Kate asks for references on the use of cold vs. heat for engorgement.

One of the first things to assess is whether any swelling is being caused by
incoming circulation, edema or both. Certainly, if the majority of the
discomfort is being caused by milk, then milk removal is the best thing. Or
perhaps, you are seeking to head off discomfort in the first place, before
it happens, as I have recently counseled several mothers with histories of
severe engorgement to plan as one proactive method of altering their next
postpartum experience.

I can't give you the exact reference, but I remember attending a talk at
ILCA once, given by someone who did a pilot project (with something like
less than 12 mothers, I think) to test whether the use of cold worked as
well or better on relieving swelling, and also whether if interfered with
the MER. (It may have subsequently been published in JHL even.)

I remember clearly that she found that it did not interfere with the MER,
and dimly, I must have been impressed with the rest of her talk because I
have been recommending it ever since.

One of the most important things for safety's sake is to recommend that
there be

   1. a cloth protective covering beween the ice bag and the skin, and
   2. that it not be left in place for any longer than 20 minutes, and
   3. not be used more than once in every 2 hours, in order to avoid any
   danger of frostbitten tissues.

I think its effectiveness may come from somewhat of a numbing effect, and
from "tamping down" on the amount of incoming circulation, and possibly, in
some way, helping excess interstitial fluid (edema) be reabsorbed into the
venous and lymphatic systems. I always wondered how it could do that while
causing blood vessels to constrict, but I read in a physiology book that
once the temperature of the blood vessel gets down to 59 degrees F. that
apparently this "numbs" the nerves in the blood vessels that was causing the
constricting effect and that the venous (and maybe lymphatic???) capillaries
automatically dilate. But then again, maybe the arterial capillaries would
then do likewise as nature would try to warm the tissues back up again!)

The use of heat vs. cold is a complicated subject which is still quite
controversial in the physical therapy profession according to the last
things I read about it (through googling).

Jean
*****************8
K. Jean Cotterman RNC, IBCLC
Dayton, OH USA

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