Re: the mother who is adamant about not breastfeeding:
This certainly does sound 'deep-rooted', possibly connected with abuse of
some kind in the past, and I think you are wise in doing advance planning on
how to honor her wishes and still keep her comfortable if severe swelling
does occur.
However, even though most vaginally delivered moms today now leave the
hospital much earlier than the height of engorgement, I believe those who
choose to formula feed simply wear a firm bra and allow nature to take its
course by leaving the milk in the breasts to give feedback inhibition, with
perhaps a covered ice-pack used for 20 minutes out of every 2-3 hours at the
height of any discomfort.
Instead of Tylenol, I would suggest ibuprofen, which is an anti-inflammatory
medication as well as a pain medication. In order to maintain its
anti-inflammatory effect and minimize inflammation, it should be taken
regularly around the clock according to the OTC directions for several days
till she is no longer uncomfortable.
Nearly 60 years ago, when I started nurses training, and continuing on,
for several more decades when I worked in OB, when hospital stays were 3-5
days for vaginal deliveries, we kept engorged, non-nursing mothers
comfortable with the use of firm binders.
Back then, we had cotton breastbinders in the linen closet, but a bath towel
that is large enough to go around her chest might be used, being sure to
protect her nipples from the roughness of the terry cloth with a smoother
layer.
Application of a binder was a 2 person task between the mother and the
helper. We would have the mother lie flat with the binder under her.,
pre-positioned so that the top would fit comfortably under the arms to
include the Tail of Spence. The mother would be instructed to hold the
edges and pull them forward. The nurse began at the bottom, pulling the
edges comfortably but firmly together, fastening them with large safety
pins, placed straight up and down to avoid slippage. Gradually, we would
have the mother arrange inside the binder whatever degree of uplift she felt
comfortable with.The "cinching in" and pinning every few inches, continued
till the top was reached
For a mother with severe engorgement, this is much different and more
comfortable than a firm bra. It uses the same physical therapy principal of
compression that is used in the edema associated with lymphedema in breast
cancer patients, the use of elastic hose for leg edema, etc. etc. etc. To my
knowledge, no one has proved it harmful in engorgement for those mothers who
choose not to breastfeed. She might not even experience too severe a case
of swelling, so she could either wait and see how much swelling occurs or
decide to have the binder applied early to head off any severe degree of
swelling in the first place.
Spitz AM, Lee NC, Peterson HB, Treatment for lactation suppression: Little
progress in one hundred years, Am j. Obstetr Gynecol, 179;6 Part
1:1485-1490.
If the mother should choose to take a shower allowing warm water to strike
just her back, which would trigger the MER, and then one time, massage a
little to allow leakage to reduce any discomfort, I don't think that would
make any great difference in stimulating production, but it doesn't sound to
me as if this would appeal to her.
Jean
*************
K. Jean Cotterman RNC, IBCLC
Dayton, OH USA
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