Regarding Karen's request for help on unilateral engorgement. First, is she wearing a constricting bra (or one with an underwire)? Is she laying on that side or doing anything more with that arm (is she left handed and just started back to a job that requires this arm or does she carry babies on that side only)? Also, in terms of pain relief, I have found that ibuphrophen works much better in engoregement cases (reduces swelling too). Has she tried wearing a breast shell on that side to encourage leaking? Make sure she takes her temperature and watches for signs of mastitis. In other times and places, a case like this would be managed by having a toddler or animal latch on to that side, but this is not socially acceptable here in the US, and regardless of acceptability presents risks in terms of HIV. To get milk out in stubborn cases try in this order: leaning over a sink of warm water (with baking soda in high concentration to encourage the lymph and other fluids out of the breast); deep massage, stroke and shake the breast while leaning over (sometimes hands and knees or leaning over a chair; the Marmet technique is quite effective (p.174 in the revised BREASTFEEDING ANSWER BOOK); deep breathing, quiet music, and dim lights are also helpful. Following the pumping or expressing, mom might try ice flowers to reduce swelling. I have also found that wearing microwaved or rolling pinned cabbage leaves work best for reducing engorgement. One more thing, some moms find the Flexishield to be a helpful attachment to a pump (by A/E). Some moms find relief with the use of Vitex Anus-castus L. which increases flow and perspiration. Encourage mom not to restrict fluid intake. Good LLLuck--I hope something in this helps. : )Chris Hafner-Eaton, PhD, MPH, CHES, IBCLC email: [log in to unmask] : ) : )HSR & Health Educational Consultant voice/fax: 541 753 7340 : ) : ) **CHANGE THE WORLD, NURTURE A CHILD!** : ) : ) : ) : ) : ) : ) : ) : ) : ) : ) : ) : ) : )