All the interesting discussion about heat v cold for engorgement reminds me
- I hardly ever see it nowadays, and I mean almost never....

I'm talking primary engorgement here, which used to cause a real problem
when I first got into breastfeeding counselling (early 80s). Now, if I
speak to women who experience it, or who have experienced it, if at all,
it's a transient phenomenon that lasts no more than 12-24 hours, and which
is almost always easily coped with.

I hardly ever get a mother describing the 'milk just won't flow',
water-melon breasts, soreness and difficulty with latch syndrome that used
to be so common, and which lasted maybe two or three days or more.  For the
record,  our usual recommendation is to have a bath/shower/massage to
relax, extremely gentle hand expression (if possible)  if the baby can't
latch at first then the application of packs of frozen peas well-wrapped in
a towel for a short time (frozen peas are the one thing everyone has in
their freezer or fridge here, and they are a good shape for curving over
the breast).  Oh yes - lots of skin to skin when peas not present : ) Like
Jan, I'd love to see some really good research on all of this.

As we've already said on Lactnet, engorgement is made far more likely when
early bf is mis-managed. I suspect that in the UK the big difference has
been (almost) universal rooming in and far more unrestricted breastfeeding.

There's no figures on this - our ONS survey lists 'painful breasts or
nipples' in the problem section, but not engorgement as a topic. I'd like
to know if other UK-based Lactnet people have discovered 'disappearing
engorgement'.

Heather Welford Neil
NCT bfc Newcastle upon Tyne UK