Gloria writes:
Early this morning she was like grapefruits again.   She has been using
cabbage
leaves and cold compresses switching to warm compresses prior to pumping.
She told me she has the vacuum suction on the pump up to maximum--if she
doesn't, she does not get any milk.   The most she pumps per session has been 3
ounces combined.   She describes it as the milk not coming out.   It is there but
won't come out.   It does not spray out--only drops.   She has only felt one
letdown.
I've often seen this with extreme engorgement.  I've found it better to hand
express for a while first.  Hand expressing combines pushing fluid out of the
areola along with obtaining milk.  Once started we can switch to the pump and
the mom and/or I massage the breast while the pump runs, also putting some
pressure on the alveoli that you can feel, and the milk flows.  I think the
swelling in the breast can put such pressure on the ducts under the areola as to
impede the milk flow.

But it's not uncommon to get only a half ounce or ounce, or 1 1/2 oz. that
first time.  A small amount of milk can result in a great relief of pressure for
the mom.  Occasionally a mom has obtained 3 or more ounces this way.

 We then put the baby to breast.

After this initial extreme engorgement is reduced and the mother takes care
to put the baby to breast often, it doesn't come back with that extreme
swelling and things settle down.  Mother can continue to use cabbage leaves, cold
packs, ibuprofen, if she feels any return of engorgement.

One thing Peter Hartmann reiterated last week.  Only use the suction pressure
setting that feels comfortable.  The point is to elicit a let-down -- which a
higher pump suction setting might NOT do if it results in discomfort for the
mother.  Mothers did better in their lab when they used the suction setting
that was comfortable.  So cranking up the suction pressure may not be the
answer. And only frustrates the mother.

Mardrey Swenson IBCLC

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