Your breasts are engorged. They feel rock-hard and throb with pain. You can’t sleep or hold baby to your chest. What causes engorgement? Can it be prevented? What the best way to relieve discomfort?
What is breast engorgement?
Engorged breasts are a normal occurrence for many women in the first 2 to 5 days after child birth. When milk first "comes in" there is a flooding of lymph fluid and blood, which causes the breast tissue to swell. The swollen tissues push down on milk ducts clamping them shut; this then restricts the flow of milk (frustrating a hungry baby). As the milk builds up in the breasts engorgement occurs.
Engorgement can also develop at other times if baby's demand for breastmilk decreases suddenly or the mother is unable to empty her breasts resulting in her breasts becoming overly full. (Engorgement should not be confused with normal breast fullness that can occur at times.)
Engorgement can occur in one or both breasts. When the breast becomes engorged the entire breast, including the nipple, the areola (the colored area surrounding the nipple) and the area under the armpits become hard and swollen. The swelling causes breast throbbing pain. The skin is warm to touch and may appear tight, shiny and transparent. A low grade fever may also be present.
Although painful, for most mothers breast engorgement is a temporary inconvenience which when promptly treated usually subsides in as little as 12 to 48 hours. On the other hand, if left untreated breast engorgement may lead to other problems. Prolonged breast engorgement increases the risk of mastitis (a breast infection), due to inadequate milk flow. The swelling around the areola area may cause the nipple to become flat and taut, making it difficult for the baby to latch-on properly. A poor latch-on can result in sore or cracked nipples.
It's not possible to prevent the engorgement that occurs when your milk "comes in". However, it may be possible to prevent engorgement associated with inadequate drainage of the breast due to missed or delayed feedings.
- Mastering the skill of a deep latch-on will assist to minimizing the discomfort of engorgement and prevent many breastfeeding problems from developing. (See Breastfeeding basics for details.)
- Breastfeeding as soon as possible after your baby's birth to give him time to learn to breastfeed before your breasts become full and firm.
- Breastfeed 8 - 12 times in 24 hours to prevent milk from accumulating in your breasts. There may be times when you need to wake your baby for feeding.
- Don't restrict your baby's time on the breast by limiting feeding based upon a prescribed number of minutes.
- If you miss a feeding, hand express or pump to remove the milk.
- Whenever possible wean gradually.
- Avoid giving your baby supplements of water or formula unless advised to do so by your health care provider.
The treatment of breast engorgement usually focuses on relieving symptoms. Severe breast engorgement generally does not last for more than 12 to 48 hours. One or more of the following may help to alleviate the symptoms...
- Take your bra off for feeding to make sure your bra is not constricting your milk ducts during feeding.
- Before breastfeeding, warm your breasts by taking a warm shower or applying warm moist compress to your breasts for 10 minutes before feeding. Take 2 disposable diapers, put 1 cup of water in each and microwave. Then mold one around each breast inside your bra. This will stimulate milk flow.
- Massage your breast in a circular motion from the chest wall towards your nipple before feeding.
- Hand express or pump a little milk to soften the areola after warming. This will make it easier for your baby to latch-on.
- Breastfeed as often as possible, 8 to 12 times per day.
- Massage your breast again while feeding. Along with massage, try breast compression to encourage a greater flow. When your baby loses interest in feeding and slows down or begins to comfort suck, support your breast with your thumb above and fingers below, as far back from the nipple as possible, and gently compress your breast. Keep the pressure up until your baby no longer drinks. Wait a short while and compress again. (Breast compression is not necessary if your baby is feeding well.)
- Allow your baby to finish the first breast first rather than switch sides after a set period of time.
- If your breasts still feel hard, hand express or pump for comfort i.e. only long enough for your breasts to feel comfortable.
- If your baby is hungry and refuses the breast offer some expressed milk from spoon, medicine cup, eye dropper or syringe.
- Apply cold compresses (a bag of frozen peas works well) or chilled diapers. Add a cup of water to a disposable diaper and chill in the freezer for about 1/2 hour. Better still use chilled cabbage leaves. Strip the large vein from the cabbage leaf and cut a hole for your nipple. Wash (to remove any chemicals) and chill before use. Wear a leaf inside your bra. Change every 2 hours. Stop applying the cabbage leaves once you notice the swelling is beginning to lessen.
- Take a mild pain reliever such as acetaminophen (paracetamol) or ibuprofen.
- Make sure your clothing, bra, baby carrier or seatbelt do not constrict your breasts.
- Consult your health care provider if engorgement persists beyond 2 days; if you have increased pain or a fever higher than 101° F (38.4° C); or your notice red streaks on your breast/s.
Written by Rowena Bennett