Introduction
Breast fullness and breast engorgement are different.
Breast fullness is characterized by swollen yet compressible breast tissue. The
infant is able to latch on properly and suckle effectively at a full breast.
Breast engorgement is characterized by swelling, heat, hardness of breast
tissue, breast skin tightness, discomfort, and in severe cases pain. The infant
has difficulty latching to an engorged breast due to the hardness of the
tissue, which decreases the milk transferred from mother to baby. The inability
of the infant to transfer milk can exacerbate the engorgement.
Riordan and Auerbach recommend that only electric pumps
that provide intermittent vacuum at minimum pressure should be used to relieve
engorgement. They further suggest that pumping the breasts to relieve
engorgement "should also be limited to a maximum duration of 10 minutes to
avoid traumatizing the distended breast tissues."(page 228 -
Breastfeeding and Human Lactation 1993)
This pilot study examined the effectiveness of a new
method of milk expression for the relief of engorgement and for its impact on
breast tissue. The Whittlestone Breast Expresser uses compression and a
constant underlying vacuum to produce a low, sinusoidal delivery of vacuum to
the breast for milk expression. This dynamic combination of vacuum and compression is termed pulsation.
Methods
A convenience sample of eight women was used. Women in
the first week postpartum seeking lactation management assistance for painful
breasts were asked to use a new type of electric breast milk expresser. The
women reported that the infants were unable to latch on the breast. After
consent was obtained, the breasts were palpated by an IBCLC and assessed for
hardness, lumps, heat, and dilation of the veins. The Whittlestone Breast
Express Kit ™ was then placed on the woman's breasts. The pressure
was set on the lowest setting and increased slightly to the mother's comfort.
Milk ejection reflex (MER) was timed in hundredths of a minute. Total expressed
volume from both breasts was measured in milliliters (ml). Total time expressing was timed in minutes
and expressing was stopped at 20 minutes or when breasts became slightly
compressible, whichever came first. After expressing, the breasts were visually
inspected for any trauma. Each woman was asked if she felt any discomfort. The
total amount of time before the baby was able to latch on the breast was
measured in minutes from the start of expressing. Warm compresses were not used
on the breasts before expressing.
Results
The information for each individual is listed in Table 1. All of the eight women were able to
latch the baby on their breasts after expressing. The average time to MER was
three minutes. The average Total Time of expressing was almost 14 minutes. The average
Total Volume was 54 mls.
|
Table
1. All times are expressed in minutes.
|
|
Participant
|
Time
to MER
|
Total
Volume Expressed
|
Total
Expresser Time
|
Time
to latch-on
|
|
#1
|
1.50
|
48 mls
|
19.00
|
20.00
|
|
#2
|
1.75
|
64 mls
|
8.00
|
8.50
|
|
#3
|
1.00
|
68 mls
|
11.00
|
12.00
|
|
* #4
|
10.00
|
44 mls
|
20.00
|
25.00
|
|
#5
|
.50
|
42 mls
|
6.50
|
9.00
|
|
#6
|
2.00
|
70 mls
|
13.00
|
13.5
|
|
#7
|
2.25
|
34 mls
|
15.50
|
18.00
|
|
#8
|
1.50
|
62 mls
|
18.50
|
20.00
|
|
Average
|
3.00
|
54 mls
|
13.94
|
15.75
|
The information from all
eight women was used in the initial analysis. However, the average time to MER
without the highest and the lowest times is 2.25 minutes with a standard
deviation of .65 minutes. Averages and standard deviations, without the highest
and lowest value, are seen in Table 2. None of the eight women had nipple
damage or trauma to the breast tissue after expressing. All eight women
reported feeling no discomfort while expressing. All eight infants were able to
latch on within a maximum time of twenty-five minutes and nursed until they
were full.
|
Table
2. All times are expressed in minutes.
|
|
Participant
|
Time
to MER
|
Total
Volume Expressed
|
Total
Expresser Time
|
Time
to latch-on
|
|
#1
|
1.50
|
48 mls
|
19.00
|
20.00
|
|
#2
|
1.75
|
64 mls
|
8.00
|
8.50
|
|
#3
|
1.00
|
68 mls
|
11.00
|
12.00
|
|
#6
|
2.00
|
70 mls
|
13.00
|
13.5
|
|
#7
|
2.25
|
34 mls
|
15.50
|
18.00
|
|
#8
|
1.50
|
62 mls
|
18.50
|
20.00
|
|
Average(std)
|
2.25(+.65)
|
58 mls(+14)
|
14.17(+4.32)
|
15.33(+4.73)
|
Discussion
Eight subjects is a small
number on which to base conclusions. The Whittlestone Breast Expresser worked
well for these women. It may not be appropriate for every woman that is
experiencing engorgement. More study is needed with larger numbers of
participants before generalized conclusions can be drawn.
*Participant #4 was apprehensive about using an electrical device for expressing milk. She was
concerned about pain but was willing to "try anything" to get the
baby latching on and transferring milk. Much to her relief, she did not experience pain while using the
Whittlestone Breast Expresser. Twenty mls of transitional milk were expressed
from the left breast and twenty-four mls from the right side. The baby then
latched on to the left breast and vigorously transferred milk for six minutes.
Baby was burped and nursed on the right breast until asleep.
This research was conducted by Health & Nutrition, Inc. of Reno, Nevada. Robin Hollen, RN, IBCLC and Jimi Morrill, BS, MS, IBCLC are the lactation consultants for Health & Nutrition, Inc.
