Engorged breasts are painful. They feel heavy, hard, warm and sensitive —as if they are ready to burst! As well as being painful, engorgement can lead to other breastfeeding problems if not treated. Being able to recognise engorgement will help you to treat it promptly, avoiding complications.
Most mothers experience some engorgement in the first weeks after birth. With changing hormone levels, your breasts swell and enlarge as milk production increases. It may seem as though they are filling up with milk, but engorgement is more than milk storage. Your body directs extra blood and fluids to your breasts to boost milk production. This causes congestion and swelling which will decrease as your body adjusts.
Minimizing early engorgement
Treat engorgement to…
When to treat engorgement
After the first few weeks
Causes of engorgement
Treating engorgment
Be sure your baby is sucking effectively
Reverse pressure softening
Keep comfortable
Watch out for signs of mastitis
Minimizing early engorgement
New mothers vary in how engorged their breasts become in the weeks after birth; some experience little engorgement, others describe their breasts as feeling like watermelons!
Try these suggestions
- Breastfeed your baby frequently from birth: at least 8–12 times in 24 hours. Keeping your baby close makes it easier to nurse every hour or two.
- If your baby is sleepy, perhaps from a medicated birth, you may need to wake him and encourage him to nurse.
- Aim to be comfortable while breastfeeding, and learn how to get your baby latched on well.
- If your newborn is unable to breastfeed, hand express frequently until your milk ‘comes in’, then combine with using a hospital-grade electric breastpump to help establish your milk production and relieve engorgement. Your milk can be given to your baby until he is able to nurse.
Treat engorgement to…
Make breastfeeding easier
Even if you feel as though you have lots of milk, engorgement can make it harder for your baby to latch on to your breast and feed well. A poor latch-on can give you sore nipples. Your baby may also have trouble coping with the flow of milk from engorged breasts.
Protect milk production
When milk isn’t removed from your breasts, you will produce less milk. Treating engorgement gives your baby more milk now and helps protect milk production for when your baby is older.
Avoid blocked ducts or mastitis
Engorgement can result in blocked ducts leading to mastitis.
When to treat
Engorgement after the first weeks
Treat as outlined below while working out the cause so you can prevent it happening again.
Common causes of engorgement are:
- A missed feed or expressing session.
This can easily happen during holidays and festivities or when visitors arrive. Encourage your baby to feed more often, or express more frequently if you’re apart from your baby. - Feeding a baby on a schedule
Recent research has revealed that mothers vary in how much milk their breasts can store without becoming uncomfortable. Mothers following routines often suffer from engorgement, mastitis and low milk production because their breasts are not drained often enough. - Expressing milk.
Some books advise expressing to keep milk production one step ahead of a baby’s needs. However, making more milk than your baby needs can increase your risk of engorgement and mastitis, especially if you go for several hours without feeding or expressing. - A baby who is unable or unwilling to nurse well for any reason
Expressing milk frequently until your baby can nurse well will help you maintain milk production and avoid blocked ducts or mastitis. - Weaning from the breast too quickly
If you experience engorgement during weaning, you may need to slow down the process. This will give your breasts time to adjust to the reduced demand for milk. If breastfeeding more often is not an option, try expressing just enough milk to relieve the fullness by hand or pump.
Treating engorgement
Reduce swelling and keep milk flowing:
- Aim to breastfeed every 1½ to 2 hours during the day, and at night every 2–3 hours from the start of one feed to the start of the next. Let your baby finish on the first breast before switching to the second
- Avoid using bottles or dummies. If a supplement is needed try using a spoon, flexible feeding cup or syringe.
- Between feeds, apply ice for 15–20 minutes at a time between feeds to reduce swelling. Use an ice pack, crushed ice in plastic bags or bags of frozen vegetables (that can be refrozen several times before being thrown away). Wrap them in a lightweight towel to protect your skin.
- Just before feeding, apply moist warmth to your breasts for up to two minutes to help milk flow. Try a warm wet towel, warm shower or immersing breasts in a bowl of warm water. Then, express to comfort if your baby isn’t ready to feed.
- Use gentle massage from the chest wall toward thenipple area in a circular motion.
Be sure your baby is sucking effectively:
Position your baby with his chest and tummy in full contact with your body. With his cheek in close contact with your breast, your baby can easily tip back his head to latch on. This way he’ll take a large mouthful of breast. Listen for swallowing as he feeds.
If your baby is finding it hard to latch on – when your baby bobs his head and licks the nipple, he naturally makes it easier to latch on.
For more information on getting your baby positioned and attached comfortably see here.
Reverse pressure softening
works by moving fluid away from the nipple area.
- Press all five fingertips of one hand around the base of the nipple. Apply gentle steady pressure for about a minute to leave a ring of small dimples on the areola.
- You can also press with the sides of fingers. Place your thumb on one side of the nipple and two fingers on the other side where your baby’s lips will be.
- If this isn’t enough, gently hand express a little milk before feeding to soften the areola. If you choose to use a breastpump, set it to minimum suction.
Keep comfortable:
- Ask your midwife or GP to recommend an over-the-counter, anti-inflammatory medication suitable for breastfeeding mothers to relieve pain and swelling.
- A well-fitting, supportive bra may help. Avoid bras (and underwires) that are tight or put pressure on specific areas of the breast.
- Cold, raw cabbage leaves worn inside a bra can be soothing. Change when they become wilted or after about 2 hours. Use only until swelling goes down as long-term use may reduce milk supply. Stop use if a skin rash or other signs of allergy appear.
Watch out for symptoms of mastitis:
- Inflamed, hot, red or darkened localised areas of your breast, depending on your skin tone. Changes in breast appearance may be harder to spot in darker skin. You may still have engorged breasts without a noticeable red or darkened area.
- Temperature over 38.4ºC or flu-like symptoms.
- Weaning can make a breast infection worse so continue to breastfeed frequently especially on the affected side and treat as for engorgement. Rest and drink fluids. If fever persists, continue breastfeeding and check with your GP as you may need antibiotics. More information on mastitis.
Engorgement should improve within a day or two. If not, contact an LLL Leader for further suggestions. You may need to improve your baby’s breastfeeding technique or find ways to reduce your milk supply. These are not difficult problems to solve, especially if treated promptly.
Written by Karen Butler, Sue Upstone & mothers of La Leche League Great Britain
Further Reading
The Womanly Art of Breastfeeding. LLLI. London: Pinter & Martin, 2010.
Beginning Breastfeeding
Comfortable Breastfeeding
Dummies and Breastfeeding
Hand Expression of Breastmilk
Mastitis
My Baby Won’t Breastfeed
Nipple Pain – why and what to do
Positioning and Attachment
Sleepy Baby – why and what to do
This information is available to buy in printed format from our shop
Copyright LLLGB 2016