Sara wrote: "I wondering if we need to re-look at our use of cold and warmth??" This is an interesting thread that is being revisited. I enjoy the cultural elements. Well established practice here for "normal" engorgement on day 4 or so is for the mother to take a warm shower before feeding. Also, the use of cold cabbage leaves between feeds is often used and well known by both mothers and health care providers. Mothers report enjoying the coldness. Some mothers will use a packet of frozen peas. Instead of the shower, I prefer to try gentle expression to soften the areola or to use Jean Cotterman's reverse pressure softening. I do suggest cabbage leaves, too. For badly managed breastfeeding, often time-consuming hand massage will get the milk flowing and baby can do the rest. Electric breast pumps are in short supply and I would be cautious in using one before getting the milk flowing by other means. Ibuprofen can be useful sometimes. We also often use ultrasound therapy which is really effective for milk stasis. I am trying to encourage a therapist to write about this. My 2ml worth Jean Ridler RN RM IBCLC Cape Town, South Africa [log in to unmask] *********************************************** The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(TM) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html