While there is some research on engorgement, it is quite old, and did not often look at treatment. My pilot study looked at engorgement and IV fluids rather than treatment of engorgement. 

However I do have some clinical experience of extreme engorgement. I worked with a mom who had a family history of extreme engorgement. Her mother had suffered through rock hard enlarged breasts and with no help was unable to breastfeed. I worked with this mom for a few weeks to get the engorgement resolved. I tried the usual warmth, massage, hand expression, RPS, etc. The only thing that even got milk moving was ice packs for 20 minutes to decrease swelling enough to allow milk to move. We needed to do ice before every pumping/feeding session for about 4 days before things settled enough to go without. I have since had other mothers with the same issues. They don't come along often, but when they do, nothing is moving that milk but to decrease swelling. All the mothers I have worked with have gone on to have excellent supply and were able to breastfeed. So, I am not sure how much I believe sweeping statements. 

I also think that clinically it makes no sense to take a swollen body part and add heat. Heat increases swelling. Breasts that are engorged in my experience have a combination of factors at play, milk being just one of them. Physiologically there is an increase of blood, interstitial fluid, and milk. Since we cannot guess at how much each of these contribute to engorgement, treating just one of these may not be ideal. Warmth applied to the breast will increase blood flow. Yes, there will be some pick up of interstitial fluid by doing this but not enough to balance or even decrease swelling. Ice/cold will decrease blood flow, and thus decrease swelling. It is why we use ice on inflamed tissue, like a sprained ankle. The idea that warmth can relax ductal tissue and allow milk to flow only addresses one of the 3 fluids. If the breasts already have an influx of blood and interstitial fluid, then warmth will make that worse and engorgement will become worse. 

I think engorgement is far more complex than we would like to believe. I also think sweeping statements and failure to look at the physiology of what is going on will be problematic. Certainly more research is needed in this area, and breaking down the systems that are involved with engorgement is a great first starting point. Understanding the physiology of what is going on in the breast tissue will help guide treatment. 

my two cents worth,
Sonya
who remembers when all breast pain was thrush and every baby had a tongue tie - sweeping statements land us in hot water
and for any who are interested in my pilot study, here is the link: https://internationalbreastfeedingjournal.biomedcentral.com/articles/10.1186/s13006-015-0043-8

             ***********************************************

Archives: http://community.lsoft.com/archives/LACTNET.html
To reach list owners: [log in to unmask]
Mail all list management commands to: [log in to unmask]
COMMANDS:
1. To temporarily stop your subscription write in the body of an email: set lactnet nomail
2. To start it again: set lactnet mail
3. To unsubscribe: unsubscribe lactnet
4. To get a comprehensive list of rules and directions: get lactnet welcome