Welcome Spring! It’s always a good feeling when the weather becomes warmer so that the children are seen playing in the park! I love it when the days are longer, too! What’s been happening? On my personal life side, my mom has settled into our household regimen and is helping me out some with the household chores and fetching pumps. Our son adopted a new American Bulldog named Oscar who has stolen all of our hearts! Our daughter graduated from middle school and will go to high school next year. The years are going by fast! Our son will be going to school for EMT training.

This summer our family will be vacationing in Los Cabos Mexico. It will be sunny and hot! We’re looking forward to sitting around the pool gazing at the beautiful ocean with a Margarita sipping contest! Then the next time I go west in July will be hot again as our U.S. Lactation Consultant Association conference takes place in sunny Las Vegas! I will be finishing my 2-year term on the board of directors and transferring the baton! It was a nice experience, but I’m also finished with my part in the progression of insurance reimbursement for lactation consultations. My record of reimbursements is excellent in the state of IL with the advanced practice nurse license. I really am grateful! In fact, one persistent mom pestered Blue Cross/Blue Shield enough that she was reimbursed the entire purchase price of her Pump In Style Advanced breastpump because she had twins.; There are a few other billings in the works right now for other infants with a medical necessity of the breastpump because of medical problems. In my experience, I still hear of too many people spending money on the purchase of breastpumps at the stores and not getting reimbursed according to their insurance policy. It seems to be a deep, dark secret!

Here are the abstracts of two recently published articles from the team of Dr. Peter Hartmann:

Tongue movement and intra-oral vacuum in breastfeeding infants.

Geddes DT, Kent JC, Mitoulas LR, Hartmann PE.
The University of Western Australia, Biochemistry and Molecular Biology, School of Biomedical, Biomolecular and Chemical Sciences, Faculty of Life and Physical Sciences, Australia.
OBJECTIVE: The mechanism by which the breastfeeding infant removes milk from the breast is still controversial. It is unclear whether the infant uses predominantly intra-oral vacuum or a peristaltic action of the tongue to remove milk from the breast. The aim of this study was to use ultrasound to observe movements of the tongue during breastfeeding and relate these movements to both milk flow and simultaneous measurements of intra-oral vacuum. METHODS: Submental ultrasound scans of the oral cavity of 20 breastfed infants (3-24 weeks old) were performed during a breastfeed. Intra-oral vacuums were measured simultaneously via a milk-filled supply line (SNS) connected to a pressure transducer. RESULTS: Vacuum increased during the downward motion of the posterior tongue and at the same time milk flow and milk ducts in the nipple was observed. Peak vacuum (-145+/-58 mmHg) occurred when the tongue was in the lowest position. CONCLUSIONS: Ultrasound imaging demonstrated that milk flow from the nipple into the infant's oral cavity coincided with both the lowering of the infants tongue and peak vacuum. Therefore vacuum is likely to play a major role in milk removal from the breast.

Importance of vacuum for breastmilk expression.

Kent JC, Mitoulas LR, Cregan MD, Geddes DT, Larsson M, Doherty DA, Hartmann PE.
Biochemistry and Molecular Biology, School of Biomedical, Biomolecular and Chemical Sciences, Faculty of Life and Physical Sciences, The University of Western Australia, Crawley, Western Australia, Australia. Jacqueline.Kent@uwa.edu.au

OBJECTIVE: To determine the effect of the strength of applied vacuum on the flow rate and yield of breastmilk using an electric breast pump. STUDY DESIGN: Twenty-one breastfeeding mothers and two expressing mothers expressed their breastmilk for 15 minutes using an electric breast pump set at their own maximum comfortable vacuum, and at one to three softer vacuums. Milk yield and flow rate were measured. RESULTS: At the maximum comfortable vacuum (-190.7 +/- 8.8 mm Hg) 4.3 +/- 0.4 milk ejections occurred during 15 minutes of expression and yielded 118.5 +/- 11.4 mL of milk (65.5 +/- 4.1% of the available milk). Softer vacuums yielded less milk volume (p < 0.05) and less of the available milk (p < 0.01). Milk flow rate was greater during the first milk ejection than the third or subsequent milk ejections (p < 0.001). Cream content of the milk was highest after expressing for 15 minutes using the mother's maximum comfortable vacuum. CONCLUSIONS: Use of the mother's maximum comfortable vacuum enhances milk flow rate and milk yield. The cream content of the milk at the end of the expression period was an indicator of how effectively the breast had been drained.

Both of these studies support the theory that sore nipples is a common, fixable problem. Increasing milk supply with the use of a Medela Symphony breastpump can play a major role in extracting milk from the breast so that the baby who cannot currently breastfeed well can have time for us to work out the issues with my assessments of the root cause of the problem and developing a plan to remedy the situation.

Hope everyone has a fun summer!
Sincerely,
Carol Chamblin, RN, APN, IBCLC