Engorgement

How can I prevent and treat engorgement?

What is Engorgement?
Most women will experience some breast fullness and firmness when their mature milk comes in at 3 to 4 days. This is normal. As milk production increases, blood and lymph fluids accumulate in the breast. If the baby is nursing frequently, effectively, and as long as he wants, this fullness will decrease significantly in 12 to 48 hours. A woman may continue to experience some fullness as her body learns how much milk her baby needs.

If the baby is not nursing frequently, effectively, and for as long as he wants, the mother`s breasts can become engorged. Engorgement is different than normal fullness because it is more painful and more likely to interfere with the baby`s ability to nurse.

Signs of Engorgement

• Breast swelling.
• Breast tenderness.
• Breast warmth.
• Breast redness.
• Breast throbbing.
• Breast pain.
• Flattening of the nipple.
• Low-grade fever (below 101 degrees F).

Causes of Engorgement
A breastfeeding mother is more likely to experience engorgement in the first week after birth if the following risk factors are present. It is helpful to counsel mothers during pregnancy on the strategies to help prevent engorgement.

Risk Factors and Prevention Strategies for Engorgement

1. Risk: Baby is nursing infrequently.
   Prevention:
   • Rouse a sleepy baby to nurse
   • Avoid formula supplementation.
   • Nurse 8 to 12 times every 24 hours.
   • Pump milk if mom or baby is unable to nurse. Experts recommend moms begin pumping within 6 hours of birth to ensure a good supply.
2. Risk: Severe breast pain or nipple injury that causes the mother to delay or stop nursing.
   Prevention:
   • If her baby is not nursing, use a hospital-grade double electric breast pump to express her milk every time the baby would normally feed.
   • Refer her to a lactation specialist to assess her pain or injury.
3. Risk: Baby not nursing effectively.
   Prevention:
   • Correct latch on problems.
   • Correct positioning problems
   • Go to a lactation specialist if needed.
4. Risk: Limiting how long the baby can stay at the breast.
   Prevention:
   • Allow the baby to continue nursing as long as the baby is actively sucking.
   • End feedings by watching the baby, not the clock.
   • Offer both breasts at each feeding.
5. Risk: History of breast surgery.
   Prevention:
   • Engorgement may not be preventable depending on the type of breast surgery.
   • Always see a lactation specialist if you have a history of breast surgery for thorough assessment and close monitoring after baby is born.

Treatment for Engorgement
Note: See a lactation specialist if engorgement does not improve in 48 hours or when your baby has symptoms of inadequate milk intake.

It is imperative that milk be removed from the breast in order for engorgement to resolve. Assisting the baby to latch on correctly and feed frequently is the number one priority.

1. Keep the baby skin to skin to encourage him to feed more often.
2. Nurse frequently.
3. Before nursing take a warm shower or apply warm moist compresses to the breasts.
4. If the nipple is flattened from the engorgement, help to soften the areola before the baby latches on.
   • Express or pump some milk before nursing.
   • Use `reverse pressure softening` before nursing. Reverse pressure softening is done by pressing against the areola firmly for 1 to 3 minutes before the baby latches on.
5. Change positions with nursing so the baby will stimulate increased flow from all parts of the breast.
6. If the baby is sleepy at breast, rouse the baby by switching sides during feeding to encourage active nursing.
7. After nursing apply ice packs or green cabbage leaves to the breasts to decrease inflammation.
   • Wash and dry green cabbage leaves and keep them in the refrigerator.
   • Before applying them to breasts, crumble each leaf then unfold and apply to the breasts.
   • Cover each breast with leaves and keep them on until the leaves wilt (up to 2 hours).
   • When breasts soften, express some milk to soften the areola and put the baby to the breast.
   • Do not use cabbage leaves more than 3 times a day or for more than 24 hours.
8. Take an over the counter anti-inflammatory medication like ibuprofen, as directed on the bottle, to decrease discomfort and inflammation.

NOTE
Mothers who have had breast reduction surgery may experience more extreme engorgement because milk ducts and major nerves have been cut or damaged decreasing effective flow of milk out of the breast. Milk-making tissue with no ductal outlet will begin producing milk, become engorged, then slow milk production when milk is not released from the breast. They may not produce enough milk to exclusively breastfeed. Mothers that have had breast enlargement have breast tissue that may be less elastic due to the implants. This makes it more likely that she will develop extreme engorgement that will decrease milk production. She may not produce enough milk to exclusively breastfeed. If exclusive breastfeeding is not an option, many mothers will continue to nurse using a supplemental feeding device at the breast.



Comments: Engorgement

Comments 1 to 6 of about 6.


em2 stewarts wife - 1205 days ago.
My breasts became engorged after both of my D&Cs (I had 2 missed miscarriages which required D&Cs) and the first time was horrible, I had no idea what was happening and wasnt warned that it could even happen! My boobs just hurt at first so my mom recomended I put a heating pad on my chest (exactly not what to do in my situation) the milk came the next day and the only thing the drs told me, 'wear a tight bra' (um yea ok dude, these puppies are 4 times their normal size, rock hard and HURT sooooo bad!) and also put cabbage leaves on them... Surprusingly the cabbage leaves actually worked. So for those who arent breast feeding or for those who went through what I did try the cabbage.. it helped in a couple days both times.

annarelle - 1400 days ago.
omg, i am 38weeks pregnant with my 4th and my breasts have gne hard and enlarged even more already! i have failed to breast feed properly every time but will try again this time .The extremly painfull memory of engorgement is so disheartning, why must the pain keep coming after the birth :( its all sooo worth it though. i remember i just keep thinking it will pass and it dose.. not a moment too soon thank god!

michahormiltedjmom - 1562 days ago.
Jennllewis, I am having the same problem. I breast fed for the first 3 days, then decided it wasn't for me. Now my breasts are really engorged and hurting. I just called the breastfeedding hotline at my hospital and she told me to massage them, used cold compress (ice packs), and cabbage leaves. My breasts have gone down a little since yesterday, but still pretty bad. She said they should get a lot better over next couple of days.

kungfu-ronin - 1600 days ago.
jennllewis- I had mastitis and ouch!!!! I had it with my first child when she was first born but refused to take medications and stop breastfeeding her, so it went away after a short while and i am still nursing her (trying to stop now, have baby number 2 on the way! ) Have you tried using a heating pad? I was extremely engorged with mastitis i could only nurse out of one breast and the other one was infected and the size of my head! so my midwife had me every 20-60 mintues use a heating pad (have a thick towel around the pad so you don't burn yourself) and leave it on your breast for 15-20 minutes. Then you should put and ice pack on them ( i dont remember if it was after or before the heating pad, I don't think it makes a difference though) and keep rotating. Also a warm soak in a bath every night would help too. It is painful engorment, but if you just do these things and hang in there, you should be fine in a few days to a week. Just don't nurse!! Good luck!!

AandDsMommy - 1621 days ago.
I had this problem when my daughter was born 3 years ago. I can only say thank God for the cold cabbage!!! It relieves the pain and discomfort. I also had to wear a really tight sports bra to help. I am hoping that it doesn't happen when I have my son in feb. Did this happen to anyone more than once??

dandunam - 1641 days ago.
Can only recommend raw white cabbage leaves stored in the fridge!!!! it really works....place seperated leaves in your bra and keep there until wilting!!!! Repeat as needed.

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