Hi Denise, We don't disagree. There most certainly IS iatrogenic
engorgement caused by poor management, or resulting from a poorly latched or
weakly nursing infant. We've all seen this. So obviously, we can
contribute with education on good latching and on freq. early feeds. The
Hill and Humenick data, and my comments were more specifically to point out
that sometimes IN SPITE of good early management, including keeping
colostrum drained (with pump or otherwise), some women have engorgement
patterns that surge to very dramatic levels and stay there a while.
Hill and Humenick identified 4 common patterns of engorgement in their
normative study: 1. low level (moms have very mild, briefly noted breast
changes), 2. moms who have a spike of considerable engorgement for a day or
so but calm down from then on, 3. moms who report multiple spikes of
engorgement, and 4. moms who come on at high levels of engorgement and stay
there for 12-14 days. So the pattern of engorgment may have individual
hormonal control mechanisms going on in individual women which exist APART
from the management issues (altho they probably interact). So I don't think
we can guarantee that early management per se will prevent engorgement.
Having worked with my fair share of super-producers, I can tell you that
isn't true from my exper. I have one now, on her 3rd baby, that we just put
on estrogen containing bc pills to try to calm her down. She's about to
lose the lactation due to 5th case of mastitis in 3 months. She is the
person with the double abscess seen in The Breastfeeding Atlas. That was
her first child, and she has stumped the best efforts by me, her OB and the
best breast surgeon I know, all of whom have tried to help her manage her
over-supply with baby #2 and even worse now with #3. Yes, we've tried sage
and cabbage. Both foods, so I wasn't too scared we'd make her sicker :)
So no doubt the management also plays a role, as does the interaction with
the baby, including amount of skin-to-skin as per P. Meier's work, but we
don't know that much yet about engorgement. I think that is amazing given
what a ubiquitous experience it is. It could stand a whole lot more
scrutiny, and my comment was mostly just a tickle to get people questioning
assumptions.
Barbara Wilson-Clay, BSEd, IBCLC
Austin Lactation Associates, Austin, Texas
http://www.lactnews.com
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