In a message dated 8/13/2005 12:06:00 AM Eastern Daylight Time, 
[log in to unmask] writes:
I believe the pump is pulling edema down from surrounding tissue into the =
pump flange, which then occludes the milk ducts.  The tissue softens with =
application of heat, and then the milk can flow again, but only until the =
pump pulls that edema back down.  =20
I agree with your theory, having experienced this with my second child.  With 
my first I only had a manual pump, so this did not play out quite the same 
way.  However, in my case, heat application quickly aggravated the engorgement 
to the point of continuous throbbing.  I would think cold application would be 
helpful to relieve the engorgement.  The IBCLC that helped me adviced cold 
when there is pitting edema present.  Since the heat seems to get the milk 
flowing for her, perhaps cold after pumping or nursing.  But I also think she should 
hand express instead of pumping.  This provided more relief, and I could work 
selectively on the most full parts of the breast.  For me it took 2 days of 
ice packs almost continuously applied between feedings before I could even leak 
milk.  With the pump I could only get about half an ounce and no relief.  I 
remember the first day this happened I was waking the baby every 2 hours to try 
to get him to nurse, so he would relieve the pain.  He wouldn't wake up 
though.  I had to work on massaging knots out of both breasts for weeks, which is 
why I think an electric pump is bad for this type of engorgement.  In fact, 
this required so much effort that I had pain in both arms from the wrist to the 
shoulder, making it difficult to lift the baby.  Maybe I'll get this whole 
thing right by the next baby, and I won't need to pester the IBCLC's.  ;-)

Jennifer Stevens, RN

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