Engorgement

By Krista Gray, IBCLC. Last updated March 2, 2013.

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What is it?

Somewhere between days 2-5 following birth, a woman’s milk will “come in.”  This is accompanied by an increased blood flow and fluids in the breast.  Breastmilk, breast fluids, breast fullness, and a breast that is warmer, larger, and mildly uncomfortable in the early days are all normal.  In contrast, when a mother experiences these things along with a breast that is tight, shiny, painful and potentially has trouble with milk flow she is experiencing engorgement.

What causes engorgement?

Though most women experience breast fullness and perhaps a mild uncomfortableness in the first two weeks following birth, feeding your baby often and on demand will greatly reduce your chances of engorgement.  Typically, engorgement is caused by scheduled feeds, poor positioning and attachment, and/or ineffective milk removal.  And though it is most common in the first week or two following birth, it can happen later, for example, if milk removal is suddenly reduced.

What are the symptoms of engorgement?

  • Swollen, tight, shiny breasts
  • Pain (can be mild to severe)
  • Heat and redness
  • Occurs in both breasts (typically)
  • Mild fever
  • Difficult for baby to latch and breastfeed effectively

How is it treated?

Even if you do nothing, breast engorgement will eventually subside.  However, there are a variety of ways to treat it and help you be more comfortable:

  • Anti-inflammatories such as ibuprofen
  • Warm compresses before breastfeeding
  • Cold packs after breastfeeding
  • Cabbage leaves – cut out hole for nipple and place inside bra
  • Acupuncture 1
  • Reverse pressure softening – applying gentle pressure on areola to move swelling and fluids back into the body (especially useful if baby cannot latch effectively due to engorgement)
  • If areola is engorged (termed areolar edema) it is helpful to use reverse pressure softening as well as a laid back nursing position so that gravity can help breast fluids drain away from areola
  • Milk removal – either by breastfeeding, hand expression, or pumping.  It is important to breastfeed (or express) frequently.  During the first 2 weeks following birth, your baby should breastfeed at least 8 times in 24 hours.  Make sure your baby is nursing effectively (typically at least 20 minutes though some newborns can nurse more efficiently and others can take much longer.  Watching a clock is not nearly as important as watching your baby nurse, listening for active sucking and swallowing, and feeling your breasts drained afterwards).
  • When baby is nursing on one side, allow the other breast to drip freely
  • If baby is nursing frequently and effectively but breasts are still uncomfortably engorged, express just enough milk to be comfortable.  (Expressing too much when your baby is already eating well will cause your body to make even more milk, thus exacerbating the problem; not expressing at all when your breast is painfully engorged can lead to involution.*

Engorgement without milk removal will lead to decreased (or cessation of) milk supply.  Therefore, it is important to ensure engorgement is not caused by ineffective milk removal and, if it is, to breastfeed (or express) frequently to ensure your engorgement doesn’t very quickly turn into a dwindling milk supply.

What can I do to keep from becoming engorged?

The very best way to ensure you don’t become engorged (or deal with it quickly and effectively if you do) is to feed your baby, often.  Feed your baby as soon following birth as possible (ideally you will have immediate skin-to-skin contact and breastfeeding). Make sure your baby has a good latch and you are feeding on demand.  When your baby shows early feeding cues, make sure you don’t have her wait.  Don’t time the feeds and restrict them to a set amount of time.  Always allow your baby to drain one breast completely (or until she comes off satisfied) and then offer the other side.  At the following feed, begin with the “second  side” from the previous feeding. Feeding in this manner is more effective against engorgement than trying to equally feed from both sides at each nursing. 2

What if I am trying to wean or stop making milk?

Severe engorgement without frequent and effective milk removal will lead to breast involution quite quickly.  If you are trying to dry up your milk supply, you may want to express just enough milk to take the edge off the pain so that engorgement doesn’t lead to a plugged duct or mastitis.  Also, taking an anti-inflammatory (such as ibuprofen) can help manage the pain and inflammation more effectively.

Show 2 footnotes

  1. Kvist LJ, et al. (2007) A randomised-controlled trial in Sweden of acupuncture and care interventions for the relief of inflammatory symptoms of the breast during lactation. Midwifery. 23(2):184-95
  2. Evans, K. et al. (1995) Effect of the method of breastfeeding on breast engorgement, mastitis and infantile colic. Acta Paediatrica.  84(8): 849-852.
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