Mary writes: <after she nurses her week old baby, her areola swells in a kind of half moon pattern above her nipple and a little below it. It does not hurt or anything but we are curious about what it could be. > Despite the fact that this was a home birth, if edema is present, at one week, it was probably very near its peak. You did not mention any pumping, but my guess is that with the kind of history she has: < The other problems she is having are; breasts enlarged lots during all three pregnancies, had too much milk with first two and has tons this time, too. Has engorgement even with home birth, lots of nursing from beginning.> the temptation would be to use a pump to try to manage swelling, mimicking some of the iatrogenic factors that often accompany hospital birth: attracting edemas to the flanfe area, and overfull ducts crowding the lumphatic drainage channels. Interstitial fluid is normally not "liquid" as the word 'fluid' suggests, but is in a 'gel' form. The very definition of edema is that there is at least 30% more interstitial fluid than normal. At 30-50% the gel cannot absorb much more so that extra interstitial fluid is, in fact, more "liquid" and can be pushed around more easily. Unfortunately, edema is easily attracted into the vacuum, and that would make for extra edema in the interstitial tissue of the areola, despite a <home birth, lots of nursing from beginning.> (This is the reason that when RPS is being done with thumbs or straight fingers in two quadrants at a time rather than simultaneous pressure all around the central areola, it is important to alternate the quadrants every 2-3 minutes so as to partially cover the previous pits, in order to discourage the edema from going to the side of the fingers at the surface, instead of into the deeper areas of the central areola, far enough backward, out of the latch area.) If a baby is put to breast in either straight-across cradle, or cross-cradle, or for that matter, straight-across football hold, if the upper and lower jaws are compressing at 9:00 and 3:00 on the areola, that means that the corners of the mouth (at 12:00 and 6:00, where there would be little or no compression), would be the natural place for tissue fluid to emigrate to, <in a kind of half moon pattern above her nipple and a little below it.> Were she to lie down to nurse so that the jaws would be compressing at 12:00 and 6:00, the 'half-moons' would therefore end up at 9:00 and 3:00. I suggest she stop using a pump, spend a fair amount of time lying nearly flat on her back to let gravity help drain the interstitial fluid into and pass upward through the venous and lymphatic channels, massage upward toward the axilla and clavicle, (and this would be helped by the weight of the baby if she were to nurse in 'Australian' or on-top-of-chest position) and do a small amount of hand expression after RPS if she feels she absolutely must remove some milk for relief. <At first I thought it might be fluids as she had some pitting on RPS before nursing, but when I touched it it was very soft and then her nipple became erect from the touching and the swelling disappeared. Swelling came back when nipple relaxed.> You are very observant. I think you were right the first time. Edema, especially the more liquid >30-50% it becomes, doesn't have to be firm. It all depends on how much 'room' there is in that particular tissue to contain extra fluid. Remember that muscle, when it contracts, places pressure on surrounding interstitial tissue and fluid. (In fact, the pumping action of larger muscles is one of the main factors in moving fluids upward from the lower parts of the body, and is one of the main treatment modalities in treating lymphedema, and why use of the pectoral muscles may even help some in resolving engorgement.) When her nipple became erect, the radial and circular muscles may have placed some pressure on the fluid, but my guess is that their firmness temporarily altered the contour of the skin and 'terrain' a little so that the area appeared evened out, making it appear to have moved the fluid. When the nipple contraction ceased, it again became evident which quadrants had fluid collection because the jaws had compressed the opposite quadrants. Another thought on <The other problems she is having are; breasts enlarged lots during all three pregnancies, had too much milk with first two and has tons this time, too. Has engorgement even with home birth, lots of nursing from beginning.> I see this mom as one who may have been gifted, when she was an embryo within her own mom, with a full complement of secondary buds branching off the primary bud, and every one of them canalized, so that she might be one of those moms who truly might have 20 lobes to each breast, whereas many others may have only 10, or fewer. I had a mom with such a history (in-hospital, but completely natural water births and early hospital discharge) several months ago. My prenatal plan suggested to her was: 1) to avoid heat from the beginning, other than an occasional warm shower falling mainly on her back, 2) If needed for comfort, use cold packs for 20 minutes at a time, no oftener than every 2 hours. 3) use only one breast for any and all feedings within a 3 hour period, switching to the other during the next 3 hours, 4) very, very gradually begin extending that time slightly, to take advantage of any possible 'feedback inhibition' that might be operational at that stage. 5) completely avoid pumping unless she absolutely felt she had to remove just a small amount for comfort, preferably by hand expression. 6) use forward massage and breast compression to keep milk moving forward during nursing, 7) then if edema was obvious, spend time lying on her back, with upward massage toward the axilla and clavicle to use gravity to help move interstitial fluid backward through the lymph channels. She decided she didn't need the cold packs, nor the time on her back with upward massage, but otherwise followed this plan fairly closely. This, her 3rd nursing experience was much more comfortable than the first two, and she had only about 12 hours discomfort at the height of the swelling, and nursing continues to be satisfactory. 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 mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(R) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html