1 L-CERP + 1 CEU

Case Study: Horrendous Engorgement and Tremendous Commitment

Allison Walsh, IBCLC, LCCE, FACCE, Postpartum Doula
Course description
This case study explores the experience of a first time lactating parent who experiences extremely challenging pathological engorgement. An overview of her health history (including pregnancy and intra-partum), the interactions of this client and her IBCLC, the care plan, and a summary of this case will be shared.

In this case, as in many challenging cases, professional policies and boundaries were stretched. Considerations for appropriate management and support will be discussed. 
Meet the Instructor

Allison Walsh,
IBCLC, LCCE, FACCE, Postpartum Doula

Allison Walsh IBCLC LCCE FACCE is an International Board Certified Lactation Consultant (2006), Lamaze Certified Childbirth Educator (2000), and and doula (2000) in private practice in New York City. She is one of the three founders of the Lactation Learning Collective, which offers education and support to those on the pathway toward certification as International Board Certified Lactation Consultants along with families in need of lactation support. She trains childbirth educators as a Co-Director of the NYC Lamaze Childbirth Educator Program and is a past president of Lamaze International and current member of Lamaze’s Certification Council. Allison has represented Lamaze International as a delegate to the United States Breastfeeding Committee since 2004, and has served in various leadership and committee roles.  

Allison is a member of the New York City Breastfeeding Leadership Council, the New York Lactation Consultant Association, and an active La Leche League Leader. She co-chaired the Save the Birthing Center Committee which was a group of professionals, advocates and consumers who fought valiantly but unsuccessfully to stop the closure of the Mount Sinai West (formerly Roosevelt) Birthing Center in New York City.  

Prior to the birth of her first child, Allison was a political consultant and community organizer. Skills from that “past life” are useful in all aspects of her work in the birth world. She is a graduate of Syracuse University and mother of three formerly breastfed children. Allison thinks that babies are the most interesting of all people and never underestimates the power of a good cup of tea, fresh air, and fresh bed linen. 
Patrick Jones - Course author

Learners say 

It was perfect timing of this presentation. After I finished the case study I got a severe engorgement case. I wasn’t able to see the client but I was able to educate my contractor to help support this mom. I loved the care plan example. I come from the hospital setting and this was helpful to teach me how to do my care plans. You did a great job! Thank you!

Ashley Lucas, RN, IBCLC

This case illuminates the emotional support and educational elements that improve parental understanding, as well as a plan and actions to help resolve the issue. It is illuminating to get inside Allison's critical thinking process to get through this extreme case.

Mia Borgatta, IBCLC

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Knowledge Gap
Physiologic engorgement is commonly addressed by IBCLCs. This presentation will entail a discussion on pathological engorgement which is less common. Additionally, professional ethics and boundaries will be discussed. 


The participant will be able to identify the features of pathological engorgement. 


The participant will be able to differentiate between physiological and pathological engorgement during lactation.


The participant will be able to list at least three strategies for reducing engorgement and facilitating comfort. 
IBLCE Content Outline
I. B. 1 Breast development and growth 
I. B. 4 Maternal anatomical challenges
II B1. Hormonal influence of milk production
III. B. 8 Nipple and breast conditions 
III. B. 9 Nipple pain and trauma
V. 1 Transition to parenthood 
V. 2 Birth practices 
V. 6 Identifying support networks 
V. 9 Mother-baby relationship
VII. A. 3 Nipple devices (e.g., shields, everters)
VII. A. 5 Pumps 
VII. B. 1 Active listening  
VII. B. 2 Anticipatory guidance 
VII. B. 3 Care plan development and sharing 
VII. B. 5 Educating mothers and families 
VII. B. 8 Emotional support

Course Lessons

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