1、Comment 华华华1: postpartum fluid shift直译为产后移夜，或者产后体液变化，但通过沟通有关于静脉输液会影响第二泌乳产程泌乳的文献，所以翻译为泌乳，不知是否合理Comment 华华华2: Wikipedia中查到sub-areolar abscess这种病症，翻译为“乳晕下脓肿” ，故而将 sub-areolar tissue翻译为“乳晕下组织”Comment 华华华3: latch直译为锁住闩住的意思，但在查 wikipedia查询时 latch针对 breastEngorgement Help: Reverse Pressure SofteningJULY 27
2、, 2011. Posted in: BF CONCERNS: MOTHER,COMMON NEWBORN CONCERNS a technique to aid latching when a mother is engorgedFinnish | Russianby K. Jean Cotterman RNC, IBCLC. Reprinted with permission from the author.More health care providers are observing that mothers receiving multiple intrapartum IVs exp
3、erience 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
4、织的阻力，造成乳头扭曲，干扰（宝宝）舒适而有效的衔乳。Comment 华华华4: placental delivery 直译为胎盘分娩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,
5、 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 su
6、rrounding 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
7、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 babys mouth. 这时，乳晕组织就必须扩张以适应这些水肿，这样宝宝
8、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.Comment 华华华5: bury我理解为组织增厚导致原先的乳晕下导管不那么明显。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
9、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 succe
10、ssfully.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 mothe
11、r, 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。Comment 华华
12、华6: latch若翻译为衔乳，就与之前在群里面了解的信息矛盾衔乳时间过长会造成乳头水肿；若翻译为闩住锁定，那就是指反式按压的手法。 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 o
13、f 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
14、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。
15、（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） HCPs 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 fi
16、rst several fingers on each hand lengthwise above and Comment 华华华7: 按摩手法不翻译了，看图。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 th
17、e entire area at the base of the nipple.Two handed, one-step methodFingernails short, fingertips curved;each one touching the side of nipple.Two handed, two-step methodUsing 2 or 3 straight fingers on each side, first knuckles touching nipple. Move turn. Repeat above & below nipple.Two thumbs, two-s
18、tep method (Step 1). Using straight thumbs, base ofthumbnail even with side of nipple.Two thumbs, two-step method (Step 2).Move turn. Repeat above & below nipple.One handed “flower hold”Fingernails short, fingertips curved,placed where babys tongue will go.(To see your areola better,try using a hand
19、 mirror.)Soft ring methodCut off bottom half of an artificial nipple to place on areola to press with fingers.Comment 华华华8: 因为没有太多的文献考证，这个 excess interstitial fluid （组织间隙液）是否是指淤积After RPS, additional fingertip expression to further soften the areola is much easier, more comfortable and more producti
20、ve.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, nea
21、rly 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.Comment 华华华9: 字面意思是，宝宝的吞咽声是很好的反馈 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 relie
22、ves 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 babys 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 tong
23、ue.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 Cotterm
24、an are retained. You may contact me at: See also:Engorgement at KellyMomToo 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.
