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Engorgement
By Kelly Bonyata, BS, IBCLC
What is Normal?
It is normal for your breasts to become larger and feel heavy,
warmer and uncomfortable when your milk increases in quantity (“comes
in”) 2-6 days after birth. This rarely lasts more than 24
hours. With normal fullness, the breast and areola (the darker area
around the nipple) remain soft and elastic, milk flow is normal
and latch-on is not affected.
How to prevent or minimize engorgement
- Nurse early and often - at least 10 times per 24 hours. Don’t
skip feedings (even at night).
- Nurse on
baby's cues ("on demand"). If baby is very sleepy:
wake baby to nurse every 2-3 hours, allowing one longer stretch
of 4-5 hours at night.
- Allow baby to finish
the first breast before offering the other side. Switch sides
when baby pulls off or falls asleep. Don't limit baby's time at
the breast.
- Ensure correct latch
and positioning so that baby is nursing
well and sufficiently softening the breasts.
- If baby is not nursing well, express your milk regularly
and frequently to maintain milk supply and minimize engorgement.
Signs & Symptoms of Engorgement
When? Engorgement
typically begins on the 3rd to 5th day after birth, and subsides
within 12-48 hours if properly treated (7-10 days without proper
treatment).
How does the breast feel?
The breast will typically feel hard, with tightly
stretched skin that may appear shiny, and you may experience warmth,
tenderness, and/or throbbing. Engorgement may extend up into the
armpit.
How does the areola feel?
The areola will typically feel hard (like the
tip of your nose or your forehead) rather than soft (like your earlobe),
with tight skin that may appear shiny. The nipple may increase in
diameter and become flat and taut, making latch-on challenging.
You may also have a low-grade fever.
Moms’ experiences of engorgement differ. Engorgement:
- May occur in the areola and/or body of the breast;
- May occur in one or both breasts;
- May build to a peak and then decrease, stay at the same level
for a period of time (anywhere from minimal to intense), or peak
several times.
Tips for treating engorgement
Before nursing
- Gentle breast massage from the chest wall toward the nipple
area before nursing.
- Cool compresses for up to 20 minutes before nursing.
- Moist warmth for a few minutes before nursing may help the milk
begin to flow (but will not help with the edema/swelling
of engorgement). Some suggest standing in a warm shower right
before nursing (with shower hitting back rather than breasts)
and hand expressing some milk, or immersing the breasts in a bowl
or sink filled with warm water. Avoid
using warmth for more than a few minutes as the warmth
can increase swelling and inflammation.
- If baby is having difficulty latching due to engorgement, the
following things can soften the areola to aid latching:
While nursing
- Gentle breast
compressions and massage during the nursing session can reduce
engorgement.
- After nursing for a few minutes to soften the breast, it may
be possible to obtain a better latch by removing baby from the
breast and re-latching.
Between feedings
- If your breast is uncomfortably full at the end of a feeding
or between feedings, then express milk to comfort so that
the breasts do not become overfull.
- Hand expression may be most helpful (though obviously second
to breastfeeding) as this drains the milk ducts better.
- Mom might also use a hand pump or a quality electric pump
on a low setting for no more than 10 minutes (engorged breast
tissue is more susceptible to damage). A "juice-jar"
pump may also be used.
- Massaging the breast (from the chest wall toward the nipple
area) is helpful prior to and during milk expression.
- It's not good to let the breasts get too full, but
you also don't want to overdo the pumping, as too much pumping
will encourage overproduction. If you do need to express milk
for comfort, your need to express will likely decrease gradually
over time; if it does not, then try gradually decreasing the
amount you express.
- Use cold compresses (ice packs over a layer of cloth) between
feedings; 20 minutes on, 20 minutes off; repeat as needed.
- Cabbage leaf compresses can also be helpful.
- Many moms are most comfortable wearing a well fitting, supportive
bra. Avoid tight/ill-fitting bras, as they can lead to plugged
ducts and mastitis.
- Talk to your health care provider about using a non-steroidal
anti-inflammatory such as ibuprofen (approved
by the American Academy of Pediatrics for use in breastfeeding
mothers) to relieve pain and inflammation.
AVOID:
- Excess stimulation (for example, don’t direct a shower
spray directly on the breasts).
- Application of heat to the breasts between feedings. This can
increase swelling and inflammation. If you must use heat to help
with milk flow, limit to a few minutes only.
- Restricting fluids. This does not reduce engorgement. Drink
to thirst.
Contact your lactation
consultant or health care provider if:
- Engorgement is not relieved by these measures.
- Baby is unable to latch
or is not having enough
wet/dirty diapers.
- You have mastitis symptoms:
red/painful breast, temperature greater
than 100.6 degrees F, chills, body aches, flu-like symptoms.
- You have any questions.
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Other treatments for engorgement
Cabbage
Applying cabbage leaf compresses to the breast can be helpful for
moderate to severe engorgement. There is little research on this
treatment thus far, but there is some evidence that cabbage may
work more quickly than ice packs or other treatments, and moms tend
to prefer cabbage to ice packs.
What are cabbage compresses used for?
- Engorgement.
- Extreme cases of oversupply,
when the usual measures for decreasing supply (adjusting nursing
pattern, nursing "uphill," etc.) are not working
- During weaning,
to reduce mom's discomfort and decrease milk supply.
- Sprains or broken bones, to reduce swelling.
To use cabbage leaves:
- Green cabbage leaves may be used chilled or at room temperature.
- Wash cabbage leaves and apply to breasts between feedings.
- For engorgement or oversupply:
Limit use as cabbage can decrease milk supply. Leave on
for 20 minutes, no more than 3 times per day; discontinue use
after engorgement/oversupply subsides.
- During the weaning process: Leave
the leaves on the breast until they wilt, then apply new leaves
as often as needed for comfort.
For further information on how to use cabbage leaves:
"Juice Jar" breast pump
This simple pump can be useful to help with engorgement, and to
draw the nipple out when baby is having a difficult time latching
on.
- Find an empty glass jar or bottle at least 1 liter in size
with a 5 cm or larger opening. The type of bottle that cranberry
juice comes in is often a good size.
- Fill the jar nearly full with very hot water. The glass will
get very hot and you will need to hold it with a towel.
- Pour all the water out of the jar.
- Use a cool washcloth to cool down the rim and upper part of
the jar so you can touch it without burning yourself (test it
with your inner arm).
- Place your breast gently into the mouth of the jar so that
it makes an airtight seal. Some moms lean over a table to do this,
others put the jar in their lap on a pillow and lean forward.
Expect this to take a few minutes, so make yourself comfortable.
- As the air slowly cools inside the jar, it creates a vacuum
inside the jar and this gentle suction expresses milk from the
breast. Break the suction immediately if you feel discomfort -
if the jar cools too quickly it may create excessive suction which
can damage breast tissue.
- Repeat for the other breast.
- Some moms need to repeat this, others find it works sufficiently
with only one try.
Fenugreek seed poultice
This is a traditional treatment for engorgement or mastitis.
Steep several ounces of fenugreek seeds in a cup or so of water.
Let seeds cool, then mash them. Place on a clean cloth, warm, and
use as a poultice or plaster on engorged or mastitic breasts to
help with let-down and sore spots. For more information, see Fenugreek.
Page last modified:
10/10/2005
Written: 7/10/03
Additional Resources
@ 
Reverse
Pressure Softening... aids latching when
mom is engorged
@ other websites
Prevention
and Treatment of Engorgement by Becky Flora, BS, IBCLC
Treating
engorgement by Kathy Kuhn, IBCLC
New
Perspectives on Engorgement by Mary Kay Smith, IBCLC, from Leaven,
Vol. 35 No. 6, December 1999-January 2000, pp. 134-36.
Animation
of baby nursing when mom is engorged showing how engorgement
can lead to nipple trauma, from the Breastfeeding Management Series
software by Sallie Page-Goertz, MN, CPNP, IBCLC and Sarah McCamman,
MS, RD, LD
Engorgement:
What it is, how to prevent it and how to treat it from Breastfeeding.com
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