I would like to suggest (I know - it's controversal!), but as well as the
obvious - massage, hot and cold, frequent feeds and some light expressing
etc. to add a 'good' expressing of both sides to *almost* empty and start
again from there.  I was told (I had extreme engorgement)to only express
enough to *feel* comfortable etc. which I did, but it wasn't comfortable for
long and was despariing, in the end I hand expressed and hand pump expressed
loads, all in one sitting till not only were they *comfortable* but down
right relieved and feeling almost empty - I stuck this in the freezer for
much later, then continued with frequent feeds and some massage, and I never
got that awfull feeling again (until the next was born!).  I would certainly
go for a one off good *clearout* and start the usual regime from there - as
least the mum will feel much better.

Pam


>Subject: pathological engorgement
>
>Hi,I need some help for a mum I've met with a terrible engorgement. This is
>her second baby and she didn't breastfeed her first one for the same
>reason.It was a planned cesarean section, lots of fluids and...baby in the
>nursery.She used a manual breastpump in her room and the electric hospital
>one while in the nursery she massaged the breast and used warm water
>bottles  . She had access to the nursery 2 days after birth and feeding
>times where 3 1/2 hours apart with a 6 hours gap at night.NO COMMENT- THIS
>IS HOW IT GOES IN OUR HOSPITALS .5 days after the birth she was discharged
>and the baby (2850gr)stayed in the hospital because of jaundice
>phototherapy.Her breasts are really sore and stone hard.The pumping
>releaves her simptoms for few minutes but, then she has the feeling the
>breasts become even more hard and sore. The baby latches on on one breast
>after reverse pressure but doesn't at the other.I have advised her  to use
>cabbage leaves and to keep on with massage, heat and pumping telling her
>that things eventually will improve.
>She has no help at home, her husband is out all day, she has a 4 years
>daughter to take care of and she is about to switch to bottles.
>Do you have any suggestion that can releave quickly a pathological
>(iatrogenic) engorgement
>Marina Baldocci IBCLC Rome-Italy


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