I have been traveling and have not been able to read all the posts on this thread. I find Pam's post of great interest:
<What I have found is that these moms are drinking at least 8-10 glasses of water, some of them could almost float with all the water they are trying to drink to flush this out of their system. My theory is that the side effect of the meds and IV fluids combined with the patients increase in oral fluids causes a shift in the electrolyte balance.  The fluid then sits in the tissue and the tissue acts like a sponge just soaking up all the oral fluids mom is taking in, causing the pitting edema.>

I'd like to add this. In writing my article on RPS, now in press for JHL, my search for the effects of I V's on the physiology, especially of pregnant and newly delivered mothers, consistently mentioned not the electrolyte balance, but the colloid osmotic pressure, determined by the level of plasma proteins. This is one of the main factors in determining whether and how rapidly that fluid leaves the arterial capillaries to go into the tissues to carry nutrients to cells and return cellular waste products, and how rapidly it re-enters both the venous and lymphatic capillaries to return to the circulatory system.

The IV fluids that exceed the body's need for hydration seem to "dilute" the concentration of proteins in the plasma. Can the nutritionists here tell us whether it might be helpful for the mother to eat an adequate, or perhaps higher quantity of protein before induction, or after she is allowed to resume eating post-delivery? Or is the body perfectly capable of breaking down muscle tissue, etc. to supply protein for resumption of normal colloid osmotic pressure?

I had a lab tech friend look up this test for me, and while it was once a very common test (I remember the term from my early days as a nursing student) it is apparently now seldom done. Physicians are fully aware of the risk of pulmonary edema from over-hydration. I am amazed that we don't have more mothers afflicted with frank pulmonary edema. Their youth and general good health apparently allows them to compensate, although many chest x-rays done postpartum do show some sort of change. (Sorry, all my references for these statements are home in Ohio.)

Diuretics can't effect the fluids unless, or until, the excess fluid actually re-enters the circulatory system, because until it does, it cannot, of course, be carried to the kidneys for excretion. Also, the pitocin molecule is very similar to the anti-diuretic hormone (ADH) molecule, so the total amount of pitocin received would seem to have some bearing on whether and how quickly and easily the kidneys could respond to diuretics, be they pharmaceutical or from foods.

The half life of pitocin, I believe, refers to the measurement of its presence in the blood stream. But just because it has left the blood stream would not necessarily mean that it had broken down and was inactive - it might just as well mean that it had left the circulation to attach to the vasopressin2 (part of ADH) bonding sites in the kidney and possibly elsewhere. The complicated physiology is way beyond me. But I certainly wish the specialist nurses and physicians and pharmacists and biologists, etc. would jump in on this issue with their knowledge!

In the meantime, it is also helpful to remember that pressure adds to the forces causing tissue fluid to re-enter the venous and lymphatic capillaries. Gravity is one such force. (It's important to remember that although fluids enter the breast through the arterial system, they leave the breast in two opposite directions: milk forward and centrally, tissue fluid upward and posteriorly.)

The breasts, especially the front of the breast, where the all important nipple-areolar complex is situated, can be elevated by having the mother spend a lot of time flat on her back with support to the breasts. Gravity will then lead fluid away from the front of the breast to the natural channels of lymphatic and venous drainage in the upper posterior parts of the breast, the inner chest, etc. to the subclavian and jugular confluence near where the fluid re-enters the large veins on their way back to the heart. Gentle massage of the breast (somewhat like that used in the monthly breast self-exam) in an upward direction, starting near the clavicle, can assist this clearing of the tissue fluid swelling from the breast. So can movement of the pectoral muscles.
(Does anyone remember the old "heartburn-lactation" exercise taught in CBE classes in the 50's?)

For the ankles, while massage has traditionally been discouraged for fear of causing emboli, active motion of leg muscles, and perhaps elastic hose and elevation of the legs for parts of the day might also provide helpful pressure.

I applaud Pam for her forward thinking. It is long past high time we begin to scientifically examine this "alligator in the living room" which many in OB have come to consider "normal" because it is so common, common that is in mothers who receive crystalloid intravenous (and now intrauterine) fluids and pitocin. In my view, it is one of the major stumbling blocks to the initiation of effective breastfeeding.

Jean
******************
K. Jean Cotterman RNC, IBCLC
Dayton, Ohio USA (currently enjoying my family in Glendale AZ.)

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