Dawn writes:

<< What caught my attention was her reference to RN's still using heat
 prior to nursing to facilitate letdown with engorgement. Have I missed
 something? Please give me a reference on the contrary. We do use cold
 packs after pumping or nursing to decrease swelling >>

What happens if you put heat on an already edematous portion of one's anatomy?
You increase blood supply.  What happens when you increase blood supply?  You
bring more fluid to the area -- ergo, more swelling.  (Lawrence, p 256, ed. 5,
1999).  What treatment is recommended for swelling?  Ice/cold.  There is
increased vascularity in the breasts, which theoretically could compress the
ductal system making it even more difficult to express milk.

Granted, some women feel relief from a warm shower or leaning over a bowl of
warm water, however, bear in mind this will not reduce the engorgement.  If
engorgement was all milk, it wouldn't be a problem -- and, in fact, if a woman
is engorged (because the baby slept a long period of time unexpectedly), then
heat is probably the way to go.  But in this case we are talking about primary
engorgement (days 3 to 7).

Your goal is to reduce the swelling so the baby can once again latch on
without discomfort to the mother.

If the mother is uncomfortable and needs to relax, heat to the back of the
neck, a warm shower with the water on her back, not her breasts, will
facilitate the MER.  However, if the breasts are so swollen that no milk is
getting through, you aren't going to get anywhere regardless of the amount of
oxytocin in her system.  You need to reduce the swelling and vascularity --
and that comes through using cold.  And cabbage.

ARE there any studies that demonstrate the efficacy of heat to the breasts?
Or is it something "we've always done" which is why it continues to be done
prior to feeding?  And perhaps the issue as to whether or not "it works"
depends on the severity of the engorgement?  If the mother is a +2 or +3, heat
works?  If a +4 it doesn't?  Just a question here.  I've not seen a study that
supports packing the mom in hot compresses prior to a feed -- just "this is
how to treat engorgement" with no supporting scientific evidence.  I have,
however, seen much in the literature recently r/t cold.  (Most of the studies
are trying to determine if it is cabbage that reduces the swelling or the
effect of the cabbage being cold.  Haven't seen a study that uses heat as one
of the controls).

But, if anyone has a study that demonstrates that heat used prior to a feed
decreases swelling so that milk flow is increased, I'm up for changing my
protocols back to heat prior, cold after....

Jan Barger