May 4, 1997
Subject:      ENGORGEMENT
Content-Type: text/plain; charset="us-ascii"

The subject is in all caps because I'm trying to impress upon you the horror
of the engorged breast I saw last Friday.  This woman is a small woman and
her breasts were wider than her body.  Together (and they were so tight
together that it was hard to get cabbage between them) they spanned over 20
inches. She was in such pain and had been so since Tuesday morning(day 3
after birth).  She got no relief from the limited measures at the hospital,
except for powerful pain medication, and was discharged with no hope for
resolution.

I've never seen, even in the most extreme pictures, such distorted tissue.
It was actually lumpy on the surface.  She had a c-section and very little
breastfeeding assistance.  At the hospital they offered her a pump from
Wednesday on but nothing would come out. She was very frightened by all that
happened at the hospital.  She is Spanish speaking and there was noone there
whom she could communicate with.

I arrived with my head of cabbage, some ibuprophen, and Rescue Remedy (
which helps to stimulate an MER (let down). After the RR, she was able to
pump about 1/2 ounce from each breast and we applied the cabbage.  Within
half an hour we smelled steamed cabbage and we changed the leaves.  It took
a lot of cabbage to cover the surface.  I left her with instructions to
pump every 2-3 hours, use the R.R., take the ibuprophen every 4 hours and
to change cabbage every pumping.

The next day she was feeling sooo much better-- no pain-- and was pleased
that the swelling had gone down some.  She was no longer "frying" the
cabbage.She was glad that she had been able to discontinue the pain meds.
from the hospital, as
they were making her groggy.  Today I returned and the breasts still are
huge but less so and are a bit more moveable.  We were able to get the
cabbage between the breasts with ease. She is still pumping about 1-1 1/2
ounce in 10 mins of pumping.

You may wonder about the baby's feeding at the breast.  Well, she has been
so traumatized by all of this that she is determined not to breastfeed the
baby.  She has been using abm since Tuesday when the engorgement began. She
is afraid that if she feeds the baby it will get terrible again.  She just
wants her breasts to go back to where they were. All she wants from me is to
resolve the engorgement and to not talk about breastfeeding. That's what I'm
doing. When things are better I will see if she is still determined to feed
abm and I will respect her wishes.
______________________________________________________


Date:         Fri, 16 May 1997 05:46:57 -0500
Reply-To:     Lactation Information and Discussion <[log in to unmask]>
Sender:       Lactation Information and Discussion <[log in to unmask]>
From:         "Patricia Gima, IBCLC" <[log in to unmask]>
Subject:      Re: ENGORGEMENT
Content-Type: text/plain; charset="us-ascii"

Long ago, before the crash of my internet service provider, I wrote about a
mom with terrible engorgement.  Thanks for the responses.  I want to give
you an update.

I had been called in on this case by a fellow Lactnetter who had to be away
for the weekend.  The mom continued throughout the weekend with cabbage,
ibuprophen, Rescue Remedy, and pumping.  She would not give her baby the
milk.  She told me several times through her friend/translator that she
didn't want to breastfeed, just to get her normal breasts back.

As her breasts softened so did her spirits.  My daughter (who speaks
Spanish)went with me a couple of times to translate and as they talked and
laughed the milk flowed.  I couldn't understand what they were saying so I
watched the pump and acted like a technician, and I didn't talk about
breastfeeding.

On Monday the Lactation Educator (hopefully IBCLC this summer) returned,
along with her determination to assist this mother to breastfeed her baby.
The mom had been in her b'feeding class before the birth, where she had
expressed enthusiasm for b'feeding, as most of her friends were doing it.
The LE just "didn't hear" of her decision to not breastfeed, but continued
measures as if, of course, she would feed the baby at the breast. Mom had
discontinued the ibuprophen but was still using the cabbage.

I arrived on the scene during one of these learning sessions, in which the
LE had worked on the baby's suck. The mother was standing in the room and
her breasts began to leak and she had most accessible nipples.  I walked
forward holding the baby and "THOMP" she latched on to the breast and
suckled a bit as we just stood there. (Not a great latch, but a latch.) Then
the little one looked up at mom and SMILED. Well, this mom of one week just
melted.  We suggested that if she pumped a bit the baby might be able to
latch on to the breast. She did and she did!  We had, fortunately,
progressed to a chair instead of standing in the middle of the room and now
the mom held the baby. The baby fed beautifully for a long time and mom had
what I call a "full-body smile." There was true joy in that room.

The LE continued to instruct and encourage the mom for the long night to
come.  I wondered if she would be able to keep going, being without
assistance.  I had my doubts, but the LE didn't. She had given of her time
and energy and caring and never gave up on this mom.

The last I heard, breastfeeding is going well and mom, baby, and dad are all
sooooo happy, and grateful to the LE who helped this mom, in the face of
seemingly impossible odds, realize her dream. I had a role in this
case--shrink the breasts--and I did have deep compassion for the mom and
hoped that she would change her mind about the feeding.  But the LE was the
real support person because she had established a relationship with this
woman, and gave her all.

What we do is important, but who we are while we do it is much more
important. We all can remember cases in which we were able to rise above our
own limitations and help a mom and baby launch a beautiful breastfeeding
experience. It's what keeps us keeping on.

I feel fortunate to have been witness to such a life drama.

Patricia Gima, IBCLC
Milwaukee


Mailto:[log in to unmask]

             ***********************************************
The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(TM)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html