Edema of areola
... Preparation of the breast for the attachment of the child during the engorgement.
Jean Cotterman, RNC, IBCLC.
Translation by V. Nesterova, with permission of the author.
Physicians are increasingly noticing that mothers whoreceived during the birth numerous intravenous infusions, swelling after childbirth leave later than usual. This increased edema in the early postpartum period increases breast engorgement, increases the density of tissues in space behind the areola, changes the shape of the nipple and interferes with the comfortable, effective application of the baby to the breast.
I would like to share a reception that turned out to bevery effective for moms in the first 7-14 days after delivery. I call it the Pressure Relaxation (English original - Reverse Pressure Softening). This method uses gentle pressure on the areola. It can be used by health workers, and / or he can be taught by his mother - if necessary, even with telephone consultation.
The volume of intercellular fluid can increase by30% before our eye sees swelling (Guyton, 1977). Therefore, early, preventive use of diabetes can improve the outflow of milk, prevent discomfort and nipple injuries, help nagrubaniya go faster.
As for the application of the breast pump, the impactnegative pressure (vacuum) on the areola during this period may lead to further increase of the edema of the tissues in the area where the funnels of the breast pump adjoin the breast, especially if pumping is carried out at maximum draft. Such an "additional layer of puffiness" can block access to the lacteal sinuses in the region of the areola. When this happens, neither the work of the baby's tongue, nor the manual pumping, nor the breast pump itself can effectively remove the milk from the breast.
It is best to apply SD directly beforeeach application of the child to the chest, as many times as required. It is necessary to press evenly and gently on the areola towards the chest and keep the pressure at least a full minute, and even longer (2-3 minutes, repeating, as necessary). It is necessary to focus on the areola where the nipple joins it. (To see the time, but do not follow the arrow of the clock, you can ask your mother to sing a lullaby.)
If the nails of the mother are short enough, she cansimultaneously press the areola with the bent fingers of both hands, while her nail plates will almost touch the nipple. The goal is to create a ring of 6-8 small holes or dents in the areola around the base of the nipple. If a medic or other assistant does this, two large or index fingers are pressed to the areola sideways. As a result, dents of 2.5-3 cm in length appear from above and below the nipple. But this method will require additional 60 or more seconds of pressure: the fingers will have to be rotated by 90º (partly overlapping the first dents) to ensure softening of the same area around the nipple.
If the edema is extremely strong, the areola tissue is veryfirm, when using the pressure method with your fingertips, an additional 1-3 minutes of constant pressure may be necessary for a better result. (A relaxed observation of how a trickle of sand flows in a three-minute hourglass is another good way to record time and avoid a restless expectation).
When the areola is strongly swollen, the methodpressure by two fingers, it is possible to achieve a more even distribution of the interstitial fluid if one presses on the sectors alternately, in three or more approaches for 60 seconds each.
If a mother who has short nails is freeonly one hand, it can make a "hole" in the central part of the areola, grasping the nipple and pressing your fingers inward, towards the chest for 1-3 minutes. In this case, the bent first phalanges of the fingers increase the pressure application area. If necessary, you can turn your hand from a different angle and repeat.
- Any excess of intercellular fluid is temporarily squeezed inward, towards the natural outflow of lymph.
- Longitudinal compression of ducts under the areola displacespart of the milk back, into deeper channels. The weakening of tension in the walls of the overflowed ducts under the areola reduces the discomfort when applying. Increases the elasticity of the nipple-areola complex, and as a result, the child can draw it into the mouth deeper; The breast gives milk better in response to the wavy movements of the baby's tongue.
- Almost always in three minutes or evenearlier it is possible to cause a reflex of separation of milk due to uniform stimulation of nerves going to the nipple and areola. This reflex moves the milk forward, to the nipple.
After applying SD it is easier to get andadditional manual pumping to further soften the areola. It comes out more comfortable and efficient. If the engorgement is very strong, additional manual pumping in the area where the child's chin will be, often helps to achieve a deeper breast capture.
Guyton, AC, Basic Human Physiology: Normal Function and Mechanisms of Disease, 2nd Ed. W. B. Saunders Co. Philadelphia, 1977, p. 321.
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