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Subject:
From:
"Linda J. Smith" <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Tue, 29 Dec 1998 11:18:57 -0500
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On the heat vs cold engorgement issue again..

The first principle of health care is "First, Do no harm."  I agree with
helping the mom in the way she wants ... but only to a point. If she "needs"
to relax and thinks smoking a cigarette would be the best way, is that
something I should suggest or support? What about smoking a joint of
marijuana? Or drinking a double Scotch?

Actually, the research on the need for moms to "relax" in order to let down
their milk is pretty thin. Niles Newton's study had a subject pool of one
person - herself. Let-down is rarely a problem for women, in my experience,
unless one of the following situations is occurring: (1) edema is present,
constricting the milk ducts or (2) milk supply is low. Applying heat/warmth
fixes neither. If milk is present and edema is absent, let-down is rarely,
if ever, a problem. Ordinary mechanical means (baby nursing or a decent
method of expression) will remove the milk quite well.

The ultimate justification for any intervention - applying cold or heat or
drinking Scotch - is solid evidence of safety and effectiveness. Where's the
research showing that application of warmth/heat to engorged/inflamed
breasts is safe and effective? "We've always done it this way" is not
evidence-based practice.

Linda J. Smith, BSE, FACCE, IBCLC
Bright Future Lactation Resource Centre
Dayton, OH USA
http://www.bflrc.com

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