Eva writes:
<I am wondering if anyone can answer this question hypothetically.
Would edema 5 days after birth have anything to do with low milk supply?
I was thinking, if pregnancy edema (without a diagnosis of
pre-eclampsia) persists after the birth, would that be a sign that the
body had not yet recognised the absence of the placenta and was
therefore not moving into the making of mature milk? >
I can't answer your question as to whether the body might not yet have
recognised the absence of the placenta, but I have heard that the amount of
fatty tissue that an obese mom has may well still be storing progesterone,
and may have some effect on delay.
Five days after birth is a very common time in the U.S. for edema to be at
its peak, because obstetric interventions are so common. Any pre-existing
edema from pregnancy would just make the following scenarios worse:
It might be "back up" edema, or tissue flooding" edema or a combination of
both, appearing either before or superimposed on the normal process of
engorgement. It is not unusual for it to take up to 14 days to resolve.
Breast edema at 5 days, even in mothers who had no birth interventions, may
be in part from well-known causes such as feeding delays or ineffective
feeding. This generally does not interfere with establishment of
Lactogenesis II, but the edema begins to appear slowly, as if "backed up"
and it is only able to leave the breast slowly, partly from pressure of full
ducts/alveoli on venous and lymphatic capillaries, but also, perhaps from
raw materials "waiting in the wings" to be absorbed by the membranes of the
alveolar cells once they have been emptied and again ready to continue
synthesizing milk.
A much more common type that we see in the US among women who have had
obstetric interventions is a "tissue flooding" phenomenon, due to IV fluids
administered during labor/birth/anesthetic. The more fluids she received,
the more likely there is to be some degree of overhydration, and the breast
participates with the rest of the body (swollen ankles are seen so often
that OB staffs apparently consider this "normal") in storing retained fluid
until such time as it can get back into the circulation and out through the
kidneys.
If the IV's administration began 24-48 hours before birth, the edema begins
to appear sooner, perhaps even present at birth, and can interfere with
latching from the beginning, which would also contribute to further buildup
of the "back-up" edema as well.
This "tissue flooding" type of edema is associated with a "dilution" of the
protein content of the blood stream, lowering what doctors call the "colloid
osmotic pressure", (This is the factor which is responsible for holding the
normal amount of fluid inside the blood vessels.) When this "dilution"
occurs, more fluid than normal leaves the arterioles to enter the
interstitial fluid, which is supposed to be carrying raw materials to the
milk making cells, and waste products back from them to the venous and
lymphatic circulation, as well as storing modest amounts of tissue fluid to
keep the body in proper hydration.
However, even though the breast, at this point, may appear quite "swollen",
depending on how much "dilution" and overhydration is taking place, the
excess interstitial fluid may be slow in transporting raw materials,
hormones, etc. necessary to make milk, and could theoretically delay the
onset of Lactogenesis II and the arrival of mature milk.
I am going to send you an attachment with some of my thoughts about pitting
edema and a solution I have found helpful if the edema is interfering with
latching. Many Lactnetters are familiar with the technique called Reverse
Pressure Softening and have attested to its helpfulness in such situations.
Anyone else who might also like these attachments can e-mail me privately.
Jean
***********
K. Jean Cotterman RNC, IBCLC
Dayton, OH USA
***********************************************
To temporarily stop your subscription: set lactnet nomail
To start it again: set lactnet mail (or digest)
To unsubscribe: unsubscribe lactnet
All commands go to [log in to unmask]
The LACTNET email list is powered by LISTSERV (R).
There is only one LISTSERV. To learn more, visit:
http://www.lsoft.com/LISTSERV-powered.html
|
