Hi Jan--
I doubt if Dawn Staust-Vanek and I were the only ones to go "Huh? when you
lumped IBCLCs who "... are still packing the breasts in hot compresses for
15 minutes prior to a feed for engorgement, despite evidence that heat
increases blood flow to the breast, thereby increasing fluid to an already
fluid overloaded breast ..." with those who are clearly not in tune with
getting breastfeeding well established.

Much of our current literature still discusses using warm compresses prior
to a feeding or pumping (and cold compresses following the feeding or
pumping) (BREASTFEEDING ANSWER BOOK, BREASTFEEDING MANAGEMENT IN AUSTRALIA,
Canada's NATIONAL BREASTFEEDING GUIDELINES FOR HEALTH CARE PROVIDERS, etc.)
If it's the "15 minutes" or the "hot" you're taking issue with, then I
agree--that's too long (none of these resources mention this length of time)
and warm does the job.

But if it's the whole concept of using warmth for a few minutes before
feeding or pumping, then I have to ask whether there's been some research or
review article in the past 8 months or so (I'm not always as current with my
reading as I'd like) that says that using warm compresses before the feeding
or pumping actually makes things worse. If so, I've missed it. Warming up a
breast that has had cold compresses on it feels wonderful and maybe it
actually DOES "help the milk to flow" as some resources suggest. If there is
strong evidence that it is damaging to make this suggestion, I'll have to
look at the research and rethink my practice.

Leslie Ayre-Jaschke, BEd, IBCLC (1987, recert 1997)
Peace River, Alberta, Canada
(coming in from lurking and NOMAIL for the past many months)