One thing I've noticed missing from the discussion is WHY the
engorgement happened. I'd like to throw this into the mix and ask for
some creative ideas on dealing with it. The reason we see so much
engorgement here is the cultural expectation that "I don't have much
milk yet so the baby is getting bottles" or "I'm going to breast and
bottle feed" (ARRGGHH!) so they mix feedings from the start. We are
working very hard on education; staff and prenatal patients with the
information that this is setting them up for failure from the start.
However, I have a hard time convincing the patients sometimes.  So what
I hope to acquire from all of you is some ideas on how to put this in a
culturally acceptable way. Currently I ask them to dedicate the first
2-4 weeks to breastfeeding. Sometimes they look at me like I'm from
another planet when I suggest that. Other times I have actually begged
people to give it 24-48 hours with no more bottles to see how it works.
I've asked my boss if I could hav $$ to bribe them! :)
I know that nature provides food for the first few days but they just
don't believe it, even after I express colostrum and show them how the
baby gets it. Any ideas, folks?
Mary Kay Smith, CLE, IBCLC
Mount Sinai Hospital, Chicago