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What is Engorgement, and how do you Make it Better?

By Jennifer Lincoln, MD, IBCLC, Board Certified OB/GYN

Engorgement is a term that is sometimes incorrectly tossed around anytime a nursing mom says her breasts feel very full. This fullness can be a sensation she notices when her milk first comes in (usually a few days after giving birth) or if her breasts aren’t completely drained during a feed (such as if there is an improper latch or plugged duct).

True engorgement, however, is above and beyond the breasts feeling full, as is often the case in the first few weeks of breastfeeding. Engorgement is when the breasts are abnormally distended, either from swelling known as edema (this can happen when mom has mastitis, for example) or from milk not being properly removed from the breast.

Engorgement can first and foremost be very uncomfortable and even painful for a woman. Her breasts can feel very heavy, hard, and tender to the touch. She may notice that her baby now can’t latch, and this is because the breasts are now so full that he can’t fit enough of the nipple and areola into his mouth. Unfortunately, this can cause a vicious cycle of less milk being drained, which means her engorgement only gets worse.

So what’s a mom to do if she succumbs to engorgement? Checking in with her lactation consultant would be her best bet, but here are some things to try at home:

Soften the breasts and help with milk let-down. This can be done by applying a warm compress or breast massage before a feed. Another excellent technique known as reverse pressure softening can help a baby latch better to an engorged breast. You can find a great description of how to do this (with pictures to help guide you) from the La Leche League.

Continue removing milk. Keep nursing your baby, but if your baby can’t latch or is not feeding adequately, express milk either by using a pump or hand expression. Hand expression may be quicker and easier in the early days of nursing. If your baby won’t latch at all, express milk as often as they would normally feed to keep your milk supply up. If your supply is adequate (that is, you get a ton of milk in a short amount of time), then only express enough to make yourself comfortable. If you do more than this, you could cause oversupply and only prolong the engorgement!

Feed on demand. Many moms who try to schedule feeds (either by spacing them out or stopping a baby who is still nursing) will end up with engorgement simply because they are not allowing their infants to drain their breasts enough. Watch your baby, not the clock!

Stop what is causing it. If your baby isn’t latching correctly and can’t drain milk, engorgement can certainly occur and won’t get better until the latch is fixed. If left alone, your body will get the message to eventually stop making milk which can lead to true low milk supply. This is why any new mom with engorgement that doesn’t get better over 12-18 hours should seek treatment from a lactation consultant to evaluate for these kinds of problems.

Decrease the edema. Combined with reverse pressure softening, other techniques can help reduce breast swelling, which can prevent milk from draining properly. You can try to apply ice packs for 20 minutes at a time as well as take an anti-inflammatory such as ibuprofen.

Any signs such as a fever, red skin, or flu-like symptoms should trigger a call to your doctor or midwife to make sure that you’ve not developed mastitis on top of engorgement, which can certainly happen. This is because if milk is not removed, bacteria that normally live on the skin can start to grow in the milk and cause an infection.

Sources:

  • Riordan and K
  • Wambach
  • Breastfeeding and Human Lactation, 4th edition. La Leche League International
  • My breasts feel extremely full and uncomfortable
  • What is happening and what should I do about it?

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