Ooops! It's hard to think in three dimensions at this hour of the morning. Let me take back what I said about the baby's nursing creating a "whoosh" against the downstream side of a plug. Of course, of course, the direction of pressure that a baby's nursing exerts is always (from the baby's point of view) distal to proximal---tip of the tongue INTO the mouth---and (from the mother's point of view) proximal to distal---inside the breast OUT TOWARDS the nipple. Maybe I need a different analogy. A stream of water has to stay where it is, but a milk duct is a flexible tube. It's like your vacuum cleaner hose that gets a plug of dog hair stuck in it. (I thought about this as I was walking Martha, my faithful 10 yr old mutt.) Massaging is like squeezing and bending the hose, changing its shape in hopes of dislodging the plug, or breaking off parts of it. Depending on how far the plug is from the nipple---how far back upstream in the breast---the baby's tongue may or may not be able to exert direct pressure on and around it. But the mom's fingers can reach any plug that is near the surface and massage it. Now if you're picturing a vacuum cleaner, please remember that I'm NOT talking about suction, as in *Baby sucks breast and milk comes out* like dust being sucked INTO the vacuum cleaner. I just chose the analogy because lots of people have coped with a clogged vacuum cleaner hose. The milk duct would be more like a garden hose---fluid runs through it under pressure---but (luckily) we don't have impurities in our water system big enough to clog a hose (not yet, anyway), so that image isn't as accessible for me. Pointing the baby's nose toward the plug is like putting your vacuum cleaner hose under a sofa cushion and trying to work on the plug through the cushion. (The cushion is like the thickness of the breast between the baby's tongue and palate.) There's diffuse pressure everywhere, but less direct pressure on the plug itself. Pointing the baby's chin toward the plug is like laying the hose on top of the cushion and working on it with your hand. Of course, what you don't want to do is squeeze the whole hose firmly from all sides while you try to dislodge the plug. That's what swelling in the area does---just packs everything tighter. I would imagine that the pressure from swelling also tends to dry out the plug, making it a firmer consistency and more difficult to break up. Women have reported squeezing out elongated plugs that looked like short pieces of spaghetti, and one woman told me she expressed hard things like little diamonds. I asked a dairy physiologist about this later, and he told me that, yes,indeed, cows do get milk stones sometimes. Knowing what we know about how painful kidney stones and gall stones can be, we know that we don't want plugged ducts to go this far! Another thing about the MER, though, is that myoepithelial cells along the ducts contract to make the ducts *shorter and wider* under the influence of oxytocin. That would be like having a way to widen your vacuum cleaner hose, loosening the plug and allowing the vacuum to pull it through. That's enough for now. Chris