Engorgement

Engorgement occurs most commonly in the first week postpartum. It can be a result of delayed, infrequent, or inefficient milk removal. It’s also often worsened by intravenous (IV) fluids given during labor and/or inflammation caused by hormonal shifts. 

When your milk comes in, it can be subtle. You just start to notice some fullness and you may leak some milk. Baby seems more full and content, even milk drunk after a feed. For other moms, it’s more like an event. Your milk is in! Your breasts are several sizes bigger than the day before. They are rock hard and it’s very difficult to get the milk to flow.

Our blood volume doubles during pregnancy. After the birth, the extra fluid has to go somewhere until the body can release it through peeing it and sweating it out. Some goes to our ankles, fingers, face, and to our breasts. This is engorgement. Add the IV fluids that you may have gotten during labor and that engorgement can be so painful.

During engorgement, breasts feel very full, warm, and heavy. Swelling can extend up into the chest and armpit area. Engorgement can be very uncomfortable. Due to the hardness of the breast tissue, it may be difficult for babies to latch onto and remove milk from the breast. Although some breast fullness is common and normal, severe untreated engorgement has been implicated in future low milk supply. It may also result in infection (mastitis) and early weaning due to pain and discomfort.

• Breastfeed in the first hour after birth. If effective latching is not established within one hour of birth, hand expression is recommended.

• Nurse frequently (every 1-3 hours, in the first days after birth, waking your baby if needed).

• Feedings should not be shortened or restricted.

• Skin-to-skin contact can help regulate milk supply and hormones, as well as trigger a better latch. The more, the better!

• Parents who receive IV fluids during labor, especially due to a cesarean section, epidural, or long, medicated labor are more likely to experience severe engorgement.

• The use of breast compressions while a newborn is latched can aid in milk removal.

• Cold compresses (ice packs or bags of frozen vegetables) used for 15-20 minutes in between feedings can help reduce swelling in breasts. Heat before breastfeeding or milk expression can assist with milk flow. Heat should only be used briefly, as it can increase inflammation.

• Using reverse pressure softening a few minutes before latching helps soften the area around the nipple so your baby can latch better and milk can be removed..

• Massage can be used during or before breastfeeding, while pumping, or in the shower. Here is a video with some techniques for massage that can help with milk removal and engorgement. Massage toward the armpit, using very light pressure, along with hand expression can help reduce inflammation. http://vimeo.com/65196007

• Raw cabbage leaves are proven to reduce swelling and engorgement. Slit the veins in the refrigerated leaves and place them inside your bra. Replace when leaves become wilted. Cabbage can reduce milk supply.

• At times pumping can worsen engorgement by pulling inflammation toward the nipple, inhibiting milk flow. If you have the need to pump, the use of your hands can aid in milk removal. Stanford University has an excellent video on hands-on pumping. Keep in mind, the more milk you remove, the more milk your body will make. It may be best to only pump to comfort.

• A silicone milk collector (Haakaa) is another popular way to collect excess milk.

If you have difficulty getting milk out, take a warm shower. Lean forward using gravity to help release milk. Using very gentle massage and hand expression can encourage milk to flow and fluid to move. You can take a probiotic like Lacta-Biotic to help with breast pain and support breast health. The strain L. fermentum has been found to relieve pain from plugged ducts.

Although engorgement is very common in the first few weeks of your baby’s life, it can happen at any time, including during weaning. Possible causes include:

• Your baby sleeping longer than expected, resulting in a missed feed

• Feeding on a schedule rather than on demand

• Poor positioning and attachment that affect how your baby breastfeeds

• Using a poorly fitted nipple shield

• Weaning too quickly

• Tight clothing, a tight bra or bag strap, or even a finger pressing on the breast during a breastfeed

• Having an oversupply of breast milk

• Pumping more milk than your baby needs

• Breast trauma, including vigorous massage or previous breast surgery

Anything that interferes with feeding on demand can increase the risk of engorgement. If painful engorgement is left untreated, it can lead to breast inflammation, including clogged ducts or mastitis. If you regularly produce more milk than your baby needs, it may be helpful to speak with an IBCLC lactation consultant about breastfeeding management and to read our article on oversupply of breast milk.

Sunflower Lecithin is an emulsifier. It helps by discouraging the fat molecules in milk from clumping together, allowing it to flow more freely through your milk ducts and get the clog out. As a lactation supplement, sunflower lecithin is often used for plugged ducts and can work quickly. Most women see results in 24 - 48 hours.

Breast tissue can extend into the armpit and it has a special name, “the Tail of Spence.” During engorgement or at the beginning of lactation, you may notice lumps and swelling in your armpits. It’s also possible to have extra breast tissue that is not connected to the breast both in the armpit and in other areas of the body.

This “accessory” breast tissue can also increase in size and/or produce milk. Accessory nipples or mammary tissue can sometimes be found anywhere along the mammary line from armpit to groin in 1-6% of those who are breastfeeding.

• Your baby is not able to latch

• Pain/discomfort is not relieved by above techniques

• Improvement is not seen within 8-24 hours

• Symptoms worsen or are severe

• You experience flu like symptoms (fever, body aches, etc.)