It's not uncommon for moms to have slight differences between their 
breasts that make babies prefer one or the other. Infant issues such as 
torticollis (look in the archives, there's good stuff on this) can also 
make the baby more effective on one breast than the other.

Some strategies that make pumping on an engorged breast more efficient:
-Reverse Pressure Softening immediately before pumping. (Jean Cotterman 
had a fabulous article in Leaven on this, if you don't have it, look 
online.)
-Ice compresses for a few minutes before pumping, to reduce swelling.
-Using a hospital grade rental pump. See if she can get an Ameda Lact-e 
or SMB or a Medela classic; or an Ameda Elite.

(The consumer grade double electric pumps are screwdrivers. Great for 
tightening screws (pumping when working, once milk production is 
established). The hospital grade pumps are hammers. One can hammer in a 
nail with a screwdriver, but it's bad for both the screwdriver and the 
wall! That's how I explain the difference to moms. For professionals, we 
talk about the smoothness of the suction curve, and the sustained 
pressures the pump can generate.)

She can do RPS or ice and then pump for 10-20 minute spurts, at least 
once an hour, until the engorgement goes down. Or she can put ice packs 
on the breast while pumping, and pump right after RPS. Gentle massage of 
the breast (dad or grandma can do this if mom is comfortable) from front 
to back can help during pumping as well.

You can explain to mom that engorgement is mostly swelling, but getting 
milk out helps some of that fluid get made into milk and exit the 
breast. It may take one or two days of very frequent pumping to make the 
breast soft enough for the baby to take. Then if baby cannot breastfeed 
well on this breast, further evaluation for infant-sided problems should 
happen.

Catherine Watson Genna, IBCLC  NYC

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