Dear Friends:
  More comments on heat. In cases of engorgement, the measures that everyone
has recommended are perfect: hand expression or pumping, frequent nursing, use
of cool and/or cabbage after feeds. Once in a while, there is such engorgement
that pumping doesn't work. Perhaps there is so much  swelling that the
oxytocin can't get through the cell borders to make those myoepithelial cells
contract. They have no room.
   In these cases, relief can come from a combination of gravity and warm
water. Mom leans forward, immersing her swollen breasts in comfortably warm
water. This can be in a bathtub, or in a washbasin that is large enough top
fit her comfortably and which can be placed on a table. After a few minutes of
immersion, the milk will let go and begin to jet into the water. Then she can
hand express and nurse. The leaning forward part is as important as the
immersion part.
   If she has had a cesarean section, then this won't work. Then, use cool and
cabbage constantly until the swelling goes down enough that some milk can
release.
   Most helpful is to teach moms to nurse one breast per feed just until the
end of the milk surge, or first week.  Or to let the baby finish the first
breast at its own pace, and ask for the second only if it wants. Most
engorgement can be prevented.   Warmly, Nikki Lee