Information About the Care of Engorgement When Breastfeeding

WHAT IS ENGORGEMENT?

Engorgement is the term that describes the change in your breasts as they become full, firm, warm and perhaps tender as milk production increases and colostrum begins to transition to mature milk.
Engorgement is caused by the swelling of the blood vessels in your breasts as well as the arrival of the early milk.
This is often an exciting time as you know that “my milk is in”! This excitement can also be dampened by the discomfort you may be feeling.
Although engorgement occurs most often in the early stages of breastfeeding, it can occur anytime during lactation when milk is not removed regularly.

Engorgement symptoms occur most commonly between days 3 and 5 after your baby is born. Symptoms of engorgement may be noted for up to 2 weeks.
Symptoms range from breasts feeling overly full and a little tender to feeling very hard and very sore.
Mild to moderate engorgement is common and normal. Extreme or prolonged engorgement is not normal.
With engorgement, you may have a slight elevation in your temperature. See “What to be concerned about” in the section below if you have a high fever.
Both of your breasts may be swollen and hard. They may also feel warm to the touch and the skin may look thin, shiny and transparent. The nipple may flatten out.

The incidence of engorgement may depend on breastfeeding management within the first few days after birth.
Studies show that engorgement occurs less commonly when babies spend more time

breastfeeding in the first 48 hours.

If you had large amounts of intravenous fluid during labor, this may increase the amount of swelling that you experience.
Women who have had breast surgery also may experience more or extended length of swelling of the breasts.
Avoid the use of bottles or pacifiers as your baby is learning to breastfeed.
Breastfeed at least 8 – 12 times in 24 hours. Latching on well and often is the single most important thing you can do to avoid extreme engorgement.
If you must miss a feeding or if your baby is not nursing well, use hand expression or a pump to remove the milk.

Symptoms of engorgement often resolve in 1 – 2 days.
Feeding your baby frequently with a deep latch is one of the most important things you can do to work through the engorgement.
It is important to rule out other causes of severe engorgement such as improper latch on and positioning.

Before Breastfeeding

Gentle breast massage and relaxation techniques may help improve milk flow. A video that shows how to massage your breasts can be found at: https://vimeo.com/65196007
To start the milk flow, use warm, moist heat on your breasts for a few minutes or take a brief shower. It is important to limit the time with the heat to less than 5 minutes to avoid increasing the swelling.
If your baby is having a hard time latching due to the fluid around your nipple and areola, reverse pressure softening can help if done just before feeding your infant. With this technique, you are pushing the fluid back away from your nipple so that your infant can latch on deeply.
With this technique, you use your fingers placed on your areola around the base of your nipple to put firm but gentle inward pressure toward your chest wall for about 60 seconds, repeating this as you rotate your fingers around your nipple. This may form “dimples” in the fluid in your areola.
Pictures of the reverse pressure softening technique can be found at: http://www.health-e-learning.com/articles/RPS_JCotterman_ver2005.htm
A video that shows the reverse pressure softening technique can be found at: https://www.youtube.com/watch?v=3ULnIUeHAIM
Hand express or pump briefly prior to feeding if your infant cannot latch on. For a video on hand expression see: https://globalhealthmedia.org/portfolio-items/how-to-express-breastmilk/?portfolioID=5623

While Breastfeeding

Gently massage and compress your breast when your baby pauses between sucks to help drain your breast.
Feed your baby until your baby finishes on the first side, and then offer the second side.

Between Feeds

Cool packs after breastfeeding can be helpful in providing comfort and possibly decreasing the swelling in your breasts. You may choose to use one of the following: a cool, wet washcloth/towel, a bag of frozen peas or corn wrapped in a thin cloth or cabbage leaves that have been chilled in the refrigerator and veins have been broken up. Apply any of the above to your breasts for about 15 minutes after your baby feeds. In Japan, they use grated potatoes to help with the swelling.
If your breasts are uncomfortably full, express a little milk. The goal at this point is to remove enough milk to provide relief but to avoid telling your body to make an excess of milk.
If it is generally safe for you to take a pain reliever such as Acetaminophen or Ibuprofen, this may provide some relief from the discomfort you are experiencing. Ibuprofen has the added benefit of also decreasing swelling.
A few other treatment considerations that have shown in studies a reduction in symptoms are Gua- Sha Therapy and Oketani breast massage. Acupuncture has also been used.

If you have a high fever (over 100.6 degrees Fahrenheit) and/or redness of your breasts and/or feel like you are getting the flu, this may be signs of a breast infection (mastitis). Typically, a breast infection (mastitis) will affect only one breast and there is a portion of the breast that is red and hot. Notify your OB or midwife if you are experiencing this.
If your baby has trouble latching on or is having a low diaper count (fewer than 6 -8 wet diapers or fewer than 3 dirty diapers once your milk becomes plentiful), contact your baby’s doctor and your lactation consultant
Unrelieved, prolonged engorgement can lead to lowered milk supply.

We are here to help you develop a customized plan. For breastfeeding concerns, call your lactation consultant at 888-818-5653

My Lactation Consultant is: ______________________________ Ext: ___________________

Lauwers, J., Swisher, A.Counseling the Nursing Mother:A Lactation Consultant’s Guide, 6^thed. Burlington, MA: Jones&Bartlett Learning:2016

Berens, P.,et al, Academy of Breastfeeding Medicine. ABM Clinical Protocol #20: Engorgement, Revised 2016. Breastfeeding Med 2016;11:159-163.