Engorgement, Part Two: Care Plan

In Preventing and Treating Engorgement Part One, we learned what happens when the milk “comes in”, common concerns about fullness or over-fullness, and how to manage mild to severe engorgement.
Here’s an easy to follow plan.

Heat before and cold after, frequent nursing (or pumping), ibuprofen, comfortable bra

  • Move milk frequently. Encourage your baby to nurse on both breasts every 1.5 to 3 hours, or at least ten times each 24 hours.
  • Use heat before nursing or pumping. A warm wet washcloth or hot shower combined with gentle massage may help soften breasts and get milk flowing.
  • Babies latch better when the areola is soft and flexible. If the breast is hard and latching is difficult, soften the areola with a minute or two of hand expression, or use a manual or electric breastpump for 1 to 2 minutes.
  • Offer both breasts at each feeding, and encourage your baby to stay awake and eating with random little pokes and prods, sitting baby up to burp, or a diaper change between sides if baby is sleepy. (It’s ok if he doesn’t take both sides each time)
  • Gently massage whatever areas of the breast you can reach and/or stroke down the breast toward the nipple, during breastfeeding or pumping.
  • Use ice packs after and in between feeding sessions. Keep 4 small bags of frozen peas in freezer to re-freeze and re-use. These adjust nicely over breasts and under armpits just where you want them.
  • Ibuprofen (Advil or Motrin) 600 mg every 6 hours with snack for 48 hours. Used as an anti-inflammatory, it will help to reduce swelling and discomfort (if your provider approves).
  • Pumping to relieve severe engorgement (short-term) is okay! As long as you don’t pump frequently, then softening or even “emptying” your breasts once or twice a day for a couple of days will not lead to over-supply or make engorgement worse. Rock hard breasts are painful, not good for milk production, and make it harder to breastfeed. Short-term pumping might remove a lot of milk and help dramatically. On the other hand…
  • Not all breast swelling is milk. Pumping may not remove large volumes of milk or work to soften the breast significantly. Hand expression may work better, along with frequent nursing, ice packs and ibuprofen.
  • Positioning at breast: If your milk is spraying or flowing quickly and your baby is coughing or spluttering at the breast, some new positions can help. Nursing positions that hold your baby more upright or keep his head level with, or above the breast, especially at the beginning of the feeding, make it easier for him to manage the fast flow of milk during let-down.

New Mom FAQ: How necessary is burping a newborn, really?

  • Wear a supportive bra. Or don’t, it’s up to you to decide which feels better. Most new mothers find that wearing a supportive but comfortable bra or nursing tank are helpful. Tight bras or any breast binding will not help engorgement and are not recommended.

Call your midwife or provider for engorgement if: you can’t get your baby to latch at all, or, your breasts are hard, hot, and painful, or, you’re having fever and/or chills.

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