Common Breastfeeding Problems - Engorgement

What is Breast Engorgement?

Many women experience breast engorgement in the first week of life as their milk supply suddenly increases.  When the breast becomes overfull, the blood vessels in the breasts become constricted and the lymphatic system slows down.  The result is hard swollen breasts.  The breasts are often very sore, the skin is pulled taut and may be shiny and warm, and the nipple may become flattened and inelastic.  Fortunately, breast engorgement is easily treatable and does not usually last long.

Preventing Engorgement

The only prevention for engorgement is to keep the milk flowing.  It is normal to feel overly full as your milk supply increases.  Your breasts should become heavier, larger and perhaps tender.  But they should stay soft to the touch and the areola should remain elastic.  It is milk stasis I.E. leaving milk in the breast, which causes the swelling and pain.

Nurse your baby on cue from the very beginning.  Don't miss night feeds.

If your baby is sleepy and not waking to feed, try to feed her every 2-3 hours.  You can allow for one longer stretch of 4 to 5 hours.  Make sure that the baby is nursing effectively.  Ask a lactation consultant to watch your baby nurse if you are unsure.  Let your baby finish eating from the first side before offering the second.  If your baby is not eating well, you will have to either hand express your milk or use a quality breast pump.  Keep all your baby's sucking at the breasts, avoiding pacifiers and bottles.

Treating Engorgement

Getting the milk out of your breasts will relieve the engorgement.  Engorgement impedes milk flow making it difficult to express milk. There are several things that you can do to alleviate the swelling prior to breastfeeding or expressing.

Cold compresses relieve the swelling and discomfort.  You can use cold compresses, such as ice packs wrapped in a small cloth, before a feed for up to 20 minutes.  Make sure to protect your skin from the cold.

Green cabbage leaves also relieve swelling.  The leaves work best when chilled.  They should be used for 20 minutes at a time for up to 3 times if needed.  Since some lactation professionals maintain that cabbage leaves may lower milk supply, it is best to limit their use.

Messaging your breasts from the chest wall and/or armpit down towards the nipple can help get the milk flowing.

Helping the Baby While You Are Engorged

Your baby may have a difficult time latching on to your breast if they are swollen and hard.  Reverse Pressure Softening will soften up the areola and make latch on easier as will hand expressing milk from the areola.

If your baby does manage to latch on, you may want to re-latch him after several minutes of nursing.  Usually he will latch better after having relieved the engorgement.

If you are feeling uncomfortable between feeds, you can try expressing to comfort or using cold compresses. 

Though engorgement is most common in the first week it can happen anytime during the course of lactation if breastfeeds or pumping sessions are missed.