Dear Lacnetters,

I've been reading the recent posts about severe engorgement with interest.
I've always read in the Dutch information that warmth is what is always
needed before a feed (eg. warm compress on the breast before latching) and
not cold. But what your saying about using cold compresses before a feed
make much more sense. I think the idea of using warmth before a feed comes
from the idea that the milk ducts with 'cramp' up or contract and thus the
milk cannot flow well enough. I think there is also a fear of blocked milk
ducts and mastitis through using cold before a feed. However, it's only
obvious that its the edema in the tissues that's causing the ductal diameter
to be reduced.
I once observed a asian woman with severe engorgement who just could not
express milk, together with a LC we tried to help her relieve the
engorgement with warm compresses and a medela lactina but to no avail. We
didn't give her oxytocin as that "wasn't done in that hospital" Can't help
thinking cold would have been the best option.

I understand how the cold before a feed (ok, not necessarily immediately)
can help. But my questions are
1. does the cold directly effect the milk ducts?
2. does the cold interfer with the let down relfex? And if so at what
level - the release of oxytocin or the function of the myoepithelial cells?
3. What is the most suitable timing for using cold - 20 minutes immediately
before a feed, in between feeds etc?

From Jan's mail it looks like cold before a feed is not such a bad idea. I'd
also like to here some more about the experiences in using cold compresses
from the cold camp? I wondering if we need to re-look at our use of cold and
warmth??

Thanks

Sara Bernard
(lay bf counsellor, THe Netherlands)

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