Dear Jennifer,

At 08:33 PM 6/24/2004, you wrote:

her milk did not come in until 10 days
>pp. When  it did, she became severely engorged and got plugged ducts, but
>could
>pump  almost no milk

>Later, ...the same thing happened--engorged,
>but unable  to pump.

>Almost immediately her breasts felt fuller, but again, she
>was only able to  express about 2 oz per day when pumping 6 times


I don't know about what she needs, and I wish you all the luck in the world
with that one, but the inability to pump when engorged caught my eye
here.  Two articles in a recent JHL address the problems of applying
suction to engorged or edematous breasts -- as I understand it, this may
bring the interstitial fluids forwards and hinder milk flow.  So it might
be worth working on ways to move her lymph and other fluids back from the
breast to allow milk flow.
We recently had a mother who got more fluids than usual during delivery
(she had a fever >104) and when she was transferred right after birth to
the local tertiary care hospital they had her pumping every 3 hours: she
got virtually no colostrum and did have some nipple damage despite being a
very experienced pump user.  When I saw her 3 days later she definitely
still had edematous areolas.  So I am completely convinced that for that
situation, anyway, pump use was counterproductive. And I think it makes
sense it could work that way for engorgement in some women.  The two
articles explain ways to push the excess fluids back away from the
nipple/areola area.  I feel pretty silly saying this with Jean Cotterman
watching so I'll stop now.  Hi Jean, I've been using your paper!

One more comment: you say she's getting vitex.  I don't know from herbs,
but I went to a talk by Tieraona Low Dog last year in which she said that
that herb is not okay in lactation.  I don't remember just what she said
but I see in the Nursing Mother's Herbal that although vitex is a
traditional galactogogue, German physicians (who prescribe it for
infertility) avoid it in lactating mothers because of concerns about the
potential to lower the milk supply (lowers prolactin and milk in rats; in
humans, using it for >2 weeks was associated with a quicker return of
menses).  Some idea that maybe used for too long it causes a rebound effect??

All the best,
Elise


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