dek ini apa yah? koq bengkak putingnya? hehehehee kebanyakan kali ya dek? ![]()
-------Original Message-------
Date: 01/03/05 11:54:24
Subject: Re: [balita-anda] Bengkak di puting
Pak Bambang,
Mu menambahkan input dari yg lain.
Sptnya istri bapak kena plugged duct / engorgement ya. Hmmm bengkaknya ini
krn payudara penuh dg ASI atau krn ada benjolan keras yg sakit sekali jika
dipegang ? Kalo krn penuh ASInya, saran saya coba di massage pelan2 dan
dikeluarkan dg cara diperas atau dipompa.
ASI perasan tsb diberikan ke Razi dg sendok.
Kalo ada benjolan keras yg sakiiit sekali bisa jadi ada mastisis. Tapi
feeling saya sih gak sampe sejauh itu krn gak ada luka kan di sekitar
puting. Kalo bapak gak yakin, saran saya bawa istir bapak ke klinik
laktasi terdekat dan minta saran utk treatmentnya.
Btw coba bapak buka artikel2 ttg mastisis & plugged duct di
Semoga membantu.
Lulu
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Engorgement:
Full, hard breasts can occur in the early days of breastfeeding. This may
result in flat nipples which make it difficult for your baby to latch on.
To avoid this condition be sure your milk is being removed frequently from
your breasts. If your newborn is not breastfeeding every 2 hours or so,
hand-expressing or using a breast pump may help you avoid engorgement. (As
your baby grows he will go longer between feedings without you becoming
engorged.) This article
contains a "Suggested Care Plan for Engorgement" which will help you treat
engorgement if it occurs. (The Web page
of hand-expressing using the Marmet
technique.)-------------------------------
New Perspectives on Engorgement
From: LEAVEN, Vol. 35 No. 6, December 1999-January 2000, pp. 134-36
Engorgement is associated with maternal discomfort, difficulty with
latch-on (which can lead to plugged ducts and mastitis), and the premature
termination of breastfeeding. Several studies cite engorgement and breast
or nipple pain as primary reasons for the cessation of breastfeeding.
Engorgement is most common during the first week of breastfeeding and
occurs as a result of delayed, infrequent or interrupted removal of milk
from the breast.
While some breast fullness is normal in the second to fourth day after
birth, a mother should continue to feel well and her nipple and areola
should remain compressible. Occasionally this fullness may last as long as
seven days.
Mothers may describe their breasts as feeling warm, full, and heavy; some
have said they "woke up with something heavy on their chest." This normal
condition is caused by congestion and swelling of breast tissue as blood
and other fluids begin to accumulate along with increased milk volume in
the alveoli as milk production begins.
According to Dr. Ruth Lawrence in Breastfeeding: A Guide for the Medical
Profession, engorgement of the breast involves three elements: congestion
and increased vascularity (the physiologic response that follows removal
of the placenta and does not depend on suckling); accumulation of milk,
also a physiologic response to placental removal; and edema (swelling and
fluid retention). Breasts that are congested with milk are prone to
swelling as circulation slows, allowing fluid in the blood vessels to seep
into the breast tissues. When this sequence proceeds smoothly, no pain,
discomfort or excessive swelling occurs. However, when the edema is
evident and the surface of the skin pits with pressure, this process
requires intervention. Pathologic engorgement is the result of
mismanagement of this normal transitional period and is a condition of
abnormal, exaggerated breast fullness accompanied by heat, tenderness and
low-grade fever. It can also happen at any time during the breastfeeding
relationship when the breasts are not emptied and milk accumulation in the
breast is prolonged. The breasts can be hard and uncomfortable with tight,
translucent skin; there is frequently distention of tissue extending into
the underarm area. Severe engorgement can cause numbness and tingling of
the mother's hands from pressure on her nerves.
The nipple may be stretched and flattened by the forward pressure of milk
under the areola. Even though the nipple may appear normal, it can be
difficult for the infant to grasp. Nipple damage can occur when the infant
unsuccessfully tries to grasp and draw the nipple and areola into his
mouth.
Though there may be no evidence of infection at this time, a low-grade
fever or "fever of unknown origin" may cause the health care provider to
suspect an infection. Occasionally treatment for the "infection" can
interfere with the resolution of the engorgement and the continuation of
breastfeeding.
In a hospital setting, engorgement is seen often in mothers who have had
operative or cesarean births; feedings are often delayed due to pain or
reluctance to hold the baby in a position near the incision. Sometimes
breastfeeding is delayed due to misinformation about medications the
mother is receiving. In situations when mothers are discharged from the
hospital within 24 to 48 hours, engorgement sometimes does not begin until
mother is at home.
New information shows that mothers who received medications to suppress
blood pressure or prevent seizures in the labor and delivery period may
also experience a delay in milk production along with a related delay in
engorgement.
There is evidence that unrelieved engorgement can cause damage to the
alveoli in the breast, thus impacting potential for milk production.
Whenever milk is allowed to accumulate in the breast, a protein present in
the whey fraction of the milk acts to inhibit the production of more milk.
In addition, the process of engorgement creates pressure within the ducts
which can lead to atrophy of the secretory and myloepithelial cells (the
cells responsible for the manufacture of milk in and the removal of milk
from the alveoli). This situation, called pressure involution, can
contribute to decreased milk production and is a risk factor for lactation
failure.
One recent study (Moon & Humenick 1988) identified several factors that
increase the risk of engorgement. Short or restricted feedings are a
contributing factor as are the use of complementary and supplementary
feedings. This study also suggests several variations in patterns of
breast engorgement occurrence. Mothers with more than one child or
pregnancy were more likely to report more intense engorgement than were
those having their first child. Obviously, mothers' experiences may differ
under similar circumstances, however, this knowledge can help prepare a
woman to cope with the experience.
During La Leche League meetings mothers can be introduced to the idea that
some breast fullness is normal and they can learn management techniques
for breast fullness. They may be surprised to know that it is common and
temporary, when babies breastfeed early, often and effectively.
Frequent feedings with intervals of one and one-half to two hours are
essential. An effective latch is vital to effective breast emptying.
Mothers should hear audible swallowing at this point of milk production.
Mothers who are unable to feed the baby due to separation or pain can be
encouraged to use a breast pump in combination with other treatments.
If normal breast fullness is present, some manual _expression_ of the breast
prior to a feeding may be sufficient to soften the areolar- nipple
junction, enhancing latch-on and effective breast emptying.
The Use of Thermal Treatments
Some currently recommended treatment measures include the use of cold
compresses on the breasts between feedings to reduce swelling. In the
not-so-distant past, the use of heat prior to a feeding was encouraged "to
help milk flow." Although there is little research to prove the
effectiveness of either heat or cold treatments, the experience of many
breastfeeding specialists shows that the use of cold is more effective.
Some theories to support this new recommendation are that cold reduces
vascular and lymphatic congestion, reduces swelling and enhances milk
flow. Although some cultures avoid the use of cold during the postpartum
period, an explanation may make this treatment method more acceptable.
When using cold compresses, always use a layer of fabric between the skin
and the cold source. There are products available commercially for cold
treatments but usually crushed ice in a plastic bag or the ever-popular
frozen vegetable ice pack works just as well (bags of peas or corn mold
well to the area needing coverage). Be aware that cold on or near the
nipple can impede a let-down. The use of heat increases vascular
congestion and swelling and may impede milk flow. While it may feel
soothing, if a mother chooses to use warmth she should be cautioned to use
it only immediately prior to latch-on or pumping and for no longer than 3
to 5 minutes. Prolonged application of heat has the potential for
increasing swelling. A warm shower with spray directed at the back, not on
the tender, sensitive breasts, may help relieve breast tension and improve
milk flow as well. Other women have reported good results from immersing
the breasts in a basin of warm water while doing some gentle massage prior
to a feeding. Others have reported that using a few drops of olive oil
applied to the skin of the breast (not on the nipple) helps avoid skin
discomfort when doing breast massage.
The use of raw green cabbage leaves has been anecdotally reported to
reduce engorgement. Mothers who have used this treatment report the use of
chilled or room temperature cabbage leaves to be soothing. The advantages
of this treatment are its low cost and convenience. One study reported the
group using cabbage leaves experienced a slight reduction in perception of
engorgement and exclusively breastfed longer (Roberts 1995b). A study
comparing the use of chilled cabbage leaves to chilled gel packs found
that pain was relieved within 1-2 hours with both treatments, but mothers
preferred the cabbage treatment (Roberts et al. 1995a).
The clean, inner leaves of a head of green cabbage can be applied between
feedings for several feedings. The leaves should be changed at least every
two hours or when they wilt. Mothers should know that there may be some
smell of cooked cabbage if they choose this treatment method. They should
also know that overuse of cabbage leaves can lead to a reduction in milk
supply according to some reports. Cabbage leaves should be used only until
the swelling goes down and should be discontinued if a skin rash or other
signs of allergy appear.
Other Treatment Measures
The goals of treatment for engorgement are to reduce vascular and
lymphatic congestion and remove milk from the breasts. Use of a breast
pump is sometimes discouraged due to a fear of engorgement reoccurring,
but it can be part of an effective treatment plan. For a breast pump to
assist in the treatment of engorgement, it must effectively and gently
remove milk. An automatic cycling breast pump with adjustable suction
levels is most effective. Breast tissue is fragile when engorged and can
bruise easily. For this reason, gentleness should also be emphasized when
recommending massage of the breast during this time.
The mother may find that the use of pain medication is helpful. She can
ask her health care provider to recommend an over the counter
anti-inflammatory medication. Most are approved by the American Academy of
Pediatrics for use in breastfeeding mothers; specific drugs can be
researched by a Professional Liaison Leader. Binding the breasts is not
recommended although a supportive bra may be worn if mother is
comfortable. Some women prefer a "sports bra" for support during
engorgement. Mothers should NOT limit fluid intake to reduce engorgement
as adequate fluid intake is needed in the postpartum period to avoid
urinary tract infections and constipation.
Occasionally, wearing breast shells for about 30 minutes prior to a
feeding will help reduce the pressure and help the nipple to evert. This
does encourage the breast to leak which can help relieve the tightness of
an overfull breast.
Other Circumstances That May Be of Concern
A mother who has had breast augmentation surgery with implants should
avoid severe engorgement. She is at risk for pressure involution and a
reduction in milk supply in addition to the possibility of a breast
infection. If the baby is sleepy or not nursing well, an automatic cycling
breast pump may be helpful during this time if the mother feels
uncomfortable using hand _expression_.
When physiologic engorgement is treated promptly and consistently,
resolution should occur within 24-48 hours. Resolution of severe
engorgement may take anywhere from one week to longer. Mothers may need
some assurance that they have an adequate milk supply when engorgement is
resolved.
Suggested Care Plan for Engorgement
Frequent feedings: at least every 1.5 to 2 hours around the clock; let
baby nurse as long as possible, no time restrictions at the breast.
Warm compresses can be used for a few minutes prior to a feeding if the
mother desires. Use a warm, wet towel to cover the entire breast. It may
facilitate milk let-down in the early stages of engorgement.
Gentle areolar _expression_ can help soften the areola to assist with latch-on.
An electric breast pump can be used at low settings, if necessary to empty
the breast enough to facilitate a latch-on.
Vary nursing positions to help promote drainage of the breast; use gentle
massage during a feeding if it is comfortable.
Apply ice or cold compresses to the breasts between feedings or pumping
sessions for approximately 15-20 minutes.
Raw green cabbage leaves can be used as a compress instead of ice, if
desired. The leaves should be changed when wilted or after 2 hours. The
breasts should be assessed for reduced swelling and enhanced milk flow
with each change of cabbage leaves until the desired result is obtained.
A supportive bra may be helpful; avoid underwire styles at this time.
The mother may ask her doctor to suggest an anti-inflammatory drug
compatible with breastfeeding for pain and swelling.
The mother should contact a health care professional if any of the
following symptoms are present: temperature of more than 100.6 degrees F
(38.1 degrees C), chills, body aches, localized pain or flu-like symptoms.
Breastfeeding is not contraindicated in the case of an elevated
temperature.
AYO GALANG SOLIDARITAS UNTUK MEMBANTU KORBAN MUSIBAH DI ACEH & DAN SUMATERA UTARA !!!
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