< Why do we assume an unstimulated, unemptied breast will automatically
become engorged?>
Because the level of prolactin builds up steadily and is at a very high
level at term (nesting urge, bonding?). It is the placental hormones,
specifically progesterone, I believe, that act at the binding sites to
offer opposition to the milk stimulation function of prolactin.
When the placenta is completely delivered and the stored progesterone (in
fatty tissue) has been released and the blood level falls (within about 8
hours after birth, if I remember correctly), the binding sites are then
increasingly free to begin to "do their thing" with the available
prolactin. This is the reason that retained products of conception can be
responsible for delayed lactogenesis.
Each nursing, and probably less so, each pumping, stimulates a new surge
of prolactin within 20-30 minutes, which, if I remember correctly has a
half-life of about 2.5 hours. But even if there is no breast stimulation,
the high initial level of prolactin is capable of bringing on
engorgement.
I have no documentation, but I heard years ago, (and have often told
moms) that there are 2 ways to "dry up", (of course, I'm speaking of
deliberate "drying up", not inadvertent "drying up" by giving the baby a
little more formula each day/week/month!)
1) "The American way" (binding tightly for a few days and taking
analgesics as you describe, and more likely to end up with flabby breasts
from rapid weaning) and
2) "The British way" (stepping into a warm shower and massaging,
expressing etc. , removing however much milk will make mom comfortable,
ONCE or TWICE, at the most, if really necessary, then using ordinary good
support from a bra, with perhaps cold packs for 20-30 minutes
thereafter.)
My understanding was that this may have added 24-48 hours or so to the
"dry up" time but was much more comfortable to moms in the long run, and
much less likely to be followed by mastitis, etc. As you observed, it
seems to preserve more options for the mom, and would seem, on general
principles, to be less "unphysiologic".
Now, I hope my UK friends will fill me in, so that if I say it in the
future, I can give what's evidence based? (Or at least "straighter from
the horse's mouth" as our figure of speech might put it.)
K. Jean Cotterman RNC, IBCLC
Dayton, Ohio USA
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