Coach Smith here AGAIN on this issue. Let's look at what we DO know:

1. Heat exacerbates edema
2. Cold reduces edema if applied properly (short periods on the area,
alternating with time off)
3. "engorgement" is an imprecise term referring to edema, milk stasis, and
who knows what else.
4. There is no research supporting the use of heat on "engorged" breasts.
5. ILCA's "Evidence based practice for the first 14 days" has a section on
engorgement: "treatment should focus on measures to reduce swelling, such as
cold compresses..." and  "avoid use of heat unless breasts are freely
leaking" (strategy # 22, page 18)
6. First, do no harm.

SO - please do some critical thinking with swollen breasts. If edema is
present or possible, don't use heat.

If all you're dealing with is milk stasis, it's a "mechanical" issue - so
use a "mechanical" solution and remove some milk. Why use a thermal
treatment for a mechanical problem? Milk will flow just fine as long as
edema is not blocking/compressing the milk sinuses.

I've decided that warmth is fine for comfort, applied anywhere on the body,
as long as it does not cause or increase edema. And there are lots of other
things are also comforting, including chocolate....

ILCA's web site is www.ilca.org for the document referenced above. I have no
financial interest in the document, but I do purchase many copies and hand
them out liberally!

Linda J. Smith, BSE, FACCE, IBCLC
Bright Future Lactation Resource Centre www.bflrc.com
6540 Cedarview Ct., Dayton, OH 45459-1214 USA
(937) 438-9458 email [log in to unmask]

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