Engorgement, Part One: Prevention and Treatment

Engorgement is an uncomfortable swelling of the breasts, often occurring several days after birth.

Is your milk “coming in”?
Some of your milk is “in” already, of course. Colostrum is early milk and is present by the third trimester of pregnancy. During the first 24 to 48 hours after delivery, your breasts will likely stay soft, similar to how they have typically felt. However, several days after delivery, you’ll notice changes to your breasts, as they begin to feel warm, tender and heavier due to increased blood flow to the breast tissue. This period of time is often described as the “milk coming in”, and the symptoms of fullness (or, sometimes, engorgement) typically last for 24 to 48 hour hours.

When to expect breast changes
Over the first several days of nursing your baby after birth, the colostrum gradually becomes more plentiful and transitions into a thin, yellowish milk (called transitional milk). If you are bringing your baby to the breast frequently and he is able to latch and transfer colostrum, you can expect your milk to become more abundant, and your breasts to feel fuller, along this timeline:

First time mom, vaginal birth: Days 2, 3 or 4
First time mom, c/section: Days 3, 4 or 5.

For a second-time (or more) mom, expect breast changes or fullness to occur 12-24 hours earlier than noted above.

“But I never got engorged.”
Not all breast fullness, or mild engorgement, is painful or problematic. If your baby can latch and nurse, and your nipples are reasonably comfortable, you’ll get some relief each time you nurse, or may notice your breasts feel firmer before, and softer after nursing. Between feeding sessions, your breasts may simply feel warm or tingly, and heavier than usual. “Not being engorged” isn’t a problem at all, if you notice other changes to your breasts and see signs of  increased milk production (with increased diaper output) during the first 3 to 5 days after your baby’s birth.
Note: If by Day 5 you have not experienced any breast changes or seen an increase in milk production, speak with your midwife or provider.

Painful Engorgement
Some women do have significant engorgement, which can be very uncomfortable. The breast tissue may become hot and rock-hard, with swelling extending into the armpit area, and you might develop a low-grade fever (less than 100°F or 38°C).

This over-fullness of the breast is partly milk, and partly edema (swelling) caused by normal hormonal fluid shifts and increased blood flow to the breast tissue. Frequent nursing (or manual expression, or careful use of a breast pump) along with ice packs and ibuprofen, will provide some comfort, and will gradually help to relieve the symptoms.
Note: Call your midwife or health care provider if your breasts become very painful, or if you develop a fever above 100°F or chills.

It’s HARD to feed from an engorged breast!
During the first days after birth, when the breast tissue is soft and flexible, you and your baby are learning together how to latch and breastfeed. Then, all of a sudden, the shape and texture of the breast changes! When the breast is hard and swollen, the areola becomes firm and slippery, making it challenging to get a deep latch, and frustrating for everyone. Trying to latch on to an engorged breast is like trying to latch on to a firm beach ball with an M&M glued on, and the whole thing covered in olive oil.

When the breast is engorged, babies are more likely to shallowly latch onto the end of the nipple, quickly leading to nipple damage and soreness.
Your baby will be able to get a deeper latch when the areola is softer and more flexible. If the breast is hard, soften the areola and breast just before nursing. Use a warm wet washcloth as a compress or take a hot shower, massage the breast gently, and then use hand expression (or a manual or electric breastpump) for about one to two minutes. In addition to softening the areola for a deeper latch, a minute or two of expression may also help the milk let down quickly once your baby is latched on and nursing.

Pumping and Engorgement
A little hand expression or a minute or two of pumping before feeding can help to soften the areola or draw out a nipple, and won’t worsen engorgement or create oversupply. If you’re having more severe engorgement, you can see if trying to remove milk will help. Softening or “emptying” your breasts by hand-expression or breastpump, just once or twice a day for relief temporarily, should not lead to oversupply or make engorgement worse. Rock-hard breasts are not healthy for you or good for milk production, and make it harder for your baby to latch on and feed. However, since not all the swelling in the breast is milk, hand expression or pumping may not remove all of the fullness. Now’s the time to add ice and ibuprofen to the mix!

Prevent or Treat Engorgement with Frequent Feedings, Ice and Ibuprofen
Ice Packs: Bags of frozen vegetables make ideal ice packs to arrange around your breasts in between nursing sessions. Keep four small bags of frozen vegetable “ice packs” in the freezer, and re-freeze and reuse them as frequently as needed. The ice packs help decrease swelling and feel fantastic.
Ibuprofen: Ibuprofen (Advil or Motrin) helps by reducing pain, swelling, and fever. Ibuprofen works best when taken every 6 hours (with a snack) for 24 or 48 hours as needed. Ibuprofen is considered safe for use by breastfeeding women and is approved by the American Academy of Pediatrics for use with nursing mothers and infants. As with any medication, check with your health care provider for recommendations for your specific situation.

Read part two for an easy to follow engorgement care plan!

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