Breast Engorgement

Breast engorgement
Engorgement is the tender, full, larger feeling that many women get in their breasts between days two and six after giving birth. The breasts often feel very hard and painful. The change in size and sensation is caused by increasing milk volume and increased blood and lymph flow to the breasts. This results from a change in your hormones and is necessary for milk production. If you have received intravenous (IV) fluids during labour you are at an increased risk of having an extended period of engorgement while your body rids itself of the excess fluids you received during labour. Some degree of engorgement is normal and usually subsides within 12 to 48 hours.

Breastfeed early and often
When babies feed more frequently in the early days, nursing mothers and parents are less likely to experience engorgement. Breastfeed as often as your baby is willing (at least every two to three hours). Allow your baby to stay on the first breast until he comes off on his own. Offer the second breast if your baby is interested. If your baby isn’t interested in the second breast right away, make sure to offer that side first at the next feeding. That may be 10 minutes or two hours later.

Engorgement can cause the dark area around your nipple, the areola, to become hard and swollen and can cause the nipple to flatten. This can make it difficult for your baby to latch on to your breast. The following techniques can help:

  • “Reverse Pressure Softening”. Use the tips of your fingers to gently press around the edge of the areola for a minute. This pushes the fluid back into the breast, softening the areola enough for your baby to be able to latch and remove the milk.
     
  • Apply heat briefly right before feeding to get your milk flowing. Do not apply heat for a long period of time because this can make engorgement worse.
     
  • Use gentle breast massage before feeding or expressing to help the milk flow more easily.
     
  • Hand express a small amount of milk to soften the areola enough for your baby to latch effectively.

After feeding, express milk
Expressing milk after you feed your baby can help resolve engorgement more quickly. If your breasts do not feel softer after nursing, you can hand express or use a pump just long enough for your breasts to feel comfortable. The other option is to completely drain the breast once or twice a day rather than expressing to comfort after each feeding. Once the period of engorgement has ended (1-2 days), slowly stop expressing milk. If you continue hand expressing or pumping, your body will make more milk and you’ll have an oversupply.

You can feed any milk you express to your baby with a tiny spoon like a “dessert”. This will help ensure that your baby gets plenty to drink in the first few days. Or you can freeze the milk for use later.

Treatments for Reducing Engorgement

  • Ensure that your baby is latching well and removing your milk effectively. If you are having difficulties or need support, get assistance sooner rather than later from a La Leche League Leader or an IBCLC (International Board Certified Lactation Consultant).
     
  • Use cold compresses (not heat) between feedings to help reduce swelling and bring you comfort. A soft gel ice pack or a bag of small diced frozen vegetables works well to soothe engorged breasts. Protect the skin with a layer of cloth between the ice pack and your skin.
     
  • Consider using a nonsteroidal anti-inflammatory drug like ibuprofen to relieve inflammation and pain, or a pain-relieving drug like acetaminophen, as needed. Consult your healthcare provider if you have any questions about these medications.
     
  • Cabbage leaves have long been recommended for engorgement but research shows that they are no more effective than cold packs, however, some women find them easier to use than cold packs. Cabbage leaves can carry bacteria so if you choose to use them, it is important that they be washed well with soap and warm water before use. After cleaning, cut the large vein out of the middle of the leaf. These can then be placed in the refrigerator until you want to use them. When ready, place the leaves over your breast, directly on your skin, inside your bra or snugly fitting shirt. Remove the leaves when they are wilted and soft (usually within a few hours) or when your baby wants to feed again. Fresh leaves can be applied after a feeding or when the first ones are wilted.
     
  • Use lymphatic drainage massage to help your body get rid of the extra fluid. See Lymphatic Massage Technique video for instructions.
    *Make 10 small circles at the base of your neck, just above your collarbone. *Make 10 small circles where your breast meets your underarm.
    *Sweep from your nipple toward your chest, collarbone and underarm.

If you use these strategies, engorgement should subside within 12-48 hours. If the strategies aren’t working and the engorgement is not improving, seek help from a La Leche League Leader or an IBCLC (International Board Certified Lactation Consultant). If left untreated, engorgement can lead to inflammation in the breast, which is called mastitis. If your breasts become hard, hot, red (if you have a lighter skin tone), or swollen or if you begin to feel unwell or develop a fever, it is possible that you have mastitis. Please read the LLLC information sheet Mastitis - a Matter of Inflammation for more information. If the symptoms last more than 24 hours, consult your healthcare professional. Prolonged engorgement can also result in less milk. When the breast remains overly full for many hours, it tells your body to stop producing milk. That is why frequent milk removal is so important.

Breast engorgement can be uncomfortable and challenging. Thankfully, it is usually limited to just a few days. Once your baby is feeding well, you can expect your breasts to feel softer even though you have plenty of milk. You may have engorgement in the future if your baby goes several hours without feeding. For example, if your baby sleeps six hours at night, you’ll probably wake up with full, engorged breasts. Usually, your baby will readily drink lots of milk. If your breasts remain engorged, express enough milk for comfort.

References:
Mohrbacher, Nancy. (2020). Breastfeeding Answers: A Guide for Helping Families, Second Edition. Nancy Mohrbacher Solutions, Inc.

Updated 2022