You need to be aware of how to prevent and treat engorgement. 3-4 days after you deliver you may experience fullness in the breast. (For some it can be as early as the 2nd day or as late as the 6th day.) This is called engorgement. Engorgement is caused by swelling in the breast tissue as the blood supply increases in the area and more milk is made. (1)(2)(3)
This can make the breast feel tender and warm to the touch and the breast will seem very full before a feeding, but softer after you finish feeding.
If the baby eats often enough engorgement will not be a big deal or you will prevent it from happening all together. You may think it is only a mild discomfort; however, for others it can make the breast feel like a bowling ball with a temperature. If the breast becomes this firm, the baby has great difficulty latching on and staying there, because the nipple just slips out of their mouth. In this situation the skin is so firm, it has no give left and this is when breastfeeding can start to break the skin. In this situation, all you need to do is make the areola, the dark area around the nipple, a little softer. This way the baby can get latched on and stay latched on and the skin will have some flexibility and not break as easily. You can attempt to avoid things getting to this point by nursing frequently. This keeps the breast from becoming so firm and helps baby latch on more easily.
Engorgement usually lasts 24-48 hours. These are things you can do to make this period as short and comfortable as possible:
The best cure for engorgement is nursing frequently so that swelling and discomfort will not be a problem in the first place. (1)
If engorgement does become a problem for you:
Before feedings, soften the breast so the nipple is not difficult to latch on to. You can soften the nipple area by gently massaging the breast towards the nipple when: (1)
- when using warm compresses on the breast
- leaning into a basin of warm water
- taking a warm shower.
Warmth and gravity will cause the breast to leak a small amount of milk that will soften the nipple and areola area (the dark area around the nipple).
If this doesn’t help, you can also hand express a small amount of milk or briefly use a breast pump to express just enough milk to make the areola (the dark area around the nipple) softer. (1) It will cause the least discomfort for you if you can do this before you attempt to latch the baby on. But if you have tried to latch your baby on and they are having trouble, stop and try softening the breast with the methods described and then try again to latch baby on.
After feedings you can use cold compresses to reduce the swelling. Compresses can be made out of a cold washcloth, a disposable diaper made damp with cold water, or frozen vegetable packages (they mold to the area). (2)(3)
After feedings you can use cold cabbage leaves on the breast inside your bra until they are wilted (roughly 2 hours). (2)(3) How the cabbage leaves work is not known, but women report reduced swelling after they have used them. (1)
Normally, you will only need to use these methods for 24-48 hours until the swelling in the breast goes away.
If you notice a lump or bump under the skin of the breast, you may have a plugged duct.
This is usually caused by the collecting duct for the milk becoming plugged up. These are things you can do to try and resolve the plug:
- It will be uncomfortable to push on the area, but gentle massage while baby is feeding can help release the plug. (2)
- It may help to change baby’s position at the breast and you can try having your baby’s nose pointed toward the plugged area. (1)(2)(3)
- You can also alternate heat and massage on the area for a few minutes after each feeding.
- You want to massage from the plugged area towards the nipple. If you happen to see the plug it may look like some stringy material or piece of rice. If the baby swallows this it will not be a problem.
Usually, 24 hours of massage and heat at each feeding and feeding your baby frequently will clear the plug. You want to resolve this plugged area as soon as possible to avoid having it become an infection or mastitis.
Breast Infection or Mastitis
If you have a temperature, a reddened area on the breast or red streaks radiating from the nipple, flu-like symptoms or a bad headache, you may have a breast infection or mastitis. You need to be seen by your healthcare provider today. (3)(4)
Do not stop nursing. This will make the situation worse. This will not be a problem for your baby, but you need bed rest, frequent feedings, increased fluids and having someone help you. All these actions will help you get back to normal faster. Failing to take care of yourself can make recovery longer and risk of an abscess increases. (An abscess is a collection of pus that requires surgery to drain). Reasons mastitis or a breast infection occur are: missed feedings, infrequent feeds or scheduling feedings, damage to the nipple, illness in mother or baby, rapid weaning, pressure on the breast from a tight bra or car seat belt, mother’s stress and fatigue, mother’s poor nutrition or anemia. Even repetitive arm movements like wallpapering can be a cause.
Nipple soreness is not unusual in the first week after delivery. If the tenderness lasts longer than a week and is felt throughout the entire feeding then you need to have someone who is knowledgeable about breastfeeding watch you feed your baby. (3) An experienced nurse or lactation consultant can be especially helpful in this situation. If needed, these early days are the best time to correct your baby’s latch-on, so you can feed your baby without discomfort. As with engorgement, preventing nipple soreness is the first thing to try.
If your baby latches on and you have discomfort, but the discomfort gets better as the feeding goes along, your baby is usually latching on properly. If you have any doubts about how your baby is feeding, again, have someone knowledgeable about breastfeeding watch you feed your baby. You want to correct any problems with latching on as soon as possible.
- Breast milk can be applied to the nipples after feedings. (3)
- Air drying, keeping bra flaps down or nipples exposed to air.
- Using breast shells (plastic domes that prevent anything from rubbing on the nipple). They can be purchased at drug stores, or medical supply.
- Lansinoh ® a purified form of lanolin can be used to help the nipple heal between feedings. It can be applied after a feeding and does not have to be wiped off before the next feeding. (3)
- Gel-packs made of hydrogel or glycerin pads can be used between feedings to promote healing and prevent clothing from rubbing the area. They can be purchased at your local drug store/pharmacy. Check with your healthcare provider if you have questions about their use. (3)
- Lawrence, RA, Lawrence, RM, Breastfeeding: A Guide for the Medical Professional, 7th edition, Maryland Heights, MO, Elsevier Mosby, 2011, p 249-52, 266-67.
- Mannel, R, Marten, PJ, Walker, M, Core Curriculum for Lactation Consultant Practice, 3rd edition, Burlington, MA, Jones & Bartlett Learning, 2013, pp 747-48, 750, 759.
- Mohrbacher, N, Stock, J, La Leche League International The Breastfeeding Answer Book, 3rd Revised edition, Schaumburg, IL, La Leche League International, Jan 2003, pp 456-57, 466-67, 492, 494-98.
- Wambach, K, Riordan, J, Breastfeeding and Human Lactation, 5th edition Burlington, MA, Jones & Bartlett Learning, 2016, p 323.