Engorgement - Have you heard of ‘Reverse Pressure Softening’?
What is Reverse Pressure Softening (RPS)? I like to describe it as:
"A simple technique that you can perform independently just prior to attaching your baby to your breast. It requires only the use of your fingers to help you and baby attain a deeper more comfortable latch together".
You may be asking - When would I have a need to use this technique, and how does this relate to engorgement as I have referred to in the title of this blog post? Let us define engorgement first, followed by the rationale and techniques of RPS.
Engorgement can be defined as:
“…a mum’s breasts can become very hard, swollen and tender and her nipples become stretched and flattened. The milk will not flow well and it can be difficult for her baby to attach to the breast”
ABA
https://www.breastfeeding.asn.au/resources/engorgement
To explain further - engorgement can occur as a singular response to, or a combination of events such as:
** Large amounts of intravenous fluids given throughout labour and birth.
** Delayed first breastfeed with your baby.
** Your transitional milk comes in rapidly, as opposed to a slower progression in milk volume (colostrum to ‘transitional milk’ - expected between day 2-5 after giving birth. ‘Mature milk’ = 2 weeks after giving birth, and for the duration of your breastfeeding journey).
** Baby unable to adequately transfer your milk efficiently, that is, no noticeable softening of your breast tissue following a full feed on one or both sides.
** Supplemental or complimentary top ups with stored expressed breastmilk, or formula without removing milk from your breast for that feed (ie: hand expressing, or by manual/electric breast pump).
** Consciously or unconsciously delaying a feed (eg: baby slept longer than normal; separated from your baby; prolonged use of a dummy/pacifier when baby is showing feeding cues).
** Pumping and collecting your milk for future storage (eg: returning to work, preparing for a social engagement that requires you to be separated from your baby, or personal preference).
RPS is definitely a technique for you to explore in circumstances where you notice an increased swelling of your breasts, that causes the areola to be significantly swollen to the point of your nipple flattening or protruding much less.
To provide you with a visual of an engorged breast where RPS can help, I describe it like this:
“If you were to blow up a balloon to its maximum capacity, and then using your thumb and fingers in a C cupped shape (as you would hold a sandwich to eat), try and bring your top fingers and thumb together at the very base/bottom of the fully inflated ballon - it is almost impossible to achieve without the balloon bursting. That is, there is no give in the structure of the ballon. Now imagine your baby trying to latch to a significantly engorged, very firm areola and flattened nipple. If your baby is unable to easily vacuum in your breast tissue (areola and nipple) as they do at every successful and comfortable breastfeed, feeding has the potential to become trickier for you both.
RPS allows for the adjustment of breastmilk and additional circulating and fluctuating fluids beneath the skins surface (all normal when engorgement occurs) - to be redirected back in and away from the areola and nipple temporarily- which in turn, allows your baby to have a softer landing pad to adequately take in enough breast tissue to feed well and comfortably. This promotes:
A softer more pliable breast tissue (areola and nipple) - to be vacuumed more easily into your baby’s mouth, that more easily presses up and against their palette which elicits your baby’s instinctual sucking reflexes
Greater nipple comfort during feeding
Stimulation of the ‘Milk Ejection Reflex’ (AKA - Milk ‘Let Down’)
Easier milk transfer to your baby
Greater breast comfort post feeding
Minimising nipple damage that in turn is protective against breast inflammation and mastitis.
Please note, it is recommended RPS is best performed immediately before you attach your baby.
K Jean Cotterman, a Registered Nurse and IBCLC, has very kindly provided the techniques of and explanation in how to perform RPS. Please access all this information below in its original content. The RPS drawings are provided by her grandson - Kyle Cotterman. Permission to use.
[1] Health- e - learning
[Fact Sheet]
https://www.health-e-learning.com/articles/RPS_JCotterman_ver2005.htm
[2] ’The Breastfeeding Companion’- is a registered charity, providing free, research-based information, and led by an IBCLC, Jackie Hall – IBCLC & Founder of The Breastfeeding Companion.
[Video - explanation and demonstration]
https://thebreastfeedingcompanion.com/project/reverse-pressure-softening/
[3] [Australian Breastfeeding Association (ABA)]:
[Engorgement, RPS - Diagrams and technique]
