>My suggestions to mom included continuing with warm soaks/compresses,
>anually expressing a little around the areola to soften and allow a better
>atch, frequent attempts to nurse on that side, relaxation/nursing laying
>down or in changing positions, small dose of ibuprofen for inflammation,
>and apply chilled cabbage leaves.  Also gave her signs of mastitis to watch
>for.  What other suggestions would you make?


i just learned something many of you probably already know about
engorgement.  apparently, the approach to engorgement in the past 5 or so
years has been cold compresses for pain, swelling,  and discomfort, warm to
let down the milk.   more recenltly however, from what i understand, the
approach has moved to being cold only for the first 24-48 hours to reduce
swelling, then warm after that time frame. the thinking is similar to the
concept behind applying ice to a sprained ankle, or a wrenched back, then
following with a heating pad after ice only for some duration.  the way it
was explained to me is that when a mom is engorged. the extra lymph and
blood (swelling) constricts the ducts so that the milk cannot "escape."
this may explain why this mom cannot express anything . .. i don't quite
understand it though, because i know when i was engorged follwing the birth
of my babies, manual expression was not a problem, and i never used ice.
then again, maybe it would have resolved faster had i done so!  i see you
suggested cabbage leaves - but perhaps ice flowers and no warmth for a bit
might help . .. ?
Lyla Wolfenstein
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