Martha:
I have a couple of suggestions. Pardon if you have already tried them:
I think you are right: pumping can pull the edema forward into the pump body. So do RPS - again - with double fingers this time, or in a manner to 'sandwich' the breast if that's do-able. Never enough pressure to cause pain.
Lean mom backwards so the edema has a chance to stay back in the breast while you draw the milk forward with the pump. You can always tip the pump body to drain pooling milk down into the bottle, or sit her up to do this.
You can even latch baby on while mom is lying backwards and the areola has been softened. He has more control of the spray when she lets down.
Use a larger flange. I am getting to like the larger flanges A LOT! Especially for engorged moms. And always with RPS as often or as long as needed.
Use ice packs between pumping or feeding sessions; heat for a few minutes before pumping or before RPS.
Again, if I'm preaching to the choir, forgive me.
Hope this helps.
Phyllis in Phx.

-----Original Message-----
From: "Johnson, Martha (Lactation-SHMC)" <[log in to unmask]>
 
  The take-home message here is that pumping can exacerbate edema, to the extent that milk flow is impeded or even occluded.  We should all watch what is flowing when an engorged mother is pumping, and take action when needed to keep the breast flowing. 

 

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