> Engorgement is not just the breast over full of milk, they are also congested
> with lymph fluid and blood.  With this in mind, frequent emptying of the
> breast will not eliminate the problem in the first 24 hours or more.  The
> body needs encouragement to empty the extra lymph fluid and slow down the
> blood flow to only what the breast need to make milk.
Ann Perry wrote:
> With this in mind the approach to treat engorgement is two fold: frequent
> emptying of the breast and cold compacts to reduce the edema.
snip
> I tell moms to avoid heat through all of this, if they need
> help to get the milk to flow I prefer gentle massage, if they do use heat it
> is very limited just prior to the feeding.

Strange isn't it, how two persons with the same profession can look from a
totally opposed angle at the same problem and both achieve good results.
I always stress to avoid cold and to apply gentle warmth to any kind of plugs,
engorgement, infections and imlfammations. I warn that massaging a engorged
breast can be harmfull, while the tissues are so overstretched and tense.
My rationale for using heat and avoiding cold is that cold can cramp all vessels
(blood and milk routes and probably lymphe)and keep the fluids from flowing and
that warmth will make the fluids flow, relax the mother and help the processes
that take place inside and by the body to deal with the problem.
As for the exessive blood and lymphe: they will disappear soon after the reason
for being there is taken away, in other words when the overlaod of milk is
removed. Therefor I like to treat engorgement by removing as much milk as
possible at once (and only once) with a hospital grade double pump and after
that keeping them as empty as possible by frequent feedings.

Gonneke van Veldhuizen, IBCLC, Maaseik, Belgium
http://www.users.skynet.be/eurolac
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