Someone pressed me to respond to the binding breasts thread. So I'm dropping in again, and should introduce myself to those I don't already know: IBCLC, educator of health professionals, former ILCA Board member, etc, author of Breastfeeding Matters and Food for Thought; mother of three fantastic adults, and grandmother of one (Brigit), make that two in early February, with a lovely amiable son-in-law who really does his share of child/house work (there is hope for the world if men can change that much in a generation). In the overloaded sandwich generation, and currently moving house/office to be with my mid-80s parents before there's a crisis that demands my presence full-time. (Will be maintaining a bedsit/office in the communal St. Kilda house that my husband and grown-up family all share: brilliant huge 1880s Victorian vicarage: visiting them rather than visiting the parents and worrying about the oldies from a distance.) Please note new address from signature. To pressure on breasts The new realisation about autocrine control by the secretion of a Lactation Inhibitory Factor that signals decreased production to glandular tissue should not cause us to lose sight of the fact that pressure also inhibits/prevents milk production, as the columnar cells that make milk physically cannot do so when flattened. Mavis Gunther highlighted the importance of intra-mammary pressure decades ago; it remains true that it is the usual precursor to most mastitis. So intra-mammary pressure is a factor that we need to be able to assess and manipulate appropriately; when seeking to suppress lactation (or conversely, prevent lactation from being suppressed.) I've discussed this in chapter 2 of Breastfeeding Matters so will simply post that section, to save time. Please don't cite this as blanket approval of binders and rush off to use them in all cases of engorgement: like everything else, they are a tool that needs to be used skilfully and only when needed, and in the hands of the ignorant can do a great deal of harm. However, as a 1970s mother who was in excruciating pain before a Scottish midwife imobilised my 42DD (previously 34B) breasts, I can vouch for the relief that they can bring when used wisely and well-monitored. Others will no doubt have horror stories of the pain they can cause when used badly. Bu that's true of compression anywhere on the body: try sticking a firm bandage on a sprain that's till swelling and refuse to re-wrap, and you will know about it! excerpt from pp. 58-9 BF Matters 1. Engorgement Extreme engorgement is now being seen as iatrogenic, as it is rare when babies are fed ad libitum from birth. But some mothers will suffer a degree of engorgement even when fully demand feeding, as milk production can proceed faster than the baby's ability to remove milk. An excess of milk in the breast, combined with the vascular and lymphatic congestion usual as the breast switches on to lactation, can create pressures that prevent milk outflow or lymphatic drainage. This can lead to a degree of oedema needing assistance for prompt resolution. The most important thing to remember is that milk can flow out of the breast, while oedema must be resolved by getting lymph back into the circulation. The basic principles for the resolution of oedema can be adopted: rest, ice, compression and elevation. Treatments include the following: … 'Binders'. These would seem to work on the principle of persuading the breast to slow or stop milk production by mimicking the feedback pressure effect of total breast distension. They do cause pain to subside more rapidly when lactation is being suppressed. This, however, may not be a recommendation when lactation is to continue, as it may merely indicate greater efficiency at suppressing milk production. Before dismissing the idea of binders as unhelpful, we should listen to the reports of mothers who have found them to increase comfort when applied by skilled midwives willing to adjust them as often as needed: as in all other cases of oedema, compression relieved as often as necessary is found to be useful. But unadjusted binders on breasts are as cruel as unadjusted plaster casts put on broken bones before the swelling has reached its maximum. Just as we break open casts that are too tight, we need to monitor and adjust binders to deal with breasts still increasing in size. … Hand expression. this needs to be very gentle to avoid bruising an overdistended gland. Such expression has caused mastitis and bleeding when too vigorous. Nurses often have no idea how exquisitely painful engorged breasts can be. If it hurts, don't do it! The hot jar technique discussed in the mastitis chapter can be used initially. So too can gentle massage and expression by the mother herself in a warm bath or under a warm shower. … An electric breast pump can be used to 'empty' the breast at the end of the day, after the last feed. Following this, cold packs can be applied to help reduce the lymphatic congestion in the breasts, and often with this done, the breasts settle down as drainage is possible. Milk expressed can be frozen for later use. … Borrowing a hungry baby with more vigorous and efficient sucking techniques can also be useful. … Drugs (see ch. 4) Unless this initial engorgement is adequately dealt with, it can progress[via increasing pressure buildup] to obstructive mastitis and even infectious mastitis. Badly managed, this may bring about lactation failure. It can certainly cause a temporary supply problem. Mothers should be taught to look for lumps or painful spots in the breast or under the armpits and to ensure that these clear away with massage during feeds, etc. They should also be taught that much of the fullness of their breasts is vascular and lymphatic congestion, not milk; that when this subsides they may find their supply is just a little low and be prepared to feed more often. Mothers who think that they have been bursting with milk tend to assume that when the congestion resolves they have lost their milk altogether, and some try to 'save it up' by going longer between feeds. It is worth noting that engorgement is a general term that means overfullness or distension; it is a phase the breast can go through in the weaning process, or preceding mastitis, and the two fronts to work on remain: moving milk and ending oedema. 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