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How Can I Treat Breast Engorgement?

Engorged breasts feel heavy, warm and sensitive - not to mention painful. If not properly treated, breast engorgement can cause other breastfeeding problems. If you can recognize engorgement, you can treat it quickly and avoid these problems.

For most new moms, breast engorgement is normal in the first week after birth. Your breasts swell and enlarge as hormone levels fluctuate, and milk production increases. Although it feels like they are overfilled with milk, the feeling is actually due to more than this: your body directs extra blood to help increase milk production and also extra fluid given during delivery will accumulate in your breast causing them to enlarge. The swelling and heaviness will usually decrease in 48 hours.

Questions Moms Ask: "How can I treat breast engorgement?"

How to treat breast engorgement in the newborn period

The first week postpartum

Your milk transitions from colostrum to mature milk and increases in volume of milk produced in the first two week postpartum. Some moms will not experience much discomfort, maybe just some fullness while others may become very uncomfortable.

It is important to remember that your milk production is based on supply and demand. The more you feed the more milk you will make. Frequent feeds during the first 2 weeks is very important in establishing your milk supply and will minimize discomfort during the engorgement period. The good news is the engorgement will only last about 48 hours.

Tips for minimizing breast engorgement in the newborn period

  • Breastfeed your baby frequently (8-12 times in 24 hours) or express milk. This will minimize the discomfort felt during the engorgement period that lasts about 48 hours. Staying close to your baby and providing lots of skin to skin contact makes it easier for your baby to nurse regularly. 
  • Some babies are sleepy and may need to be woken and encouraged to nurse. Changing their diaper, undressing your baby down to their diaper and applying a cool cloth to their face, back or bottom of their feet can help wake them up for a feeding.
  • Make yourself comfortable by sitting back and make sure to bring your baby to you. You can rest your baby on a pillow so they are at breast level. It may take several tries before they latch so be patient.
  • Immediately after birth, a small amount (a teaspoon) of a thick, often yellowish form of breast milk (colostrum) is expressed. This is highly nutrient-dense and beneficial to newborns, particularly those born prematurely. Mature breast milk comes in 3-5 days after birth.
  • Feeding your baby frequently will minimize the symptoms of breast engorgement and establish your milk supply. If your baby is unable to breastfeed or you are separated from your baby, it is recommended that you use a hospital-grade electric breast pump and pump as often as you would be breastfeeding (at least 8 times in a 24-hour period).

Questions Moms Ask: "How can I treat breast engorgement?"

Breast Engorgement Treatments, and Prevention

Breast engorgement can cause your breasts to enlarge and can cause the nipple to flatten and the areola (the dark part behind the nipple) to become firmer making it difficult for the baby to latch onto your breast. A poor latch can lead to sore nipples.

Tips on how to soften the areola so your baby is able to latch deeply on the breast are as follows:

Gently massage your breast from your nipple to your axilla (arm pit). This will help move the extra fluid to your lymph nodes.

Another option is to apply pressure around your nipple. To do this, press your fingertips around the nipple and apply gentle, steady pressure for around a minute. 

Lastly a warm shower followed by hand expression, expressing enough to soften the areola, can also be beneficial. This will make latching your baby or pumping easier. After feeding, apply cold to the breast to decrease blood flow and minimize swelling.

Questions Moms Ask: "How can I treat breast engorgement?"

Common causes of breast engorgement

As mentioned above, your first experience with engorgement is during the first week after your baby is born. When the colostrum is transitioning to mature milk and your milk increases in volume, you have increased blood flow to the breast.

Later in your breastfeeding journey you may experience engorgement for any of these common reasons:

  • Missed nursing or pumping session. Missed nursing could be when your baby starts to sleep longer through the night. If you wake up from being uncomfortable you could pump to relieve the pressure and wait for your baby to wake up. If your baby starts to consistently sleep longer it will take about 3 days for your body to adjust to this new feeding schedule.
    • If you are at work and missed a pumping session, as soon as you are able pump your breast until they feel well empty. Your pumping session may be longer than normal after a longer wait period.
  • Expressing too often. Although frequent milk removal is always advised, expressing more than your baby can drink can increase the risk of engorgement. Extra pumping will increase your milk supply, so it is important to try to find a balance, so you avoid engorgement. Your goal is to produce what your baby needs.
    • If your baby is being given a bottle of expressed milk or formula you want to pump to empty your breast and maintain your supply. If you would like to pump to store milk for your baby, one way to avoid engorgement and tell your body you need more milk at a particular time is to choose a time of day you can pump consistently.
    • Most moms like to pump after the morning feeding because they have more milk in the morning, and it is easier to incorporate into their morning routine. Your body will think of it as another feeding and will produce more milk around that specific time. It takes about 48-72 hours for your body to get the message so that is why consistency is important.
  • Your baby is unable to nurse well. If your baby struggles to latch or is not nursing efficiently you will need to pump after the feed or in place of the feeding to avoid engorgement and maintain your milk supply.
  • Weaning too quickly. Weaning too quickly can lead to engorged breasts. Your breasts might need more time to adjust to the reduced demand for milk; continue pumping just enough milk to relieve the discomfort.
    • Remember it takes your body about 48-72 hours to adjust to a decrease or increase in demand. Eliminate one feeding at a time over 3-5 days. If you become uncomfortable at the feeding time you are eliminating, then pump for comfort not to drain the breast.

Questions Moms Ask: "How can I treat breast engorgement?"

Ensure your baby has a good latch 

Breastfeeding should be comfortable throughout the feeding. If your baby is not latched deep onto the areola and is only latched on the nipple this will cause you pain and will limit the amount of milk the baby will receive from the breast.

To ensure a proper latch, put the baby skin to skin, undress your baby down their diaper and undress yourself from the waist up. Lay the baby on your chest, your baby's head should be on your sternum between your breasts. Your baby's feet should be pointed down towards your feet. Wait and your baby will bob their way to the breast/nipple using their sense of smell, sight and touch and will latch themselves on to your breast.

Breastfeeding should not hurt throughout the feeding. If you are concerned it is recommended, you have a lactation consultant or medical professional observe a feeding.

Questions Moms Ask: "How can I treat breast engorgement?"

Symptoms of mastitis

  • Mastitis is usually characterized by inflamed, hot, red or darkened areas of your breast. These areas may look more purplish on darker skin tones or may not be noticeable; you could still have engorged breasts without the noticeable darkened area.
  • High temperature (over 38.4oC) or flu-like symptoms.
  • Weaning can make mastitis worse, so try to continue expressing milk or nursing your baby regularly. Rest and stay hydrated, and contact your healthcare provider, as you might need antibiotics.

Questions Moms Ask: "How can I treat breast engorgement?"

Relieving discomfort

  • Consult your healthcare provider or family medicine practitioner. You might need an anti-inflammatory to ease pain, treat fever and reduce swelling.
  • Wear comfortable, supportive bras, which aren't too tight or put pressure on certain areas of breast tissue.
  • It may sound odd, but cold, raw cabbage leaves can be placed inside your bra to ease swelling. Remember to wash the cabbage before using and remove it after a few hours. 
  • Stop using cabbage leaves immediately if you notice a skin rash or any sign of allergy. Only use this method temporarily until the swelling reduces, as longer-term use can affect milk supply.

Questions Moms Ask: ‘How can I treat breast engorgement?’

When will engorgement improve?

Engorgement usually improves within a few days. If it doesn't, contact your healthcare provider. You might need to find a way to reduce your milk supply, or if you are nursing, you may need assistance with improving your baby's latching technique.