Breast Engorgement – A Full Guide
Beast engorgement remains one of the biggest reasons why mothers seek the assistance of a lactation consultant. And all moms will agree that it is something that you won’t fully understand or appreciate until you’ve had the questionable honor of experiencing it first-hand!
Engorgement occurs when the breasts become overly full. It ranges from mild and completely normal, to severe and a sign of bigger breastfeeding problems.
THE SIGNS AND SYMPTOMS OF BREAST ENGORGEMENT INCLUDE:
- Breasts that feel full, heavy and tender.
- Your breasts may feel warm and throbbing.
- Your skin may be stretched tight and appear shiny.
- In severe engorgement the nipple and areola will also be hard, and baby may be unable to draw it into his mouth for a proper latch.
- It may affect only one or both breasts.
- It can involve the whole breast, or certain areas of the breast
- It can occasionally extend into the armpit area.
We explain two ‘types’ of engorgement
- Engorgement in the early days of breastfeeding
- Engorgement after a period of comfortable feeding
ENGORGEMENT IN THE EARLY DAYS
Normal physiological engorgement in the first week of feeding
During pregnancy the placenta manufactures the hormones progesterone and oestrogen. These hormones suppress the hormone prolactin that is responsible for making breast milk. This is with good reason – you don’t need full milk supply if baby is not born yet.
When your baby is born your breasts contain colostrum. This amazing substance is concentrated and strong, and only a few milliliters are sufficient to fulfill baby’s needs.
With the placenta out of the way, prolactin levels will rise and your breasts can start making your normal breast milk. This initial ‘coming in’ of milk happens 3-4 days (or 72-96 hours to be exact) after delivery.
Your milk will come in whether you are breastfeeding baby or not. Mothers who are not going to breastfeed will be given a tablet to stop this process.
In the early days of feeding you need to establish breast milk production. By feeding baby on demand, you give your body queues of how much milk to produce. This will take a few days to settle.
And therefore fullness 3-4 days after birth is completely normal. In fact, it shows that everything is working as it should. And if baby is latching and sucking well, and feeding on demand, it will clear within 12-48 hours.
When is engorgement abnormal?
Sometimes engorgement can go beyond what is considered physiologically normal. The following signs show that you need more specialized help; follow our tips, but if it doesn’t improve you should see a lactation consultant as soon as possible to prevent longer-term breastfeeding difficulties.
- If your breasts are so hard and full that baby is unable to latch.
- If your breasts don’t feel substantially emptier after a feed (this means baby is not effectively draining the breast and there may be a latching problem).
- If you have a lump or area in the breast that stays hard or keep coming back (this may indicate a blocked duct).
- If you have fever, or other symptoms of
- If none of the below tips seem to help (in which case you may actually be suffering from breast oedema and not engorgement).
What causes abnormal engorgement?
- If for whatever reason your baby is not latching – read our guide on what to do if a newborn refuses to latch.
- If baby is latching incorrectly, which can also lead to baby not emptying the breast well. The biggest sign of an incorrect latch is nipple pain. This is not something you can fix on your own, and you should seek assistance.
- If baby is sleepy and not feeding well. This can be due to pain medication given to mom during labour, or to prematurity, jaundice or an infection.
- If you are expressing (for example for a baby in NICU) but using a faulty pump or an ill-fitting flange (see our guide on how to measure your flange size).
- Wearing tight-fitting underwear that restricts milk flow (see our Carriwell range for excellent quality underwear that provides support without restriction).
- Occasionally previous breast surgery may lead to some areas of the breast not draining well.
ENGORGEMENT AFTER A PERIOD OF COMFORTABLE FEEDING
Sometimes a mom may develop full breasts after weeks or months of comfortable breastfeeding. This has usually got a definite cause, for example:
- Skipping feeds due to a busy schedule (often happens on holiday or while traveling as people’s normal routines and patterns are disrupted).
- Baby suddenly sleeping through the night.
- A physical restriction, like wearing an underwire bra or spending the whole day with a handbag/laptop bag strap putting pressure on the breast area.
- A malfunctioning breast pump – check your valves and other parts; if a pump suddenly stops working it often is due to a tear in a silicone part, or due to a valve no longer sealing well. There may also be something wrong with the pump’s motor. You can contact one of our Breast Pump Demo Centres for assistance.
If you develop a lump in the breast that stays where it is and doesn’t go away after feeding or expressing, you may also have a blocked duct – read our article for specific information on how to manage this.
HOW TO MANAGE BREAST ENGORGEMENT
It is important to manage engorgement well from the very start, so be sure to follow the below tips. Not treating it correctly can lead to mastitis. It can also affect your milk supply.
- Ultimately you need to empty the breast. Feed baby on the fullest side first, and allow baby to come off on his own. It would be better to empty one breast completely at a feed than to feed a little bit on both sides.
- If your areolas are too hard and tight for baby to latch you may need to first hand express a bit, or do reverse pressure softening.
- Change the position in which you hold baby; sometimes baby can empty a different area of the breast more effectively from the different angle offered by another feeding position.
- Apply heat for 3-4 minutes before a feed to encourage milk flow. You can take a shower, lean forward with your breasts hanging in a basin with warm water, or apply a warm cloth or wheat bag. Never apply heat for long periods in-between feeds as this will worsen inflammation.
- GENTLY massage your breasts before feeding from the outside to the inside, using olive oil or coconut oil. You can also use Natura’s homeopathic Arnica Gel or Heel’s Traumeel Gel to reduce inflammation and pain. Massage should never hurt or bruise your breasts.
- A nice tip is to fill a baby feeding bottle with warm water, and use that to ‘roll’ on the breast, combining heat and massage.
- In between feedings, apply cold compresses to the breast to reduce information. You can make your own by putting frozen vegetables in plastic bag and refreezing it again and again.
- Use cabbage leaves, which can double as a cold compress. Read our article on how to use cabbage leaves correctly to get the treatment benefits without doing any harm.
- Natura’s tissue salts number 4, 9 and 12 is a fantastic mix to encourage milk flow and prevent/treat mastitis. Use a tablet of each tissue salt every hour until you feel relief, and then gradually reduce it to three times a day. Once the engorgement is completely gone you can stop using it.
- Use an anti-inflammatory medication like ibuprofen to relief pain and inflammation.
- If engorgement and blocked ducts recurs you can use a Lecithin supplement.
SHOULD I EXPRESS TO RELIEVE ENGORGEMENT?
Expressing can help to treat engorgement, but if used incorrectly it can actually worsen the situation by further overstimulating your breasts and increasing production. However, sometimes a latching difficulty is at least partially responsible for severe engorgement, and expressing forms an important part of managing breastfeeding while a latching difficulty is addressed. So this is an arena where you really need to use common sense and base what you do on your unique situation. Read our article on when and when not to express (and how to go about it for each reason) for more perspectives.
As for using expressing as part of treating normal physiological engorgement in a baby latching well, keep the following in mind:
- For engorgement, many professionals prefer hand-expressing. This as sometimes despite the breasts being full, a mom may not get out much with a pump. Hand expressing is also less likely to cause overstimulation of the breasts.
- Hand expressing will also be less likely to cause overstimulation than a breast pump, but you can choose what works best for you.
- If your breast is still full and sore after baby has fed, put the pump on to relieve the worst pressure.
- Be careful to not constantly express after every feed.
- Sometimes a thorough expressing session where you empty the breast completely can do wonders to restore proper lymph drainage and blood supply. It may just give you the break that you need for your body to restore it’s balance in milk production.
- Be sure to use the correct flange size – use our guide to help you.
- You can also use a silicone suction cup (or milk collector); be careful though as it can worsen breast oedema instead of improving it. Read our guide on the role and use of these cups for breastfeeding moms.
Should you at any stage during this process experience fever, flu symptoms (chills, body aches) or have a red area on the breast you should contact a lactation consultant or see your doctor as you may be developing mastitis.
You are welcome to contact us on email@example.com for more support of to help you find a lactation consultant in your area.
More info by La Leche League (always a fantastic resource) – https://www.llli.org/breastfeeding-info/engorgement/
Reverse pressure softening – https://kellymom.com/bf/concerns/mother/rev_pressure_soft_cotterman/