Kathy Leeper writes about her Mom with very engorged breasts on day 4 and 5
with impaired milk transfer, particularly via pump.
Pumping for milk at this point is largely a useless activity. It simply
frustrates everyone involved and you end up having to convince the parents of
the obvious-yes you have milk!!!
 Unless one is pumping to produce a more prominent nipple to assist with a
latchon difficulty, the pump cannot d/t the breast's taughtness, pull the
nipple far enough into the flange to elicit milk transfer. When the baby
latches to a breast like this you can see 2 ends of the spectrum. On one end
the milk immediately starts to squirt out like a fire hose and the baby
appears to be drowning! On the other end the baby seems to latch fine but
swallows are infrequent and as the sucking goes on the *character* of the
feeding becomes less and less eficient ie. the baby isn't getting enough to
teach him how to continue to get enough!
 I find that techniques to maintain or improve the integrity of the fdng ef
fectiveness ie. breast compression-most important! but also stimulating the
baby-taking on and off repetitively ETC., really help.  I also might keep the
baby to one side per fdng when breasts are this engorged, particularly when
it takes soo long to establish flow. The other important point is that this
degree of engorgement usually resolves pretty quickly and once some of the
swelling subsides, the milk usually flows quite readily.
As far as heat vs. ice use, I continue to be more confused with the more I
read and really don't know what to recommend. It used to be, I would suggest
heat p/t the feed and ice after but one poster suggests ice prior to instead.
I think the only *safe* suggestion at this point is ice after the feed. What
does everyone else suggest?

Lynn Shea Rn,Bsn,Ibclc
Franklin,Massachusetts

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