Just a quick question. If a mom has significant engorgment that remains 
unresolved after repeated  ice, cabbage, massage is there a point where 
pumping is contraindicated?  I worry about creating even more discomofort by 
pumping, when clearly the oxytocin response is diminished..... this is in 
realtion to a mom who could not get baby latched on the one side due to very 
large nipple and engorged breast.

A midwife told one of my moms to do very deep massage ( not especially 
gentle ) and keep pumping, as opposed to hand expression, even though she 
kept getting just drops of milk at each session. This mom is the one from 
the post about a week an a half ago.  I'm back from vacation now and 
planning to contact this mom today.

LuAnn Smith RN, BSN, IBCLC
York, PA

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