Regarding Karen's request for help on unilateral engorgement.  First, is
she wearing a constricting bra (or one with an underwire)?  Is she laying
on that side or doing anything more with that arm (is she left handed and
just started back to a job that requires this arm or does she carry babies
on that side only)?  Also, in terms of pain relief, I have found that
ibuphrophen works much better in engoregement cases (reduces swelling too).
Has she tried wearing a breast shell on that side to encourage leaking?
Make sure she takes her temperature and watches for signs of mastitis. In
other times and places, a case like this would be managed by having a
toddler or animal latch on to that side, but this is not socially
acceptable here in the US, and regardless of acceptability presents risks
in terms of HIV.

To get milk out in stubborn cases try in this order:  leaning over a sink
of warm water (with baking soda in high concentration to encourage the
lymph and other fluids out of the breast); deep massage, stroke and shake
the breast while leaning over (sometimes hands and knees or leaning over a
chair;  the Marmet technique is quite effective (p.174 in the revised
BREASTFEEDING ANSWER BOOK); deep breathing, quiet music, and dim lights are
also helpful.  Following the pumping or expressing, mom might try ice
flowers to reduce swelling.  I have also found that wearing microwaved or
rolling pinned cabbage leaves work best for reducing engorgement.  One more
thing, some moms find the Flexishield to be a helpful attachment to a pump
(by A/E).  Some moms find relief with the use of Vitex Anus-castus L. which
increases flow and perspiration.  Encourage mom not to restrict fluid
intake.

Good LLLuck--I hope something in this helps.

: )Chris Hafner-Eaton, PhD, MPH, CHES, IBCLC  email: [log in to unmask]  : )
: )HSR & Health Educational Consultant        voice/fax: 541 753 7340   : )
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