Hi Tamara-

I'm behind in posts, but you mention a mom with sore nipples and severe
engorgement who was unable to let down to a pump. The subsequent posts were
most likely helpful enough to you, but I wanted to add another suggestion.
Sometimes when all else fails, I will resort to nipple shields, inverted to
place on breast well enough to draw a good amount of breast into the dome,
then place pump over shields and pump with nipple shields in place.

This works well with a woman who is large breasted with severe areolar edema
associated with engorgement and retention of extra IV labor fluids. It
provides simultaneous reverse pressure softening while pumping. I then try
to get the baby on the breast with, or preferably, without the shield, with
the end intention of getting baby on directly.

I remind you that I use this as a last resort, but it has sometimes proved
just the trick to enable mom to get through extreme engorgement (provided
she has a sense of humor, or a certain tenacity.)

Best regards,
Jan Wenk, IBCLC
Rochester, NY

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