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 16 of about 16.
1

us-n-kenzie - 29 days ago.
When I had my older daughter, i had a terrible time trying to breatfeed. My milk just never came in and I never got engorged or anything. The Dr put me on a medication that made me create milk, but as soon as I went off the medication, it stopped. I was trying to nurse almost constantly and pumping when I was not nursing. It got to where I had to use formula because my daughter was losing weight. In any case, I have decided that i do not want any part of that this time and I am going to use formula exclusively. My question is: what will happen if my milk does come in this time? Will it dry up and go away after a few days? Is it going to hurt? Do I need to do anything to make it stop?

lizzie287 - 32 days ago.
kimevansandt - I also have my nipples pierced. As long as you didn't rip your nipples or get any really serious infections after your piercing you SHOULD be good to breast feed. I asked my piercer about that before I got em done when I was 18 and she said she had no problem breastfeeding and she has both hers done twice.

kimevansandt - 32 days ago.
I had my nipples pierced about 5 years ago and I'm wondering if that will affect me breastfeeding. I didn't know if the scar tissue would make it more difficult or impossible to breastfeed. I always forget to ask the doctor when I'm in his office!

milf2b - 94 days ago.
Ladies, I need help! Has anyone here had an augmentation and breastfed afterwards? I had my surgery done submuscular so I can still breastfeed but I am so worried about engorgement with my implants, i'm scared that they might burst. PLEASE respond to my page if you have gone through this. Thanks :)

Laurada - 126 days ago.
The cabbage leaves worked for my first child. I was in so much pain and the DR told me to try it. He had no idea why it worked but his wife had tried it with their kids. So I did and the relief was fantastic.

kirstin - 126 days ago.
I definitely want to breastfeed with this child, but does anyone have a good recommendation for an electric breast pump? I had one with my first and it sucked.

smokekitty82 - 180 days ago.
ice packs help with releiving pain

momof3grtkids - 192 days ago.
Hello!! Here is a tip for relieving the pain. It may sound weird, but believe me, IT WORKS!!! Take CABBAGE leaves, cold from the fridge, and put them over your breast while wearing a bra. It really relieves the pain!!!!!! TRY IT!! It sounds weird but WORKS!!!!!!! :o)

StephanieRene - 217 days ago.
If you express the milk, it just cause more to come in. Hot showers can relieve the pain some, and will cause some of the milk to come out, but again, if it comes out, then more will come in. They usually give you pills or a shot to help you dry up if you aren't going to breast feed.

mof3il - 224 days ago.
hey ladies i was wondering.... in my previous pregnancies i pumped the milk for like a month and would bottle feed my kids... i have never really felt engorgement. we thought that my son would be our last baby so we sold my breast pump and here i am pregnant again. i know im not gonna breast feed but i dont know how ill clear up the milk... and i really dont want to buy another pump... i mean i will if i have to but im fine formula feeding. so my question is how do i get rid of the milk without a pump. ive heard somthing about cabbage leaves..... any suggestions???? thanks in advance.

doirone - 224 days ago.
By far the most painful thing I have ever experienced. I'm hoping this time around I don't have as many issues.

younghipmumma - 227 days ago.
With my first son i was so engorged i had lumps in my neck!!! It was the most painful thing i have ever expirienced!! and with the same son i was in labour for 36 hours and they had to break my pelvis to get him out and still i would that again 5 times before i would agree to be engorged again!!!

houger - 269 days ago.
Yea, pretty painful. No one warned me either. On top of it all, anytime I even thought about my baby I could feel the let-down. I was walking around trying NOT to think about the baby. You know how hard that was!

Chelsea K - 277 days ago.
Oh man no one warned me about this and it was really painful. When my milk came in my breasts were so engorged it made me cry to touch them, but I don't think most women get it that bad. Hoping to have it a little easier this ime!

TiffanyScholebo - 283 days ago.
when i had a miscarrage i had it and it hurts

jewels - 401 days ago.
Sounds painful


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