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 inadequate
breastfeeding assistance.  At the hospital they offered her a pump from
Wednesday on and 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). 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
after warm compresses and R.R. and to 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. 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 to not 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.

What I want to know is why did this get so extreme?  I know that some women
decide to not breastfeed and they don't get like this.  Has anyone seen this
and do you know what causes such severe swelling? Is it likely that it will
happen with another baby if the early days of breastfeeding don't go well?

Patricia Gima, IBCLC
Milwaukee
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