In several recent postings regarding "lack of milk" when pumping an engorged 
breast, I did not see mention of using cold packs/cabbage/ice packs to 
decrease the swelling to allow milk flow before pumping.  When working with a mom who 
is so engorged that she gets little milk, I suggest cold packs, pumping, cold 
packs, pumping, cold packs and pumping - that is several times consecutively, 
taking anti inflammatory meds if safe to do so, and after a few treatments, 
we see milk flow. A very brief application of warmth before pumping may help 
but I often hear of women over-doing the warmth, which just increases the 
swelling. 
It is my understanding that engorgement is caused by swelling of the tissue 
surrounding the milk ducts as well as milk in the ducts. If the milk can't 
flow, it won't encourage the breast to continue making milk. Sometimes I see 
decreased supply after as little as 24 hours of moderate engorgement. The La Leche 
League tear sheet and the handout at Kellymom.com both have good information 
to share with moms.
Just my two cents worth,
Mary Kay Smith, RN, IBCLC, LLL Leader
Canton MI USA

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