Diane Wiessinger wrote about Jean Cotterman's technique for dealing with engorgement: having the mother press around the base of the nipple with her circled fingertips for 1-2 minutes. Here are my thoughts. Several women I encountered while working as a hospital LC had areolar tissue I would describe as "tough." Often their breasts were especially firm---this would be on Day One or Two, too early for what we would consider "typical" engorgement. One mother commented on the change; her breasts had been soft and flexible all through pregnancy, but now she didn't recognize them! The nipples were usually firm also, unyielding, inflexible. Not anything you'd think a baby could manage, especially a baby who was getting to the breast for the first time several hours after birth. (Now you know how Baby-Unfriendly the conditions were at my institution!) In an effort to interest the baby, we would try to express some drops of colostrum. Usually the mother had never done this before and would not be comfortable doing it, so I would do the expressing. After expressing just a few drops---maybe about six---the areola would become softer and the nipple would be more flexible. Sometimes I could see the prints of my finger and thumb as depressions in the areola when I took my hand away---pitting edema of the areola??!! So I surmised that the firmness we were dealing with was caused by edema in these moms. The pressure from the manual expression must have pressed the extracellular fluid back into the breast. The change in tissue texture was more than could be explained by the small amount of colostrum that we actually removed from the sinuses. Ever since developing this theoretical explanation for the phenomenon I was observing, I have wanted to go back to the books and review the changes in physiology of body fluids around the time of birth. I know that fluids migrate from place to place in women's bodies. If other extremities, such as feet and hands, can be swollen, then breasts can be too. The trouble with edema in the nipples and areolae is that it presents the baby with a big challenge! All the more reason to have the baby nursing soon and often. For two reasons: one, the baby learns how to latch on BEFORE the areola has a chance to develop edema; two, if the baby is nursing (that is, compressing the nipple and areola rhythmically and repeatedly), perhaps the build-up of fluids in the areola can be PREVENTED. I mean...if my fingers could change a tough breast to a soft breast, how much better would the baby's mouth be at the same job! I also speculated that the women who had this problem may have been given more IV fluids than the average patient---but I never got the time to review charts to see whether this was true. Or they may have been women who were slower to diurese after giving birth. Those of you who work with post partum mothers might want to look into this. Chris