Prevention and Treatment of Engorgement

Becky Flora, BSed, IBCLC

It is normal for your breasts to become larger, heavier, and a little tender when your milk becomes more plentiful on the second to sixth day following birth. This is due to the extra blood and lymph fluids traveling to the breast to prepare it for milk production, as well as to the milk volume itself. This normal fullness usually decreases within the first few weeks after birth if the baby is feeding regularly and well.

Breast fullness may develop into engorgement if the baby has not been feeding often or long enough. It may affect the areolar tissue only (the dark area around the nipple), the body of the breast, or both. The key to preventing engorgement is to nurse frequently and unrestrictedly after birth; i.e., every 2-3 hours with one longer sleep span in a 24-hour period even if waking the baby is necessary to do so.

Engorgement is characterized by:

• swelling
• tenderness
• warmth
• skin that is taut, shiny, or transparent
• throbbing
• low-grade fever

It is extremely important to treat engorgement promptly. Doing so will prevent possible complications such as:

• feeding problems or slow weight gain if the baby is unable to latch on to the engorged breast
• sore nipples due to the baby fumbling on/off as he tries to grasp hold of a too-firm breast
• increased risk of mastitis (breast infection) due to pressure within the breast and inadequate milk flow
• damage to the milk-producing cells which may in turn cause an overall decrease in milk supply

Following are measures for treating engorgement. If these measures are promptly initiated engorgement even in its worst manifestation should subside within 12-48 hours. These measures include:

• Before breastfeeding, take a warm shower or apply warm moist compresses to your breasts.

• Along with the heat or immediately after, massage your breast with your fingertips in a circular motion from the chest wall down to the nipple.

• Nurse at least every 1 1/2 to 2 hours from the beginning of one feeding to the beginning of another. Make sure that your baby is positioned and latched on correctly.

• Allow the baby to nurse both breasts for an unrestricted amount of time. Do not limit the baby’s time at the breast based upon a prescribed number of minutes.

• Massage your breast with your fingertips in a circular motion down toward the nipple as the baby nurses.

• If the baby does not nurse long enough to soften both breasts, hand-express or pump after nursing. A hospital-grade electric pump, such as the Medela Lactina or Classic, is preferable for treating engorgement, especially in severe cases.

• Apply cold compresses (a bag of frozen peas works well) or chilled cabbage leaves to your breasts between feedings to reduce swelling. Stop applying the cabbage leaves once you notice the swelling beginning to lessen. Switch back to warm compresses in the form of warm washcloths or warmed cabbage leaves about 10-15 minutes before feeding.

• You may also take a pain reliever such as Tylenol or Advil. Because Advil is an anti-inflammatory medication, it will help with reducing any swelling as well as relieving pain.

• If your areola is engorged, pump or hand-express just enough to soften it prior to feeding so that latch-on is easier for the baby.

Some mothers are hesitant about pumping to manage engorgement for fear that it will exacerbate the problem. However, expressing some milk will make it easier for your baby to remove the milk from your breast thereby lessening your engorgement. Also, remember that the engorgement is caused in part by other fluids – lymph and blood, as well as milk.

Becky is a board certified, registered lactation consultant (IBCLC, RLC) in practice with Breastfeeding Essentials in Kingsport, TN. She is the mother of 4 children ranging in ages from 7-13 whom she all breastfed proudly!