<The questions are:
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?>>>

1. Using cold will decrease the swelling in the tissue surrounding the milk
ducts, much like a sprained ankle which is swollen needs the swelling to go
away for circulation to the injured joint.
2.  I've never noticed if the cold interfere with the let down, the pump
flange is warm (I prefer to use the Flexishield for a very firm breast)  It
could theoretically interfere but most of the time, women want relief and
they are looking forward to it. A warm drink may help.
3. Cabbage or cool compresses work better than ice. I agree with the cultural
implications but I have seen Hispanic women who agree to try it sigh with
relief and comfort. I do understand your concerns with this. I'd use it
continously until the breast is softer or milk is flowing. But ice should
only be used for 15 minutes on and 15 minutes off as it can "burn" the skin.
Mary Kay Smith, IBCLC
Romeoville IL

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