How to handle breast engorgement

breast engorgement

Breast engorgement! When your breasts are engorged, they’re uncomfortably overfilled with milk. Engorgement can make it hard for your little one to latch on, which might result in an array of problems – from cracked nipples to mastitis. Engorgement can happen in the first few days after birth or anytime your baby doesn’t empty your breasts (during weaning or illness, for example). To relieve engorgement, pump just enough to ease the fullness, and continue nursing. Engorgement usually improves in 24 to 48 hours.

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What is breast engorgement?

Breast engorgement means that your breasts are overfilled with milk. Engorgement is natural, but at certain points it becomes a problem and can even lead to serious health concerns.

Your breasts can become engorged at any time in your breastfeeding journey, but it’s pretty common in the early postpartum days. Between the second and fifth day after giving birth, your breasts will become larger, heavier, and tender as they begin producing greater quantities of milk. This is known as having your milk “come in.”

Some of the fullness is due to extra blood and lymph fluids in the breast tissue. This fullness usually eases within the first two weeks after delivery, and your breasts should feel softer, even when your milk supply is plentiful.

If your breasts become uncomfortably full, though, or painful, they’re probably engorged. One or both breasts may be affected. More than two-thirds of women experience engorgement tenderness by day 5 after birth, although it can start as late as 9 or 10 days postpartum. (If you’ve had a c-section, your milk may come in later, delaying engorgement by a day or two.)

A little bit of engorgement isn’t anything to worry about. Your breasts will likely adjust as your body figures out just how much milk your baby needs (or doesn’t need if you’re not breastfeeding). But if it doesn’t get better, or you become seriously engorged, it can lead to clogged ducts and mastitis, and it can even permanently harm breast tissue.

What does engorgement feel like?

Engorged breasts feel uncomfortably full, swollen, warm, throbbing, and/or painful. Some women describe their engorged breasts as feeling hard as a rock.

Your nipples may become flattened and, if the swelling is severe, your breasts may be so full that the skin looks shiny. The swelling may extend all the way to your armpit, and the lymph nodes in your armpits may be tender and swollen. The veins in your breasts may become more obvious as blood flow increases and the skin tightens. You may even run a low fever, called a “milk fever.”

Engorgement can make it difficult for your baby to breastfeed effectively. A hard breast and areola (the circular area around your nipple) make it hard for your baby to latch on deeply, which can lead to painful nipples and a low milk supply. (Milk production is a matter of supply and demand.)

What causes breasts to become engorged?

Your breasts may become engorged if you’re not able to nurse your baby frequently or thoroughly enough to empty your breasts in the first few days after birth. Your baby may be having trouble latching and/or sucking, or maybe they missed a feeding during a procedure. But some women become engorged no matter how well and often their baby breastfeeds.

Sometimes engorgement happens because the breasts are swollen from the IV fluids given during labor or a c-section. This engorgement will subside when the fluid leaves the body through urine and sweat, but it can take a while. (It’s not unusual to have some IV fluid retention eight or nine days after delivery.)

You may also become engorged if your milk ducts are obstructed (you have a clogged duct). Some women who’ve had breast augmentation become engorged because the implants take up so much room that there’s not enough space left inside the breast for the increased blood, lymphatic fluids, and milk.

If you don’t plan to breastfeed, you may become engorged as your milk comes in (your body doesn’t know yet that you’re not nursing). Your body will get the message and stop producing milk, but you may have some engorgement in the meantime. The adjustment usually happens within about 5 days.

Engorgement can also happen if you’ve been breastfeeding for a while and suddenly stop, or if your baby suddenly nurses less than usual (because they’re sleeping longer stretches or through the night, for example, or because they have a stuffy nose). It can also happen if you start supplementing with formula or if you quickly wean your baby. (It’s a good idea to wean gradually for this reason.)

Nursing can be tricky if your breasts are engorged or if your letdown is too strong. Hear how these moms handled their overabundant milk supply.

How can I prevent breast engorgement?

Getting breastfeeding off to a good start can help prevent breast engorgement. Here are some things you can do to reduce your chances of becoming engorged:

  • Breastfeed within one hour after birth if possible. (Your labor and delivery team can help you with this.)
  • Nurse frequently – about eight to 12 times a day. Look for your baby’s feeding cues instead of following the clock. Don’t put your newborn on a feeding schedule or wait until they’re crying from hunger to feed them.
  • Snuggle up with your baby skin-to-skin to encourage them to breastfeed. Wake your baby if more than three hours go by from the start of one feeding session to the start of the next.
  • Make sure your baby has a good latch so that they can fully drain the breast. A lactation consultant can help with this.
  • Alternate which breast you nurse your baby on first at each feeding.
  • Let your baby finish nursing on one breast before switching to the other. This will typically take between 10 and 20 minutes.
  • Use different breastfeeding positions so that all the areas of your breasts are drained.
  • Track your baby’s feedings by recording the time and duration of every nursing session. Your hospital staff and/or your midwife or doctor will look at how your baby feeds throughout the day. If their feeding sessions tend to be short, or if they skip a feeding, you might hand express or pump to remove the milk.
  • Avoid introducing a bottle for a few weeks unless there’s a medical need. This gives you and your baby time to synch up so that you’ll produce the right amount of milk based on your baby’s sucking cues.
  • If your doctor or lactation consultant advises you to give a bottle and you want to keep your milk supply up, pump and give your baby the breast milk in their bottle (follow with formula, as necessary). If you want to supplement with formula and not pump, your breasts will get used to the schedule, but you may want to pump or hand express just enough milk so you’re not uncomfortable. Keep in mind that your overall supply will drop as your breasts are less stimulated to produce milk.

Breast engorgement treatment

Try these tips to ease engorgement and make breastfeeding more comfortable for you and your baby:

Express a little milk. If your breasts are uncomfortably full and your baby isn’t ready to eat yet, try hand expressing some milk for relief. (It may be easier to manually express milk in the shower.) Many women find it uncomfortable or painful to express milk when they’re engorged. This is an unfortunate side effect of the milk ducts being overly full, but your breasts are likely to be less tender once some of the milk is removed. You can also use a breast pump to express a little milk, but be careful not to overdo or you’ll stimulate your breasts to produce more milk.

Nurse frequently. Try to go no more than two to three hours between feedings.

Apply heat. Just before nursing, place a warm compress on your breasts for a few minutes to get the milk flowing. (Dip a washcloth in hot water and wring it out.) You could also take a quick warm shower.

Don’t apply heat for more than three minutes, though, since too much warmth can increase swelling and make it harder for the milk to come out.

Soften your breasts to help with latching. If your baby is having a hard time latching on, hand express or pump just enough milk to make your areola compressible.

Massage your breasts. While your baby is nursing, gently massage the breast they’re on. This encourages the milk to flow and will help relieve some of the tightness and discomfort. You can also try reverse pressure softening, which means gently pressing on the area an inch or two from the areola (the dark part of the nipple). Press backward and upward into the breast to move the swelling away from the areola so that your baby can more easily latch on.

Use a cold pack. To soothe pain and help relieve swelling, apply cold packs to your breasts for about 10 minutes before or after nursing. You can use crushed ice in a plastic bag or a bag of frozen peas or corn, covered with a thin cloth.

Try cabbage leaves: Some moms find relief by placing raw, cold cabbage leaves inside their bra. Crumble the leaves a bit first, and remove any hard veins, if you like. Don’t cover your nipples. Replace the leaves when they’re wilted, about every couple of hours.

Wear a supportive bra. Many women find a good nursing bra to be helpful. You may even want to wear one at night. Be sure it isn’t tight and has no underwire – which can cause constriction and clogged ducts.

Lie back. When you can, lean back when you’re sitting (against pillows on the couch or reclined in a chair, for example). Fluids will drain back if your breasts are higher, thanks to gravity.

Take an over-the-counter pain reliever. Anti-inflammatory medicines such as ibuprofen can help relieve discomfort or pain. (Ibuprofen is safe to take while nursing.)

If these measures don’t seem to work and your engorgement has gone unrelieved for a few days, let your doctor or lactation consultant know. They may recommend that you work with a specialist who has experience treating breast engorgement in nursing mothers.

How much to pump to relieve engorgement

Pump sparingly. If you’re breastfeeding at least every two to three hours and it’s going well, avoid pumping milk except when it’s needed to relieve engorgement.

If you do need to pump to relieve engorgement, use a low setting. There’s no exact recommendation on the amount of time to pump (it depends on how engorged you are and how quickly it’s relieved by pumping). Pump just long enough to soften your breast so that you’re not putting in an extra “order” to make more milk. Excessive or habitual pumping can lead to overproduction of milk and prolonged engorgement.

If you’re exclusively pumping and feeling engorged, make sure you’re pumping enough (eight to 12 times in a 24-hour period) and that your pump is working well. If you’re having trouble with letdown, try massaging your breasts, applying heat, and thinking of your baby (look at their picture or snuggle with a piece of their clothing). Read more tips for exclusive pumping successfully.

If you’re not breastfeeding and want your milk to dry up, you may still need to pump (as described above) to relieve the pressure on your breasts and lower your risk of a breast infection. Talk with your doctor or midwife about ways to reduce your risk.

How long does engorgement last?

Fortunately, engorgement passes pretty quickly for most women. You can expect it to ease up in 24 to 48 hours if you’re nursing well or pumping at least every two to three hours. In some cases, though, engorgement can take up to two weeks to go away.

Once the engorgement passes, your breasts will be softer, although still full of milk.

Again, let your doctor know if your engorgements lasts more than a few days. Also call if the redness, swelling, or pain gets worse, or if you have a fever. A low-grade fever isn’t unusual in the first week or so of breastfeeding, but fever can signal the start of an infection, such as mastitis. Call the doctor if your fever climbs to 101 degrees F or higher.

Can I still nurse if my breasts are engorged?

Yes, you can and should nurse if you want to continue breastfeeding. If possible, breastfeed your baby in the first hour after they’re born, and nurse often from that point on. Again, every two to three hours is a good goal.

Keep in mind that if your baby is having trouble latching on – because your breasts are so full – they may not be getting enough milk at feedings. In this case, you can pump and give your baby your breast milk in a bottle, or pump enough to relieve engorgement so your baby can nurse more efficiently.

Work with your doctor or a lactation consultant to make sure your baby is getting enough milk and to help deal with your engorgement.

Some women breastfeed without a hitch, while others face one challenge after another. Happily, with good information and the help of a lactation consultant, you can work through most of them. Read our breastfeeding problem solver article to learn about common issues nursing moms face and how to deal with them. 

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