Dear Jan and others--
I really appreciate this discussion and am glad I came back on to Lactnet in
time to participate.

I should clarify what part of my objection to your initial statement was--it
wasn't that we shouldn't question what we've "always done." This is crucial
if we're to grow as a profession. What I was mostly objecting to was the
lumping of people who use heat for engorgement into the same group as those
who are truly NOT following current thinking. I think, however, it would be
fair to say that people who are using ONLY heat are behind the times and
need to look at their practice, and I've been beating the "cold therapy"
drum for many years so am not questioning its efficacy. I know cold works
best for my sports injuries and often works well on my chronic lower back
problem. However, I also know that heat is what I need at times. (I really
liked the post on listening to the mother and helping her relax as a part of
dealing with engorgement--heat is fabulous for relaxation).

Until something is published in a major publication, such as JHL, I don't
think it's realistic to condemn others for not doing things the way a few
people have discovered is more appropriate (the issue of nipple shields
comes to mind very quickly...). Let's not make people who aren't "in" on
various discussions or courses feel they're hopelessly out of date because
they're doing things according to common practice that is beginning to be
questioned by a few cutting edge people. What I DO think we need to continue
doing, however, is what you are doing--calling into question things we do
that haven't been backed by research and that perhaps aren't as helpful as
we'd like to think. I love discussions like this and miss them when I'm
NOMAIL (most of my life, unfortunately), since there are no other IBCLCs in
the area with which to discuss such matters.

Keep up the questioning and evaluating and attacking those sacred cows--it's
risky, but much appreciated in the long run!

Leslie Ayre-Jaschke, BEd, IBCLC
Peace River, Alberta, Canada