My problem with engorgement is that it ranges from breast fullness to
complete breast congestion and no milk flow. I manage women with no milk
flow differently to those with normal breast pain related to breast
fullness, changing breast tissue and loads of milk.

So I only tell a woman that she is engorged if she has no milk flow. I
really try to normalise full breasts both with the women and the health
professionals working with them.

The women with true engorgement are rare and usually women whose babies
are in the neonatal nursery and the mother is only intermittently
expressing. So I work with the woman showing her how to use breast
massage aiming at draining the blood and lymphatic systems in
conjunction with frequent expressing.

Cold compresses work well after the "feed". However we have a vast
range of cultural groups and I talk to the woman about what works best
for her. I generally do not promote the use of heat as this compounds
the already congested breasts - remember there is no milk flow for these
women.

I am currently collecting case histories on these women to do a paper
as they are really few and far between in our unit.

Gwen

Gwen Moody
CNC Postnatal Care
Westmead Hospital
PO Box 533 Wentworthville 2145
Phone: 02 9845 6964, 0422212774
Fax: 02 9845 8340
Page: 02 9845 5555 - 01135
email: [log in to unmask]

>>> [log in to unmask] 23/12/2009 11:18 am >>>
Believe it or not, women in Norway are advised to use heat for this, in
the form of scarves around their upper bodies or wool underwear, and
they are often sent to take hot showers and 'massage' their breasts
though the exact technique is not well described.  It works
approximately as well as doing nothing, i.e. the engorgement eases up
after a couple of days.

RPS is becoming widespread since Ammehjelpen and the midwifery journal
published a translation of one of Jean's early pieces about it some 7
years ago, and a summary of the article was included in an appendix in
the Norwegian version of the BF triage tool.   Since it deals with the
engorgement itself, of course it relieves the discomfort too.

There is a very strong belief here that cold causes mastitis.  Even
sitting in a cold draft can bring it on.  Sitting on cold ground is also
believed to cause bladder infections.  A lot of us might be more
inclined to blame a pathogen in a place it doesn't belong for both
conditions, but here a woman wouldn't dare take the risk of mastitis
from icing down her nipples.  Cultures are different.

There is almost no research on the treatment of engorgement or its
concomitant discomfort in breastfeeding mothers, which is remarkable
when one considers how many women are plagued with it, and how many
small problems turn into big ones when complicated by engorged breasts.
Cabbage leaves have been shown to be more effective than nothing, and
synthetic oxytocin nasal spray has not been shown to have any effect on
on engorgement.  Apart from that, it's all wide open.

Rachel Myr
Kristiansand, Norway

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