Denise writes:
< The women whose
babies are sleepy and breastfeed 4 to 5 hourly in those first few days do
experience significantly more engorgement than the ones whose babies are
on
and off the breast all day and all night.

I know there are exceptions to every rule - and yes I agree that some
women
(but a minority) will get engorged, and possibly quite severly so,
despite
the very best of management.  But I do suggest that these women are
exceptions.

What has others experiences been?>

There was an Israeli study published in the early 1970's describing the
use of an electric breast pump to induce labor in grand multiparae whose
uteri were more sensitive to oxytocin. From memory, I believe it stated
that besides a gradual, gentle induction of labor, a side effect
mentioned was that these mothers experienced an earlier onset of a
copious milk supply without significant engorgement.

In a number of mothers over a 30 year period whom I have advised using a
breast pump in the last trimester to help develop protractility in
inverted or severely retracting nipples, I have often noted what seemed
like an earlier onset of copious milk production. (No colostrum was
removed with the system I used, and I am now waiting till 37 weeks for
medicolegal reasons)

My eldest and youngest daughters had their first babies 8 years apart.
Each went 3-4 weeks overdue when I let them read the article and obtained
a pump and let them make their own decision about trying to induce their
labor that way. Each one did stimulate contractions, but each ultimately
had a C/S for cephalopelvic disproportion.

Even though I was close by and on hand to assist each one during the
postpartum period, I do not remember any particular problems with
engorgement, despite the fact that each had had IV pitocin augmentation
for a number of hours.

Familiarity with the use of the pump was a dividend to the younger
daughter. She had not really intended to breastfeed, but was gentled into
"at least trying for a week or so" by my dear friend (Hi, Geneva) who
rented electric pumps.

At 12 hous of age, her baby was transferred to a Level 3 hospital when he
required bilateral thoracenteses for collapsed lungs. Between me and my
nurse friends on the OB unit where I had previously worked, she received
a consistent message that her milk would be especially helpful in view of
the baby's respiratory illness.

She began to pump regularly, and when I came back in to visit on the
third day, she handed me 4 full volufeeds she had on ice at her bedside
and asked me if I thought it would be enough for him.

She had her staples removed on the fourth day and we went immediately to
the Children's hospital, where the baby's tubes had been removed and his
IV d'cd. They spent the day in a recliner rocker in a small private room
off of the NICU, getting acquainted and nursing ad lib. Again, I do not
remember observing any significant engorgement.

Considering the high rate of induction these days, I am wondering whether
breast pumps might be incorporated into the induction protocol somehow,
if for nothing but to produce this positive side effect on lactogenesis.
It's the LEAST they could do to offset the effect of the multiple IV's
and/or IV pitocin that seem to add so much edema to the postpartum
period, in the breast area included.

Jean
***************************************
K. Jean Cotterman RNC, IBCLC
Dayton, Ohio USA



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