Linda writes:
<Women who get skilled help with breastfeeding soon after delivery do not
suffer engorgement,>
Engorgement seems to mean many things to many people.
Unfortunately, the mothers I see and counsel by phone at WIC do suffer
engorgement, especially the greater number of OB interventions such as
excess crystalloid intravenous fluid and pitocin that they receive. Or,
to be specific, those who become overhydrated universally get some degree
of breast edema preceding and/or superimposed on natural (physiological)
engorgement, which itself is a necessary matter of diverting increased
circulation to the breast to deliver liquid and other raw materials for
the initial manufacture of the milk. How else would these raw materials
reach the milk-making cells? Skilled help, especially in the mother who
receives no such interventions, can certainly minimize this experience,
but IME, we delude ourselves to say:
<Women who get skilled help with breastfeeding soon after delivery do not
suffer engorgement,>
With early hospital discharge and the increasing number of women who have
the attitude expressed by Tish Durkin, the writer of that article, and
the proecedures she alludes to:
<After cheerfully signing up to have a human being either pulled or cut
out of me and then getting over all the sewing-up, . . . . .>
well, I don't think we can truthfully say that the majority of today's
mothers, home visit nurses, or LC's would agree that
<Women who get skilled help with breastfeeding soon after delivery do not
suffer engorgement,>
No matter what we label it, postpartum breast swelling, causing
nipple-areolar distortion and latching problems, is, to my mind, a
virtual certainty. I think more mothers need anticipatory guidance, but
many are in no mood to accept it prenatally, because they seem to have
such great expectations. The only ones, IME who consistently welcome it
prenatally, are mothers who are determined not to repeat the terrible
experience(s) they had in the past.
Jean
**********************
K. Jean Cotterman RNC, IBCLC
Dayton, OH USA
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