Dear Becky and Everyone, We are just as intrigued with all the various items coming through from you. It is really hard to restrain ourselves from spending more time than we have sometimes to be part of it all! What a resource! Just this morning we have had a client in deep trouble with a damaged nipple (from one episode with a poorly attached 16 week old baby), engorged breast and about half of the breast full of blocked (plugged) ducts. Over the weekend this had gone from just sore to unbearable. Her midwife referred her to us this morning. The baby had last fed (painfully) at 7am this morning and the mother did not even want to touch the breast let alone feed from it. She was crying on the phone when she rang at 9am. I asked her to soak the breast in Epsoms Salts - about 2 heaped tablespoons in about 1-2 pints (or 4-5 litres) of very warm water, until the temperature of the solution returns to about room temperature (about 10-15 minutes), then to go to a local physiotherapist for ultrasound treatment. She then came to see us. The affected breast is the one that usually leaks easily (when she undoes her bra or feeds from the other side). It was very full and had not leaked all morning, but did start to about an hour after the ultrasound. I asked her to feed from the undamaged side first so that I could assess the baby's feeding behaviour. She fed beautifully but I could see that she didn't have quite as much breast in her mouth as she could have done. This didn't hurt the mother, but when the baby came off after about 25 minutes, there was a thin compression line across the top of the nipple. The mother told me that she had noticed that this always happened after feeding. After an explanation that this meant that the baby normally fed with not quite enough breast in her mouth so the nipple was not back quite as far in the baby's mouth as it could be, she decided she wanted to try feeding from the damaged side. It took three attempts before the baby took enough breast into her mouth so that she didn't hurt her mother, and fortunately she didn't release any of it till well into the feed. (Our arrangement was that if it hurt, the baby was to come straight off!) Usually babies of this age have well developed preferences for how much breast they like in their mouths! I also explained that there is no need to change the baby's preferences unless it's causing a problem, which it obviously hadn't until now and I expected that this was just an accident that was not likely to happen again. The breast felt a lot better after the feed, and she left feeling confident that she could handle things from now on but will keep in touch as she needs to. I expect that by about 3pm the last of the blocked ducts will have resolved thanks to the ultrasound treatment and feeding will help drain off the rest of the milk. Anne is going to try to post the info on Lactnet re ultrasound dosages for breasts after she talks to one of our physio friends. Epsoms Salts soaks can be done more than once, but once is usually enough for these acute situations. We also tend to feel that if a little is good, more is not necessarily better! Robyn Noble and Anne Bovey, Brisbane, Australia