Breastfeeding A to Z

Breast Engorgement

Breast engorgement is swelling in the breast tissue.  This can happen shortly after delivery or anytime during the breastfeeding experience that mom has gone a longer than usual time without nursing.  See below for suggestions about how to take care of yourself.  Look for “if engorgement does become a problem for you” section.

DELIVERY

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.

References:

  1. Lawrence,  RA, Lawrence, RM, Breastfeeding: A Guide for the Medical Professional, 7th edition, Maryland Heights, MO, Elsevier Mosby, 2011, p 249-52, 266-67.
  2. 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.
  3. 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.

WEEK 1

Roughly 2-6 days after your delivery, your body will begin to produce milk in greater amounts.  You may experience engorgement or breast fullness; this can make the breast feel tender and warm to the touch.  The breast will seem very full before a feeding, but softer after you finish the feeding.

Several things are happening at the same time to cause this fullness.  There is increased blood supply to the breast, there is swelling in the breast tissue and the more the baby eats the more breastmilk is present.  Plus, by the third or fourth day, the mother’ milk supply makes a dramatic increase.  This is all trying to fit in the same place–your breast.  Engorgement is best prevented by nursing frequently to avoid having it become a problem in the first place.

If your baby eats often enough, engorgement will not be a big deal.  For some it is only a mild discomfort, but 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.  This is because the nipple keeps slipping 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 more comfortably for you and stay latched on.  The skin will have some flexibility or give to it and will not breakdown as easily.  You can attempt to avoid things getting to this point by nursing frequently.  For techniques to help resolve engorgement.  See Breast Engorgement, Delivery section above, especially the before and after feeding portion.