Engorgement is one of the most uncomfortable thing you can experience whilst breastfeeding or expressing. Your breasts are hard, swollen, heavy and hot, much like someone has stuffed two melons into your breasts. In this article we’ll discuss
- What is breastfeeding engorgement?
- What causes engorgement?
- How to prevent engorgement
- How to relieve your engorged breasts
What is Breast Engorgement?
Engorgement is a normal part of breastfeeding which occur when your breasts are overfilled with breast milk. Think of is as natures ‘warning system’ that baby either needs to feed now or is not feeding well enough to empty your breast.
All women should experience engorgement around 3-6 days after baby is born. The changes from colostrum to mature milk causes an increase in fluids and blood supply to the breasts. This happens whether you breast or formula feed and is usually known as your milk ‘coming in’.
After your milk comes in you may still experience engorgement in any of these situations:
- Before milk supply establishes (any time within the first 6 weeks)
- Baby isn’t feeding well (poor positioning or attachment)
- You have sore nipples
- Going too long between feeds or expressing
- Weaning from breast milk
If treated engorgement usually lasts around 12-48 hours, without treatment the feeling will subside within 7-10 days. When engorgement is resolved your breast will feel soft to touch even when full.
Breast Engorgement Symptoms
As the milk overfills in your breast with nowhere to go you will start to experience the symptoms of engorgement. It’s possible for engorgement to happen in one or both breasts. Engorgement can also occur in only the nipple or only the breast, but more commonly in both.
You’ll start to notice:
Breasts: become hard, swollen, hot, taut, shiny, redness, throbbing, painful and possibly ‘lumpy’ to the touch. If this happen in one area of the breast it’s more likely to be a blocked duct.
Nipples: appear flattened and hard to the touch, also begin to leak.
Baby: has trouble attaching as the nipple is flat.
Fever: you may have a raised temperature around 100.4°F (38°C) – not to be confused for postpartum infection.
Swollen Armpits: Lymph nodes under your arms may being to swell and tender to the touch.
What Causes Breastfeeding Engorgement?
Engorgement varies between women, and even between each child. There are four distinct pattern which you can experience engorgement.
1. Engorgement only when milk comes in a few days after birth
2. Minimal engorgement – happens rarely and is resolved within a few hours to a day
3. Peaks of engorgement – occurs regularly and can take up to a week to resolve
4. Prolonged intense engorgement – Continuous and does not resolve, can lead to more severe problems – consult with your doctor if this occurs to rule out other causes.
How often you experience engorgement will depend on a few factors:
Baby’s age: Engorgement is normal and expected around 3-6 days old as milk ‘come in’. If baby is older than this engorgement may be caused by delayed or missed feeds.
Length and frequency of feeds: Within the first 6 weeks after birth your baby should be feeding at least 8-12 times per day for around 10-30 min per feed. If baby feeds less than this the risk of engorgement increases.
Breast emptying: If you baby is not feeding effectively, they will not empty your breast during a feed. Your breasts should feel soft and empty after a feed. If they feel hard and full it’s likely you will experience engorgement by the next feed.
Compilations of Engorgement
It’s best to prevent or treat breastfeeding engorgement as quickly as possible. Complications which can occur from untreated engorgement include:
- Feeding problems or slow weight gain for baby if they are unable to attach and feed well
- Sore nipples cause by poor attachment to a flat nipple
- Mastitis (breast infection) caused by poor milk flow and pressure in the breast
- Damage to breast tissue caused by intense prolonged pressure can affect your milk supply.
How to Prevent Engorgement
It’s recommended baby is allowed to feed on demand, i.e. when they want to. This helps to establish your supply quicker. Ensure your baby is feeding at least 8 times in 24 hours and try not to go more than 2-3 hours between feeds. If baby is sleepy then wake them for a feed. Allow baby one longer stretch of 4-5 hours during the night.
No Time Limits
Its important to let you baby feed as often and as long as they want on each breast. Ensure the breast feels soft after baby has been on, before offering the other breast. Research has shown that engorgement is more common in mothers who limit baby feeding or switch breasts early during a feed.
Learn to Express
If you anticipate problems with feeding (you or baby) or any separations you should learn how to express your breast milk. There are three options: hand, manual pump or electric breast pump. It’s important to your baby’s feeding pattern as over expressing can lead to engorgement by increasing your milk supply.
It’s important to alternate breasts with each feed or one breast will become engorged. This usually happen if you have sore nipples. If it’s too painful to feed from the sore breast, express from that side and treat the cause or the sore nipple.
Positioning and Attachment
Having a breastfeeding specialist assess your positioning and attachment during a feed can stop a lot of problem in its tracks. A baby who is attached properly should be able to empty your breast at each feed. Expressing a little milk with engorged breasts can help prude a flattened nipple and make attachment easier for baby.
It’s recommended you drink to thirst, restricting your fluid intake will not prevent engorgement occurring.
If you are planning to wean baby from the breast its best to start slowly and reduce drops over a period of time. This will help your milk supply adjust to producing lower volumes of milk and decreasing the engorgement severity (if any) when you stop feeding. Sudden weaning can result in painful engorgement, however is unavoidable is some situations (illness or loss). We recommend using a breast pump to mimic baby’s feeding pattern. Slowly reduce the number of pumping sessions each day like a natural weaning pattern.
10 Top Tips for Breast Engorgement Relief
1. Heat Relief
To relax and stimulate your milk flow before feeding apply a warm damp face cloth over your breasts. You may also find a warm shower or immersing your breast in a bowl of tepid water can provide relief. The heat will increase your blood flow which can increase the pain so it’s best to only do this for 5-10 minutes before a feed or pump session.
2. Gentle Massage
If your breast are not too painful to touch try massaging in gentle circular motions around the breast before feeding. The best technique id to start at the top of the breast and work your way down to the nipple, pushing the breast tissue into the chest wall. This stimulates your let down reflex and is best combined with using heat, as suggested above.
3. Empty Breasts
If baby has fed until they are full and you still feel your breasts are not soft you should need to manually remove the milk. Use a breast pump or learn to hand express, removing only enough milk to soften the breast and no more.
4. Cold Therapy
For painful and swollen breasts using a cold compress can help provide relief. Place the compress on for around 10-30 minutes in-between feeds. Its best to use heat just before a feed as the cold can inhibit your let down.
5. Supportive Bra
If you wear a bra it’s important to make sure it’s well fitting and not tight or pinching. An ill-fitting bra can lead to mastitis or blocked ducts. We recommend using a specialist breastfeeding bra which can accommodate to engorgement. A soft sleep bra without seam or clasps is recommended at night when engorgement occur more often due to longer periods between feeds.
6. Pain Relief
If the pain in frequent and you are unable to cope, speak to your doctor about prescribing some mild pain relief. Certain types of pain relief may reduce the swelling, it’s important to ensure any medication your take is compatible with breastfeeding and any other medication you are taking.
7. Cabbage Leaves
Using cabbage leaves in your bra is an old home remedy which can provide you with some when engorged. Take a large, clean cabbage leaf, remove the large vein, cut a hole in the middle for your nipple and place around your engorged breast. The leaf will wilt within 2-4 hour and should be replaced with a fresh leaf. If it works for you it should provide relief within 8 hours of first applying. Some moms recommend cooling the cabbage in the fridge first, so it provides cold relief at the same time.
8. Breast Shells
If engorgement is causing your nipples to become hard and flat, we recommend using breast shells for around 30 minutes before a feed. Breast shells can help to protrude and soften the nipple for baby to attach easier. Check out our article on the best breast shells.
9. Nipple Shields
If hand expression and breast shells have failed at protruding your nipple before a feed then you may want to try a nipple shield. This is a thin piece of plastic which cover the nipple, shaping the nipple as baby suckles. Prolonged use of breast shield can cause problems by lowering your mil supply so it’s best to keep use to a minimum and use the techniques suggested to prevent engorgement occurring.
You can read our full guide to using nipple shields here.
10. Lymphatic Drainage Therapy
Massage therapists are specially trained in this technique, which increases the lymph flow near your breasts. This technique often works very well for moms with prolonged or recurrent engorgement with no other obvious causes.