Let me introduce myself.  I am a former lurker, now posting for the
     second time.  My name is Gail Davis.  I am a public health nurse,
     IBCLC, working in San Francisco, Ca.  I work with a diverse population
     of low income women.

     I followed the topic of engorgement with great interest.  On the issue
     of use of cold, I thought it would be good to share some cultural
     information.  Let me say that I am by no means an expert, but have
     learned some things in my 17 years of working with Black, Asian, and
     Hispanic women.

     For many women of these cultural groups, there is a postpartum lying
     in, during which cold is to be avoided.  The thought is that birth
     causes the woman to be "cold" or "open"  (vulnerable?)  During that
     time, she may be advised to avoid bathing, shampooing, or eating
     "cold" foods.  (In many hospitals here, ice water is never given to
     Asian women after delivery. Rather hot water is given in a thermos.)

     If a postpartum woman breaks the cultural rules, she may fear that she
     has ruined her chance to breastfeed, and that her milk will go bad or
     dry up.  For many of these women, the elder matriarch of her family
     has great influence, so even if the postpartum woman herself is
     westernized, this cold rule is still followed.

     Many of these women are very respectful of authority figures,(the LC)
     and may go along with some suggestions  (ice) only to later change
     their minds about beastfeeding because her milk has "dried up."

     I have had Asian women ask me "do I have to eat vegetables?" because
     vegetables are considered to be "cold" If I told her "Yes you do
     because a well balanced diet is important, blah blah, blah," she would
     probably not feel as confident in her ability to breastfeed.

     I feel that it is important to be sensitive to these cultural issues.
     We all agree that the breast is not an ankle, and that heat may help
     in some cases, if only to relax the ducts.

     Recently I asked an engorged woman "What would feel better to you,
     heat or cold?"  She (a Filipina) wanted to try cold.  It worked very
     well for her.  Because she chose, I knew it was acceptable to her. (By
     the way, a disposable diapers saturated with water and frozen, makes a
     great ice pack.)


     Respectfully, Gail Davis, PHN, IBCLC.  From San Francisco where I
     cross the Golden Gate every day to get to work.