Engorgement happens when the milk-producing cells are uncomfortably full. It is sometimes apparent in the areola or the breast, in one breast or in both breasts.
When the “Milk Comes In”
Between day 3 and 5, a mother’s milk changes from colostrum into mature milk and her breasts become swollen with breast milk. Engorgement during this time is normal.
Learn more about the delayed onset of mature milk.
Things That Can Make Breast Engorgement Worse
- When the mother and baby are separated from each other, engorgement is usually worse. The importance of breastfeeding as early as possible, discussed here.
- Engorgement and swollen, painful breasts are common during the first few weeks of the breastfeeding relationship.
- Engorgement is usually worse if the mother has been given IV fluids.
- It is worse when a baby has been given formula supplementation.
- If the baby has a sucking problem. Or if the baby has a weak latch.
- If the mother and baby are not comfortable while breastfeeding, it may hamper milk transfer and therefore increase engorgement.
- Engorgement may happen when the baby struggles to stay awake while breastfeeding, therefore not draining the breasts sufficiently.
- When a mother follows a feeding schedule, instead of feeding her baby according to hunger cues. It is recommended to breastfeed on demand.
- Timing your baby on each breast during a breastfeeding session can cause engorgement. It is recommended to allow your baby to breastfeed until he/she indicates that they have had enough, then offer the other breast. Alternate your breasts with each feeding session.
- Mothers with small breasts may struggle with engorgement more. Ladies with small breasts have a lower storage capacity, which means that they will need to feed more frequently than a larger breasted woman.
- Breasts may be swollen and engorged due to any change in a baby's feeding pattern. This can happen if your baby starts sleeping more.
- Women who have already had children, seem to experience more engorgement.
- Ladies who have had breast surgery (reduction or augmentation), may experience engorgement problems if the breast milk ducts have been damaged; the breast milk may not have an opening to leave the breast.
Symptoms of Engorgement
- Breasts feel huge and swollen. The skin of the nipple and areola are stretched tight, making it difficult for a baby to latch on to. This can also cause nipple pain.
- Breasts are hard to the touch.
- Breasts are tender or painful and may be throbbing.
- The breasts are warm to the touch and red.
- The mother may have a low fever.
Treating Engorgement of Sore Swollen Breast
- Ensure that there is a good transfer of milk and check your baby's latch.
- Familiarize yourself with the signs that your baby is drinking enough milk.
- Ensure that your baby does not have a sucking issue.
- Feed your baby as frequently as he/she wants.
- Wake your baby if he/she breastfeeds less than 8 times in 24 hours.
- Avoid using artificial nipples and pacifiers.
- If at all possible, avoid using any supplements.
- A Nipple shield may be needed if your baby has trouble latching on. It should only be used for short periods of time.
- Use breast massage to stimulate let down and increase lymphatic drainage.
- Use breast compressions during breastfeeding to help the flow of milk.
- The mother should ensure that her breast pump flange is fitted to her size. She can also pump a little milk before a feeding to soften the breast for easier latching.
- The mother should drink enough water to keep hydrated; this will prevent engorgement and mastitis.
- Symptoms of engorgement can be safely treated with Danzen and Bromelain/Trypsin complex anti-inflammatory medication.
- Apply a warm face cloth to the breast, just before feeding to help with milk flow.
- Apply a cold compress to the breast after feeding to decrease pain and swelling.
- Put a cold cabbage leaf against your breast for a few minutes. It is believed that the cabbage gives off enzymes that ease engorgement, but this is not scientifically proven.
- Ultrasound treatment can relieve the pain of tender, swollen breasts.