In my experience,  when the engorgement is so terribly severe that use of the
Medela Classic or Ameda SMB do not elicit more than drops of milk, the
effectively nursing baby does not get much milk either.  Test weights with
the BabyWeigh have confirmed this assessment in addition to baby telling me
the best s/he can that the breast just isn't working.  I have seen situations
where it took over 24 hours for the swelling to resolve enough to establish
good flow again despite multiple techniques and remedies.   In these cases,
temporary plans for keeping baby fed and mother going are needed.  When we
are using effective pumps with a good fitting flange, I think we usually are
seeing a good assessment of the magnitude of the problem and the baby may not
be able to do any better.

Natalie Shenk, BS, IBCLC; Findlay Ohio USA

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