Reverse Pressure Softening: A Simple Tool to Prepare Areola for Easier Latching During Engorgement

Abstract

Successful breastfeeding requires efficient milk transfer through the nipple-areolar complex, which includes subareolar tissue. Subareolar tissue resistance increases during engorgement, when expanded circulation and excess interstitial fluid compete for space with increasing milk volumes. Physiologic and iatrogenic events often combine to produce distortion of breast anatomy. Resulting latch difficulty, delayed milk ejection reflex, poor milk transfer, pain, and nipple damage discourage many mothers. The rationale and technique for a simple intervention developed in practice are described: reverse pressure softening (RPS) before latching significantly reduces resistance of subareolar tissue, temporarily freeing it to interact more efficiently with the baby's mouth. RPS also triggers the milk ejection reflex promptly. The health care provider can perform RPS or teach the mother and her significant others, even by telephone.

Factors associated to nipple trauma in lactation period: a systematic review

“…7 In these cases, the complex area of the nipple-areola region is flatten so more distortion of the anatomy of the breast, a fact that makes it difficult to handle the infant correctly, leading to nipples injuries. 45,46 Women with malformed nipples also presented greater chances to occur injuries when compared to breastfeeding women with protruding nipples format. 32 The nipple injury was associated to pain, 33 a common symptom that may occur in the first few hours of maternal breastfeeding 47 and is indicated as inadequacy of handling the infant to the mother's breast.…”

Conquering Common Breast-feeding Problems

“…This exposes the nipple for an easier latch. 12 • Oral anomalies such as mandibular asymmetry or ankyloglossia (tongue-tie) are infant-related conditions that can produce exquisitely sore nipples. Infants with torticollis (head turned to 1 side and tilted toward opposite shoulder) can present with feeding and latch difficulties due to asymmetries and upward tilting on 1 side of the lower jaw and gumline.…”

Breastmilk Expression and Breast Pump Technology

“…Swelling of the nipple-areolar complex can cause the infant to nurse superficially on the breast, resulting in significant nipple trauma. 15 Manual expression and reverse-pressure softening 41 are helpful to soften the areola to allow a deeper, less traumatic infant latch and suck. Frequent, effective infant feeding postpartum helps to prevent severe engorgement.…”