The poor woman who had serious engorgement and "impaired let down" has
surely resolved her problem by this time (Kathy wrote last Friday and the
case had been relayed to her.). But it never hurts for us to share our own
effective approach to a common problem.

First I would like to ask if any of you have seen over-supply with too-high
doses of Thyroxin. I had 2 cases in which this seemed to be a problem.
Apparently the thyroid needs in pregnancy and post partum are different,
but with my two cases adjustments had not been made. When the dosage was
changed after testing, the milk supply problem was easier to resolve.

And when common, if not "normal," engorgement presents I recommend
ibuprophen, cabbage leaves covering the breast at all times until milk is
flowing well, and Rescue Remedy to facilitate the let down. Rescue Remedy
is available in health food stores and is very good for facilitating a let
down either with engorgement or for mothers' pumping. My clients who are
employed and pumping in sometimes hurried circumstances find that the
recommended 4 drops of Rescue Remedy get the milk flowing and can help with
that end-of-pumping let down.

Also, I have tried to find in my files the outstanding recommendation of
pressing the fluid from the areola back into the breast with the fingers. I
thought that Jean Cotterman gave us that idea but maybe it was someone
else. I must have filed in under some "clever" subject that escapes me now.
Whoever it was, please post it again. It is very effective. I have been
able to describe this over the phone to a desperate mother whom I couldn't
see and the next time I called baby had been able to latch and all was
well. This approach is especially good for the baby who was latching well
until the bowling ball with the tiny nipple appeared. Give him his
compressible areola back and he is on his way.

Pat Gima, IBCLC
Milwaukee, Wisconsin



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