Laurie, You wrote: < I agree that many moms expereicne short-lived pain upon latch and until the milk "starts to flow", esp. in the early days of bf. I used to think this was the initial "stretching" or elongating of the nipple/areola into a long teat extending deep into baby's mouth. But maybe this is pain due to the relatively "empty" sinuses/low flow issues?. . . Any comments on this latch-on pain?.> IME, milk sinuses in late pregnancy and the first 2-3+ weeks after birth are relatively overdistended, not empty. This pain comes from positive pressure, not negative pressure. If compression takes place over the middle of the sinus, where the walls are conceivably tighter and thinner, it is quite painful till such time as the overdistention is overcome. I also visualize these walls as a richly ennervated site where compression sends a strong signal to elicit the MER. It is when the relative overdistention has been relieved that the pain begins to subside. At almost the same time, the myoepithelial cells in the walls of the milk sinuses (as well as the milk ducts and the acini) seem to be able to respond to the oxytocin and milk begins to ooze easily out through the sinuses. And the less the milk sinuses are stretched containing milk, the more the elasticity is then available to be drawn further inward into the baby's mouth. It is my observation that at least 50-75% of initial latch pain can be due to this direct compression of overdistended milk sinuses. Pain also often results if digital extraction or a breast pump (negative pressure pulling so that the milk sinuses meet resistance from the bend in the flange) compresses the "belly" of the sinuses. I have explained this phenomenon as somewhat analogous to someone in a car with a seat belt on directly over the hips and bladder. As the bladder fills, if the driver "jams the brakes on hard", the compression of the seatbelt causes severe pain in the walls of the distended bladder. I believe this example also explains why the forces correctly applied in a really good asymmetrical latch do not cause pain. In an this kind of latch, I visualize the compression of the top jaw stabilizing the areola, near the distal part of the sinuses (closer to the nipple), not further in toward the "belly" of the sinus. I see this as simply part of the leverage providing some resistance to the action of the lower jaw. On the opposite side of the areola, the lower jaw and tongue are extending well back to compress beyond the proximal end of a few of the milk sinuses (closest to the deeper ducts), gently undulating and pulsing pressure on just the underside. As I see it, then at no time are both the opposite walls at the most thinly stretched part of the milk sinuses being compressed simultaneously. In time, little by little, as the MER begins to move milk forward, the resistance of the areola lessens and the nipple-areola complex is pulled more deeply into the mouth, (or the pump), and the undulating compression reaches more sinuses Picture in your imagination, a fresh tube of toothpaste, as a generic model for a full milk sinus . You can get some out by pressing on the fattest part of the tube.The pressure displaces some forward, and tries to displace some backward, with great resistance. But you can get the toothpaste to come out with less work if you support the front of the tube and start compressing at the thin end. You can prove this to yourself simply by observing the mother when you attempt staight digital extraction, as in the Waller testing technique. (Not the Marmet technique, which is a gentler approach which seems to place the fingers and thumb so that compression begins at the proximal end of the sinus rather than over the "belly of the sinus".) You will often that find direct compression of the fullest part of the sinuses is painful to the mother. But ask her to tell you when the pain goes away. If pursued gently and slowly, after 5 or so drops have been expressed, she will often remark "Oh, now it doesn't hurt any more!" OTOH, if she finds it too painful, switch to gentle Reverse Pressure Softening as I described it in previous posts. In addition to redistributing excess interstitial fluid, this places pressure on the distal ends of the sinuses and moves some excess milk back up through the proximal end into the ducts just behind, and triggers the MER. After 60 seconds of this, then direct digital extraction can usually be done painlessly. After the tissue resistance in the areola has been reduced by relieving the overdistention, the application of a pump, or an attempt by a vigorous baby to latch will elicit little or no pain from this area. So yes, I believe you are on the right track when you posit: < Therefore it should help to "prime" the system by manually starting the milk flow? > It's just that I see in my mind's eye, a different set of circumstances than what you expressed as the cause of the pain. Your initial idea actually seems to fit better with what I have observed. If anybody is interested in a technique I have developed for assessment of nipple-areolar discomfort in the initial week or two of nursing, please contact me privately and provide me with your snail mail address. (I am computer-challenged!) I will be glad to send you a diagram of my model of 4 conceptual zones where pain may be originating, so that intervention can be targeted more accurately. Jean **************************** K. Jean Cotterman RNC, IBCLC Dayton, Ohio USA ________________________________________________________________ YOU'RE PAYING TOO MUCH FOR THE INTERNET! Juno now offers FREE Internet Access! Try it today - there's no risk! 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