moms with much actual pumping.
<A particularly engorged mom, pumping only, you can do RPS, pump a few
minutes, repeat RPS, etc. and get tons more milk than just pumping alone.
>
I am still learning, and as always, I appreciate feedback, whether it is
positive or negative.
Jean
************
K. Jean Cotterman RNC, IBCLC
Dayton, Ohio USA
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