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