Leslie says,

<< But if it's the whole concept of using warmth for a few minutes before
 feeding or pumping, then I have to ask whether there's been some research or
 review article in the past 8 months or so (I'm not always as current with my
 reading as I'd like) that says that using warm compresses before the feeding
 or pumping actually makes things worse. If so, I've missed it. Warming up a
 breast that has had cold compresses on it feels wonderful and maybe it
 actually DOES "help the milk to flow" as some resources suggest. If there is
 strong evidence that it is damaging to make this suggestion, I'll have to
 look at the research and rethink my practice. >>

The question here is, "Does it help? or, does it increase vascularity to the
breast, increasing the fluid load?"  I haven't seen anything but anecdotal
information to suggest that it does help.  I've never seen a study on it.
OTOH, there is plenty of literature that does say that heat to an already
edematous portion of the human anatomy increases the fluid and swelling -- in
fact, notice that ice is put on the episiotomy site, rather than heat -- at
least for the first 24 hours.  Once the issue of swelling is moot, then heat
is used.  Ice is used for sprained ankles, etc.

Perhaps the next question is, are we using heat to the breast based on
scientific evidence or because that's the way we've always done it?  Does it
REALLY help the milk flow?  Does it increase oxytocin to the myoepithelial
cells?  Would putting a hot compress on a uterus that is not contracting
effectively increase the contractions and make them more effective?  I'm
asking -- cuz I don't know -- but it is the same principle, n'cest pas?

I feel as though I'm slaughtering a sacred cow here... (Thanks Alison for
corroborating my last post)... Notice that the Bf Answer Book (BAB) p. 415
states that "suggest the mother begin by applying warm moist compresses right
before she breastfeeds, which will stimulate her let-down....and help the milk
to flow."  There is no reference given -- no documentation that this in fact
is the case.  Riordan & Auerbach (p. 296) state that "Cold reduces fluid
filtration into the interstitium, owing to vasoconstriction.  As in other
areas of the boyd, tissue edema in the breast is reduced by cold and is
increased by heat."  (Reference given).  However, just earlier in the passage
they state that "...she should be encouraged to be patient, to shower or use
warm compresses, and to stimulate milk ejection with gentle breast massage in
advance of attempting to express her milk."  (No reference given.)

My point is that there are no references (scientific study) that I can find
that state that applying heat to an engorged breast is a good thing to do.   I
do find evidence that states that heat increases swelling.  Taken to it's
logical conclusion....

A couple of things.  It is obvious that a good study is needed in which the
efficacy of heat applied to the breast prior to a feed/pumping vs cold/cabbage
is noted to be helpful -- and which is the most helpful?

A few years ago, "all" the books said that feedings should be limited during
the first few days (remember -- 2 minutes on each side the first day, then 4
then 7 or whatever) to prevent sore nipples.  Then that was blown out of the
water by the evidence that correct positioning prevented sore nipples, not
shortening the time at the breast.  However, you will note that there are
still some sources (admittedly, not good ones, but out there) that talk about
limiting feeds in the first few days.

Another question would be "how hot is too hot, and how long is too long, and
how much heat/length of time would be detrimental to the tissues?"  At what
point, if heat is "not bad" should we not use it and use cold instead?  And
how long should heat be applied if it is going to be applied at all?  One
minute?  Two?  five?  ten??

I really don't know the answers to the questions....so I'm up for learning too
-- and destroying sacred cows in my quest for knowledge <VBG>

Jan Barger