Bot, did I ever learn a lesson this week with a family I've been working
with!  Baby not latching on at all (she called immediately after coming home
from hospital, thank goodness), previous unsuccessful attempt to BF her 1st
child; had history of 2 lumpectomy surgeries in L breast in the past 6-7
years. She had rented a good electric pump & was using it appropriately, but
L breast was uncomfortable, engorged, lumpy, hard, especially in the area
above the lumpectomy scars. Only getting < 5cc from L, while R was yielding
1 oz. or more. R breast full but comfy. I talked with her about using warm
compresses before pumping, cold after/between, and showed her how to massage
breast before pumping, etc. Next day I got a call from her doula, who had
been out to see them - doula very concerned, baby not doing too well, and
mom's L breast getting worse; doula had done deep massage, shaking, &
stroking techniques on the L breast, and put ice on it, but hadn't gotten
any on-the-spot improvement - no increase in expressed milk, no reduction in
pain/swelling. We were worrying that perhaps the scar tissue from the
surgeries was blocking the milk, maybe that breast wasn't going to be
functional for BFing, etc.

Next day I saw mom again - breast was "95%" better - most of the lumps out,
no more pain, and expressing about equal amount on R & L sides! I'm positive
it was the ice that did it, and the excellent hands-on approach of the
doula, who didn't just *talk* about massage, she *did it*. I had *discussed*
using ice with the mom, and I had written out the instructions, and showed
her how to do the massage and encouraged her to keep it up, but, quite
honestly, I don't think she really heard me. Warmth sounded better to her,
and it was a little easier, and she was so exhausted & distressed & in
primary "milk brain" mode. But when the doula DID it for her, in no
uncertain terms and with no waffling around with "try this, or try that, or
try the other ", she got it.

And now I'm convinced re: the hot vs.cold for engorgement issue, and never
again will I be reluctant to just say "put ice on that breast!" (and head
straight for the freezer as I do so!). I say this NOT to re-open that
particular discussion, which I know was heavy and extensive very recently,
but to share how much I learned from the actions of this excellent doula.
You know, I think of myself as a good communicator, but this is my second
very recent experience of it being clear that they don't always hear what we
say!

Problems are from from over with this family, but at least we got this one
fixed, and mom is so much more comfortable that she's better able to cope
with the other issues.

Cathy Bargar, RN, IBCLC Ithaca NY (let's hear it for the doulas!!!)

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