Lisa,

Taking one aspect of the problem, it helps to avoid spontaneous MER's
during sleep if mom protects the nipples from accidental stimulation of
the sheets as she rolls over. If she's too uncomfortable with a nursing
or maternity bra, at least a sleep bra, with a little soft inner padding
over the nipple, perhaps.

And speaking of oxytocin, has her OB said anything yet about sexual
activity or lack of it because of automatic hi-risk nature of the twin
pregnancy? That might need to be discussed frankly.

I would hesitate to remove any colostrum by pumping. It's changing
composition as the fetuses (feti?) develop, and if they are born
prematurely, let's be sure most of it is there for them for the extra
benefits of premi colostrum and milk matured to nature's specification
for them! Who knows if we'd interfere with nature's careful time table
either by removing it or stimulating uterine contractions by pumping?

The edema part of engorgement might be something that could be helped
safely and easily. Even early prenatal patients experiencing breast
discomfort and never intending to breastfeed, find this a helpful
suggestion:

During the (not too warm) shower, lifting the breast  perpendicular to
the chest wall and gently massaging in a reverse direction, inward toward
the chest wall with the flats of the fingers often helps excess
interstitial fluid move back into the lymph channels. Lymphatic drainage
in pendulous breasts has gravity to work against.  Lying on her back for
any length of time is soon going to be out of the picture, but is there
any way she could use a pillow to at least prop one breast at a time up
on top of the chest wall  to favor gravity in this clearance?

And of course, I suppose there's always cabbage! As yet, I'm only
flirting with becoming a believer!

K. Jean Cotterman RNC, IBCLC
Dayton, Ohio

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