What is Reverse Pressure Softening (RPS)?

Reverse Pressure Softening (RPS) is a technique used to reduce nipple/areola oedema via gentle positive pressure to facilitate latching when the breast is engorged or overly full.

How does Reverse Pressure Softening work?

Engorgement can make the breast tissue around the nipple firm and distended, which can make it difficult for the baby to navigate their mouth around. By softening this area, RPS helps to create more pliable and manageable breast tissue for the baby to latch onto, promotes milk outflow and encourages more effective emptying of the breast. “Reverse pressure softening (RPS) before latching significantly reduces the resistance of subareolar tissue, temporarily freeing it to interact more efficiently with the baby's mouth. RPS also triggers the milk ejection reflex promptly”.

Why Use Reverse Pressure Softening?

Excess fluid: Excess fluid or oedema in the first few days may accumulate due to hormones, medications or fluids given during labour and birth. RPS encourages the movement of excess interstitial fluid inward toward natural lymphatic drainage.

Engorgement: During the initial week’s breast fullness is common as we establish our milk supply but when excess oedema occurs it can make it difficult for the baby to latch affecting milk flow and causing pain and discomfort. Early postpartum engorgement can be associated with delayed initiation of breastfeeding, infrequent or scheduled feeding, and supplementary feeding (without replacement pumping).

Comfort: When the areola is softened and more pliable through RPS your nipple can extend further into the baby’s mouth improving overall comfort, reducing the risk of nipple damage/pain and promoting effective transfer of milk. RPS “relieves overdistension of milk ducts and reduces latch discomfort”.

Improves flow and milk removal: RPS “stimulates the nerves supplying the nipple and areolar complex, thus triggering the milk-ejection reflex. This will assist in emptying the breast and reduce oedema of the nipple and areola.

How to Perform Reverse Pressure Softening

RPS can be performed by the health practitioner or the mother herself.

Single-Hand Technique

Two-Hand Technique

Hand Positioning:

• Reverse pressure softening has several variations. Use your fingertips to create pits around the circumference or base of the nipple. Position your fingertips in any combination such as above depending on your comfort.

Apply Pressure:

• Press your fingertips straight back into the breast tissue toward your chest wall. Firm enough to soften the tissue but gentle enough to not cause pain or further inflammation. Hold this pressure for about 30-60 seconds.

Softening the Areola

• Continue applying pressure until the areola feels softer. This may take up to 1-3 minutes, depending on the level of engorgement.
• If the breast remains firm, reposition your fingers and try again, focusing on different sections around the nipple.

Latching the Baby

• Once the areola is softened, bring the baby or pump to the breast. In some cases, RPS will need to be repeated.
• Ensure the baby takes in a good portion of the areola, not just the nipple, for an effective latch.
• If a pump is being used to soften the area and express milk, please note that this can pull excess fluid into the nipple and areola and you may need to alternate a few minutes of pumping with a minute of RPS.

Tips to remember for Reverse Pressure Softening

Be Gentle
When practicing Reverse Pressure Softening, it’s important to apply gentle and steady pressure. The goal is to soften the areola without causing discomfort. If you feel any pain, ease up on the pressure.

Timing
Use RPS just before feeding when your breasts feel full and firm. This technique works best when the breast is engorged or if you find that your baby is struggling to latch due to the firmness of the areola. Softening the area around the nipple will make it easier for your baby to latch deeply and effectively.

Explore Different Finger Positions:
Try different finger positions as above to find what works best for you. This allows you to target different areas of the areola, ensuring comprehensive softening. If one method isn’t effective, don’t hesitate to switch to another.

Don’t Rush the Process:
Give yourself time to see results. Hold the pressure for at least 30-60 seconds or until you feel the areola softening. It may take a few minutes, especially if the engorgement is significant.

Combine RPS with Breastfeeding Techniques:
After softening the areola, ensure your baby latches deeply, taking in both the nipple and a good portion of the areola. An optimal latch prevents nipple damage and ensures effective milk transfer. If you’re unsure about your baby’s latch, don’t hesitate to consult with an IBCLC.

Seek Support if Needed:
If you find that RPS isn’t improving your baby’s latch or if you’re experiencing persistent issues like nipple pain, engorgement, or mastitis, reach out to an IBCLC. Individualised support can make a significant difference in your breastfeeding journey.

Stay Hydrated and Rested:
Dehydration, stress and exhaustion can significantly impact your breastfeeding journey and contribute to breastfeeding challenges such as engorgement and mastitis. Ensure you’re taking care of yourself while caring for your baby.

Using Reverse Pressure Softening is a valuable tool in your breastfeeding toolkit. With patience and practice, it can make a significant difference in your comfort and your baby’s ability to latch.

If you have any concerns or need additional support, reach out to an IBCLC for expert advice tailored to your specific situation.

References

Academy of Breastfeeding Medicine Protocol Committee. (2010). ABM Clinical Protocol #20: Engorgement. Breastfeeding Medicine, 5(3), 111-114.

Colson SD, Meek JH, Hawdon JM. Optimal positions for the release of primitive neonatal reflexes stimulating breastfeeding. Early Hum Dev. 2008 Jul;84(7):441-9. doi: 10.1016/j.earlhumdev.2007.12.003. Epub 2008 Feb 19. PMID: 18243594.

Cotterman KJ. Reverse pressure softening: a simple tool to prepare areola for easier latching during engorgement. J Hum Lact. 2004 May;20(2):227-37. doi: 10.1177/0890334404264224. PMID: 15117523.

Wambach K & Spencer B (2019), Breastfeeding and human lactation, 6th edition, Jones & Bartlett Learning, Burlington WA. Pg 201

Walker, M. (2021). Breastfeeding management for the clinician: using the evidence. Jones & bartlett learning. Pg 488.

Wilson-Clay, B., & Hoover, K. (2005). The Breastfeeding Atlas (6th ed.).