Two or three days after giving birth, the ” let- down” occurs (in some countries it is called “let-down”). This is a normal and temporary situation that, although it may be somewhat annoying, disappears in a few days. However, sometimes an excessive accumulation of fluids (edema) can appear and we then speak of engorgement . Engorgement can lead to problems; For this reason, multiple measures have been studied to alleviate it, among them, the softening reverse pressure.

The problems of engorgement

As we have just discussed, engorgement is an excessive accumulation of fluids (edema) in the breast tissue. Unlike (normal) milk letdown, engorgement is considered a problem. On the one hand, it is tremendously annoying and painful for the mother ; In addition, it can be associated with early weaning . On the other hand, the breast may be so full and hard that the baby has difficulty latching on and removing milk . This can cause her to be irritable, eat less than she should and, by latching on more, injure the mother’s nipple.

What is reverse pressure softening?

Reverse softening pressure is a technique that applies pressure to the areola and allows the edema to be displaced backwards and towards the interior of the chest , thus facilitating the latching of the baby to breastfeed (or the breast pump).

It is a simple measure, in which we only need our hands, and quite useful to combat engorgement. The effect is transitory, since the liquid will progressively refill the subareolar tissue. But we can apply it as many times as necessary.

Benefits of Applying Reverse Pressure Smoothing

1. Stimulates the milk ejection reflex

Oxytocin is a hormone that, among other functions, contracts the myoepithelial cells that surround the lactiferous ducts (ducts inside the breast that contain milk), favoring the release or ejection of milk. It is released in response to the baby’s sucking, but also if we hear his cry or think about him. If we apply softening reverse pressure for 1-2 minutes, the ejection reflex is also triggered, favoring the release of milk.

2. Reduces tension on the walls of the milk ducts

With this technique, the edema moves towards the innermost part of the chest, thus reducing the distension of the ducts below the areola. This can help the milk flow more easily in response to the movements of the baby’s tongue. In addition, it could prevent nipple retraction (or what is the same, facilitate the extension of the nipple within the mouth) avoiding or minimizing damage to the nipple.

3. Reduce edema

Applying reverse soothing pressure for at least 1-3 minutes reduces subareolar edema. In this way, the areola remains softer, more elastic and allows a better attachment of the baby.

How to apply smoothing reverse pressure?

We can choose any of the methods explained below. They all share a number of basic principles:

– We need to have clean hands and, preferably, short nails

– Apply pressure gently but firmly . This should not be painful . If it hurts, it is preferable to apply less pressure but for longer periods.

– Pressure is applied perpendicular to the mother’s chest. that is, towards the back.

– We will act in a radius of 1-2cm from the center of the nipple , just where the base of the nipple joins the areola.

– Apply pressure for 1-3 minutes and repeat as many times as necessary. In some cases of large engorgements, up to 10 minutes may be necessary.

– The ideal time to apply it is just before the baby latches on, as the effect of this technique is transitory.  And we can do it as many times as necessary while the engorgement lasts.

Methods for performing reverse pressure smoothing

K. Jean Cotterman, IBCLC; describes in his article about him four different ways to perform this technique.

One step methods

1. One-handed method

Also called flower grip . Ideal when the mother only has one free hand . She will grasp the nipple at its base, where it meets the areola by curling her fingers. The thumb will press the area where the baby will place the upper lip and the rest of the fingers the area where the baby will place the lower lip and tongue. In this way, we apply the smoothing reverse pressure on the chest of the same arm (for example, we apply it with the right hand on the right chest), we will prepare the chest for a cradle hitch or inverted cradle; while if we apply pressure on the contralateral chest (right hand on left chest and vice versa), we will prepare the chest for the hook in rugby.

We will apply the pressure for 1-3 minutes and the fingers will sink little by little, as the areola becomes softer. If necessary we can rotate the fingers to soften all areas of the areola

2. Two-handed method

We place three or four fingers of each hand curved on the base of the nipple at its junction with the areola, and press as in the rest of the methods, between one and three minutes.

two-step methods

3. Straight fingers method

We place one or two fingers of each hand on both sides of the nipple in opposite directions (horizontally, so that the first knuckle touches the upper and lower base of the nipple base). Apply a few minutes of pressure and then turn them, pointing both fingers down, towards your navel. We can vary the position of the fingers to cover all the quadrants.

4. Two thumbs method

In this case, a thumb from each hand is placed on the sides of the nipple . It’s easier if someone else does it. If they are standing, they will put their thumbs up. It is important to keep in mind that the thumbs usually exert more pressure, so you have to be careful. The base of the nail should coincide with the center of the nipple. We will rotate the position of the thumbs to cover all the quadrants.

What does choosing one method or another depend on?

All methods are valid, we must find the one that is most comfortable for us . This will depend mainly on:

  • Who does it : For example, the two-thumb method is often more difficult if it is done by one person.
  • The length of the nails : for the one-step methods it is essential to have short nails; If you have long nails, it is preferable to apply pressure using one of the two-stage methods.
  • Of the hands that we can use : if we only have one of the hands free, we must perform the flower grip method.
  • On the severity of the edema : If the edema is severe, you might respond better by applying pressure with the two-thumb technique, repositioning them every 1-2 minutes. It also helps in these cases to do it with the mother lying down.
  • Of the position or angle from which we can act. For example, it will vary if the person performing it stands in front of the mother or behind her.

Breast pump and softening reverse pressure

If we have a very engorged breast, placing the breast pump directly can be counterproductive .

Especially if we apply a high suction pressure, the edema can worsen at the level of the areola and make it difficult to extract the milk by compressing the ducts; or the breast pump, if manual expression or the baby will then be able to express the milk.

However, applying smoothing reverse pressure before inserting the breast pump can be beneficial, as it promotes milk extraction.