Breast Engorgement
First of all I want to start off by saying this shall pass. Stick with it. It's just an adjustment period and there are things you can do to help alleviate the situation.
When does a mom's milk come in?
Breastmilk usually comes in anywhere from day two to day four after birth. Your milk goes from colostrum, or early milk, to mature milk. Some moms report that they wake up and their boobs are 2 sizes bigger. I've seen it and it's true. This major increase in size and fullness is called physiological engorgement.
Once again you can thank your hormones! This time your postpartum hormones.
You may find this fullness and tightness to be uncomfortable during the early days. It's normal. Here's what's happening. Your breastmilk is coming in faster than you can empty them.
You can think of this time as an adjustment period and once you and your baby get into a comfortable supply and demand, the discomfort will pass. If you're curious as how much a newborn can really drink, check out this blog post.
Other reasons for engorgement
A plugged (or blocked) duct is an area of the breast where milk flow is obstructed. A plugged duct usually comes on gradually and affects only one breast. This sometimes happens when a nursing mom has had a breast augmentation or is wearing a bra that's too tight. But those are not the only reasons.
When your breast become full and painfully engorged here's what can happen.
Your breasts can feel painfully hard and tender. You may develop a slight fever. Because your breasts are so full, this fullness can cause the nipple to flatten, preventing the baby from latching on correctly. Therefore causing the baby to only latch on to the nipple and not be able to get enough of the areola tissue into its mouth to compress the milk sinuses. Causing a problem for you and a fussy baby.
Your hormones will continue to develop milk but the baby is not able to get it out. Hungry baby sucks harder but incorrectly and the nipple become traumatized and bacteria may be able to enter through breaks in skin, setting you up for mastitis. So how can we prevent this from happening?
How to prevent engorgement:
The good news is that there are things you can do to prevent engorgement.
Start early, begin feeding soon after delivery. Teach your baby efficient latch-on with a wide open mouth and lower lip flip. See a lactation specialist in the first couple of days after the baby is born so they can make any corrections if necessary. Lots of hospitals have them on staff.
Nurse frequently, about 8 - 12 times per day around the clock, which means every 2 - 3 hours. I know it's a lot of work but worth it.
Make sure your baby latches-on well so he will empty your breasts effectively.
Keep your baby actively nursing throughout the feeding. Newborns love to fall asleep at the breast. Wake them up!
Do not skip feedings or give formula feedings during the first several weeks.
Moderate Engorgement
(Your breasts are as firm as the tip of your nose)
Apply warmth (warm wash clothes) before feedings to soften the breast and encourage the let-down reflex.
Do some gentle breast massage. Make circular motions in small areas with your finger tips and move your hand all around the breast. Then put your baby to breast.
Stand in the shower and let warm water run over your breasts. This feels good and encourages leaking.
Watch these excellent videos of hand expression:
Apply cold after feedings to reduce the swelling and provide comfort. You can use ice packs or bags of frozen vegetables wrapped in a light towel. Apply for 10 - 20 minutes.
Extreme Engorgement
(Your breasts feel as hard as your forehead)
Apply cold to the breasts, no heat. This will reduce swelling, slow re-filling of the breasts and provide some comfort.
Lying on your back helps the excessive fluid in your breasts be reabsorbed by your body.
Green Cabbage leaves may be applied to the breasts before feedings to reduce swelling. The cabbage leaves may be used chilled or at room temperature. Although this may sound like an unusual treatment, many women have found it effective in relieving the pain and fullness of engorgement. Place the chilled cabbage leaf in your bra for 15-30 minutes 2-3 times per day or until your breasts begin to soften. Not more. More can reduce your milk supply. Do not use cabbage applications if you are allergic to cabbage or you develop a skin rash.
Fenugreek seed poultice. This is an old school treatment that has been around forever for engorgement and mastitis. How to make poultice: Steep several ounces of fenugreek seeds in a cup or bowl of water. Let seeds cool (warm not hot), then mash them. Place warm, smashed fenugreek seeds on a clean cloth and use as a poultice or plaster on engorged or mastitic breasts to help with let-down and sore spots.
Raw potato poultice. Grate a raw potato and apply to breast/s 3 times a day. Remove poultice when it becomes warm, usually after 20 minutes.
If latch-on is difficult at the beginning of a feeding because of the fullness, you can use reverse pressure softening or hand expression to make your nipples graspable or use a breast pump for a few minutes. Hand expression may work best at this time.
Reverse pressure softening. Apply gentle back and upward pressure at the base of your areola for several minutes to temporarily remove swelling. This forms dimples or pits where your fingers were and makes your nipple easier to grasp. See images below.
If your baby doesn't empty your breasts sufficiently during feedings or only feeds on one breast, you may use hand expression after feedings for a day or two. It is important to treat engorgement before your breasts become very full and painful. This back pressure on the milk producing cells in your breast can damage them and reduce your over-all milk supply.
If, despite using these methods, you cannot obtain relief, seek help from a lactation consultant or other knowledgeable health care provider.
Lactation Consultants International Lactation Consultants Association
More information:
You may find my blog post Breastfeeding Mom's Survival Guide for the First Two Weeks helpful!
Good luck and don't give up! You've got this!
Resources:
The Breastfeeding book by Martha Sears,R.N., and William Sears, M.D.
For more breastfeeding information please go to: International Breastfeeding Center/handouts and breastfeeding videos
Kelly Mom - Engorgement by Kelly Bonyata, BS, IBCLC
