The goal is to create a ring of 6-8 small "dimples" or pits on the areola at the base of the nipple. If performed by the health care provider, the flats of two thumbs or two fingers can also be used sideways, creating an inch long depression just above and below the nipple. But this will require another 60 seconds of pressure in opposite quadrants, partially overlapping the first set of pits, to soften the same general area at the base of the nipple.
If swelling is extremely firm, and the multiple fingertip method is being used, one or more three minute periods of constant reverse pressure may yield better results. (Watching sand flowing through a 3-minute egg-timer is one example of a relaxing way for a mother to avoid impatience and clock-watching.)
However, if the flats of two thumbs or fingers are being used, a more even distribution of interstitial fluid is obtained by alternating quadrants repeatedly for three or more 60 second applications each.
If a mother with short fingernails has only one hand free, she can "pit" the central areola by grasping the nipple and pressing fingers steadily inward toward the chest wall for 1-3 minutes, bending the knuckles to widen the pitted area. She can repeat if necessary, rotating fingers.
Guyton, AC, Basic Human Physiology: Normal Function and Mechanisms of Disease, 2nd Ed., W. B. Saunders Co. Philadelphia, 1977, p. 321.
Copyright © Jean Cotterman. Permission to republish granted to Pregnancy.org, LLC. Illustrations: Kyle Cotterman.