2024年5月18日发(作者：内存条的作用和功能)

Engorgement Help: Reverse Pressure

Softening

JULY 27, 2011. Posted in: BF CONCERNS: MOTHER,COMMON NEWBORN CONCERNS

… a technique to aid latching

when a mother is engorged

Finnish | Russian

by K. Jean Cotterman RNC, IBCLC. Reprinted with

permission from the author.

More health care providers are observing that

mothers receiving multiple intrapartum IV’s

experience delay in expected postpartum fluid shift.

越来越多的医疗服务人员发现，那些接受过静脉注

射的产妇，他们的产后泌乳会被推迟。

Increased edema during the puerperium complicates

engorgement, increases sub-areolar tissue resistance,

distorts the nipple and interferes with comfortable,

efficient latching.

在产褥期，持续增加的水肿会使局部充血肿胀的问

题更加复杂，增加乳晕下组织的阻力，造成乳头扭

曲，干扰（宝宝）舒适而有效的衔乳。

Edema may appear early, or later, within 48-96 hours,

often lasting 10-14 days.

这种水肿的出现或早或晚，一般会在48-96小时出

现，常常持续10-14天。

(This may depend on both the quantity of IV fluid

given and the time of infusion in relation to placental

delivery, the stimulus for lactogenesis II.)

（这主要取决于分娩时静脉注射的总量、时长，以

及还有对第二泌乳产程的刺激程度。）

Reverse pressure softening (RPS) is a simple

intervention that has proven very helpful in the first

14 days postpartum.

据证实，在产后最初的14天，反式按压法是一种

非常简单的疗法。

RPS uses gentle positive pressure to soften a 1-2

inch area of the areola surrounding the base of the

nipple, temporarily moving some swelling slightly

backward and upward into the breast.

反式按压法是通过温和地按压乳晕，以此来软化乳

头周围1-2英寸处的乳晕，暂时地将肿块向上和向

后稍稍推开。

RPS may be applied by the health care provider,

and/or taught to the mother/significant others, if

necessary, over the telephone.

反式按压法可以由医生亲自操作，假如有必要还可

以通过电话方式教授具体操作方式。

Interstitial fluid volume increases 30% above normal

before edema becomes visible.

当乳房内组织液增量超过正常水平的30%，并且通

过肉眼就能分辨时。

(Guyton) To contain edema, areolar tissues must

expand, limiting their ability to extend the nipple well

into the baby’s mouth.

这时，乳晕组织就必须扩张以适应这些水肿，这样

宝宝就不能很好的衔乳。

Early proactive use of RPS causes no harm and may

facilitate increased milk transfer, reduce risk of nipple

trauma, and help resolve engorgement.

早期的反式按压法介入不仅无害，还会有助于乳汁

的生成，降低乳头创伤的产生，同时还可以辅助性

的解决乳房肿胀充血的问题。

Conversely, pumping may attract edema into the

flange area, especially at maximum vacuum settings.

相反的，假如使用吸奶器，特别是在用最大吸力档

的时候，会将肿块吸到乳头边缘。

Areolar tissue may then appear “thickened”, seeming

to “bury” the subareolar ducts.

这样一来，乳晕组织将增厚，无形中将乳晕下导管

“深埋”。

Then, neither infant tongue action, fingertip

expression nor the pump itself removes milk very

successfully.

这样一来，无论是婴儿的吮吸，还是指尖按压，甚

至是吸奶器本身都无法将乳汁吸出。

RPS is best performed immediately before each

attempt to latch, for as many feedings as needed:

在每次喂养之前，反式按压法是最好的按摩方式。

The mother may prefer to apply RPS herself, or the

HCP, with her permission, may apply RPS.

反式按压法既可以是妈妈自己亲自操作，也可以

由医生代为操作：

▪

facing the mother, or

正面面向妈妈

from slightly behind the mother, reaching

over her shoulders

妈妈躺着，按摩的人在妈妈头顶方向

or place his/her fingers over those of the

mother, to reinforce pressure.

帮助妈妈按照反式按压手法摆好，由医生

辅助按压。

▪

▪

The firmer or more swollen the areola, the more

time is needed to achieve pliability.

乳晕的越是肿胀，按摩所需的时间也就越

长。

▪

RPS often forms temporary “dimples” or

“pits”, but edema soon re-enters the pits after

pressure is released.

按压所到之处往往会造成局部组织凹陷，

但随着按压停止，水肿又会马上将凹陷填充。

▪

Positioning the mother with severe edema

flat on her back during RPS delays re-entry of

swelling, allowing a longer window of time for

latching.

按压期间保持妈妈平躺姿势，以此延缓水

肿的再生，保持按压手法要保证足够的时间。

（或者保证足够长的衔乳时间）

Firmly but gently, press steadily on the

areola, right at the nipple base.

结实而又温柔的按住乳头根部的乳晕。

Pressure should not be firm enough to

cause pain. Avoid discomfort with less pressure

for longer intervals.

按压力度要适中不宜造成疼痛。也应该避

免长时间的轻度按压造成的不适。

Press inward toward the chest wall for a full

60 seconds or longer (10-20 minutes or more if

needed. This is a good time for instructions.)

▪

▪

▪

朝胸壁内按压60秒或更长时间（若有需

要，可10-20分钟或更长。这是我们建议的合

理时长。）

▪

Any finger combination may be used. (See

diagrams)

你可以采用任何手指组合的按压方式。（如

图）

▪

Mothers may find short nails with curved

fingertips of both hands the most effective

method.（图1）

One-handed methods are convenient if the

other hand is busy.（图2 最好是借助一小面镜

子）

▪

▪

HCP’s may find straight-fingers（图3） or

two-thumb methods（图4 分为两步） more

convenient.

▪

Use the flats of two thumbs or the first several

fingers on each hand lengthwise above and

below the nipple, creating a 1-2 inch long

depression.

▪

Continue to alternate in opposite quadrants,

with repeated 2 minute periods of pressure,

partially overlapping the first set of pits, to

keep edema displaced from the entire area at

the base of the nipple.

Two handed, one-step method Two handed, two-step method

Fingernails short, fingertips curved; Using 2 or 3 straight fingers on

each one touching the side of nipple. each side, first knuckles

touching nipple. Move ¼ turn.

Repeat above & below nipple.

Two thumbs, two-step method (Step

1).

Using straight thumbs, base of

thumbnail even with side of nipple.

One handed “flower hold”

Fingernails short, fingertips curved,

placed where baby’s tongue will go.

(To see your areola better,

try using a hand mirror.)

Two thumbs, two-step

method (Step 2).

Move ¼ turn. Repeat above & below

nipple.

Soft ring method

Cut off bottom half of an

artificial nipple to place on

areola to press with fingers.

After RPS, additional fingertip expression to further

soften the areola is much easier, more comfortable

and more productive.

通过反式按压之后，后续软化乳晕的指压按摩也会

变得更加简单，更加舒适，更加有效。

Creating a special niche for the chin often permits

deeper latching

人为的张开宝宝的下颌以便深度有效的衔乳。

Benefits of RPS include:

反式按压法的好处：

▪

Steady stimulation of nerves under the areola

automatically triggers the milk ejection reflex,

propelling milk forward in the breast, nearly always

within 1-2 minutes or less.

对乳晕下的神经加以稳定的刺激会自然地触

发泌乳反射，促进乳汁的分泌，这种促进作用会持

续1-2分钟。

▪

Excess interstitial fluid is temporarily moved in

the direction of natural lymphatic drainage.

多余的组织间隙液将会暂时的被移至本身的

淋巴导流方向中。

▪

Displacing milk slightly backward into deeper

ducts relieves over-distention of subareolar ducts,

reducing latch discomfort and facilitating milk

transfer.

可以将乳汁移回深层乳汁导管中，从而将乳晕

下导管扩张，以降低宝宝衔乳给妈妈带来的不适并

且促进乳汁转化分泌。

▪

Areolar elasticity is freed for

乳晕重获原有的弹性

▪

extending the nipple more deeply into

baby’s mouth

让乳头能有更好的延展性，更深入宝宝的嘴中

responding to the rippling of the tongue.

增加有效吞咽

▪

Guyton, AC, Basic Human Physiology: Normal

Function and Mechanisms of Disease, 2nd Ed., W. B.

Saunders Co. Philadelphia, 1977, p. 321.

Permission is hereby given to reproduce and

distribute this article as long as the original wording

and my authorship and credit for diagrams by Kyle

Cotterman are retained. You may contact me at:

*****************

See also:

Engorgement at KellyMom

Too Swollen to Latch On? Try Reverse Pressure

Softening First by K. Jean Cotterman, RNC, RLC, IBCLC,

from Leaven, Vol. 39 No. 2, April-May 2003, pp.

38-40.

Cotterman KJ. Reverse Pressure Softening: A Simple

Tool to Prepare Areola for Easier Latching During

Engorgement. J Hum Lact 2004 20: 227-237.