<My question: Since this method temporarily moves excess interstitial fluid = toward the inner lymph channels and temporarily removes it from the = areolar and subareolar area (to give the baby a fighting chance of a = better latch), would this actually be contraindicated in a woman who is = simultaneously experiencing severe engorgement in the axillary region? My = client is up to her armpits in engorgement, and I don't want to make it = worse.> Brenda, Thanks for asking the question for the sake of discussion and further understanding. The short answer: No. The right amount of pressure is gentle enough to be painless, yet firm enough to temporarily "pit" the fluid out of the subareolar area. Watch the mother's body language to guide you. I find it to be an excellent first step in helping relieve severe engorgement. In my experience, RPS moves the fluid only an inch or two back and only temporarily, 5-10 minutes at the most, to provide a "window of latching time" for the baby. The baby's correctly placed jaws then continue to keep the edema at bay by rhythmic compressions during that suckling session. In fact, I have found several mothers who were so engorged that by the time I had released the pressure from the second 2 quadrants, the first two seemed partially "re-edematized". These mothers responded to repetition of RPS, one after another 3 times in a row. I am presuming this was enough to move more of the fluid a little deeper inward so it would not refill the tissue quite so quickly. Working quickly then, I was easily able to express 5-10 cc, by fingertip expression on an area which would not yield to this technique previously. (I performed the expression where I intended the baby's upper and lower jaw/tongue to go, with perhaps some attention to softening a place for the chin to nestle easily.) The thorough deep stimulation of the nerves in this area triggered the MER, and one baby was able to get a good latch with a shield, the other, directly on the nipple-areolar complex. Loud swallowing ensued, and when it slowed, a little breast compression in the axillary quadrant (where over 50% of the milk making tissue is supposedly located) promptly began to transfer the stored milk forward. This reduced the generalized swelling near the axilla, thereby lessening discomfort in that area till natural resolution of the edema there. As an aside, gentle UPWARD massage of that area after a good feeding, TOWARD the axillary lymph nodes might well help the physiologic progression of the excess fluid to its destination. I have wondered if gentle exercise of the arms/pectoral muscles might also help, since we know that movement of the skeletal muscles of the lower extremities act as an auxiliary circulatory pumping force. I would be delighted to hear of anyone else's experience, pro or con. I want to emphasize I have only used this in the initiation of breastfeeding (up to 10-14 days). I would hesitate to use it under tissue conditions suggestive of mastitis, in part due to possible pain. Jean ****************** K. Jean Cotterman RNC, IBCLC Dayton, Ohio USA *********************************************** The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(TM) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html