Actually, I have a logical reason for NOT using warm compresses before feeds
in cases of engorgement. For years in my hospital, the protocol was to send
women to stand under the hot shower to relieve engorgement.  I would see
that this just made it worse, and I tried to figure out why.
 Heat causes the ducts to expand, and may even activate the MER. Now you
have more available space in the ductal area, and the milk being released
thus filling this area with yet more milk. Heat will also cause the blood
vessels and lymphatic system to expand, and may cause so much pressure that
the milk will not flow, and the result is those hard taut painful breasts.
I started applying ice packs several years ago and started seeing amazing
results. The swelling in the area was reduced and the milk would start
flowing!!
I make my own ice packs. ( Gel packs are too expensive here.)  I take a
paper diaper and pass it under the tap two times, then put it in the
freezer.   When it is frozen, you open it and can cover most of the breast
depending on size of course. ( If you wet it too much, it will be impossible
to open after.)

Or I fill a latex glove with water, tie it off and put it in the freezer and
call this the
"c-o-l-d hand of relief".  Make sure that no ice comes in direct contact
with the skin to avoid cold burns.

Most moms find this very soothing on hot swollen breasts.  I almost never
use cabbage leaves because I am lazy, and because I haven't found that it
helps more than my cold packs.

I am still trying to make the staff understand that severe or even moderate
engorgement is NOT normal.  It is a sign that milk transfer is not taking
place.  Unfortunately  in the years that breastfeeding management did not
encourage frequent unlimited feeds, engorgement was the norm, and the usual
treatment was to put on a very tight-fitting bra day and night,stand under
hot showers, and sometimes even bind the breasts .  It is no wonder that
many women are still traumatized by breastfeeding.  I am having a hard time
convincing the staff to change attitudes and understand.  Some are still
sending the moms to the hot shower.

BTW in Breast is Best ( which I will be showing in a course I am teaching
today, thanks Rachel for this beautiful teaching tool), they show a mom
using a bag of frozen peas to treat engorgement!!

Esther Grunis, IBCLC
Lis Maternity Hospital
Tel Aviv, Israel

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