I am sure someone else will chime in with the physiology but when women 
are engorged, the electric pump often takes a while to work. And it 
tends to pull more fluid down into the nipple. I don't think three 
minutes on a pump is long enough to decide that the milk is not going to 
flow. What many have found to work well, is do one side at a time, with 
very low suction, back and forth every 5 minutes. I have seen women take 
about 10 minutes to start spraying milk when double pumping -- keep the 
suction low. Sometimes having another person gently compress the breast 
with two hands (slightly squeezing into opposites sides of the breast) 
while pumping will facilitate let down. Sometimes engorgement is the 
plugged duct kind and sometimes it is from edema, where the ankles and 
hands and breasts are all swollen and tight. Sometimes it is both kinds 
at once. I find that the ladies who are terribly swollen all over but do 
not have the hard lumps in their breasts do not always make a lot of 
milk until the swelling goes down all over her body.

Kathy Eng, BSW, IBCLC

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