< Why do we assume an unstimulated, unemptied breast will automatically become engorged?> Because the level of prolactin builds up steadily and is at a very high level at term (nesting urge, bonding?). It is the placental hormones, specifically progesterone, I believe, that act at the binding sites to offer opposition to the milk stimulation function of prolactin. When the placenta is completely delivered and the stored progesterone (in fatty tissue) has been released and the blood level falls (within about 8 hours after birth, if I remember correctly), the binding sites are then increasingly free to begin to "do their thing" with the available prolactin. This is the reason that retained products of conception can be responsible for delayed lactogenesis. Each nursing, and probably less so, each pumping, stimulates a new surge of prolactin within 20-30 minutes, which, if I remember correctly has a half-life of about 2.5 hours. But even if there is no breast stimulation, the high initial level of prolactin is capable of bringing on engorgement. I have no documentation, but I heard years ago, (and have often told moms) that there are 2 ways to "dry up", (of course, I'm speaking of deliberate "drying up", not inadvertent "drying up" by giving the baby a little more formula each day/week/month!) 1) "The American way" (binding tightly for a few days and taking analgesics as you describe, and more likely to end up with flabby breasts from rapid weaning) and 2) "The British way" (stepping into a warm shower and massaging, expressing etc. , removing however much milk will make mom comfortable, ONCE or TWICE, at the most, if really necessary, then using ordinary good support from a bra, with perhaps cold packs for 20-30 minutes thereafter.) My understanding was that this may have added 24-48 hours or so to the "dry up" time but was much more comfortable to moms in the long run, and much less likely to be followed by mastitis, etc. As you observed, it seems to preserve more options for the mom, and would seem, on general principles, to be less "unphysiologic". Now, I hope my UK friends will fill me in, so that if I say it in the future, I can give what's evidence based? (Or at least "straighter from the horse's mouth" as our figure of speech might put it.) K. Jean Cotterman RNC, IBCLC Dayton, Ohio USA ___________________________________________________________________ Get the Internet just the way you want it. Free software, free e-mail, and free Internet access for a month! Try Juno Web: http://dl.www.juno.com/dynoget/tagj. *********************************************** The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(TM) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html