What is postpartum breast engorgement?

Usually on the second to fifth day after you have your baby, you will notice changes in your breasts. They will become larger, somewhat firm, and slightly tender as they begin to produce large amounts of milk. This is called postpartum breast engorgement.

Engorgement is a normal process. However, breast swelling with engorgement may make it difficult for your baby to get milk because:

• Your baby may not be able to latch on correctly and your nipple may become sore.
• Not releasing the pressure in your breast can cause you to make less milk or to even stop producing milk.

Knowing how to manage engorgement will help you avoid these problems.

What is the cause?

Postpartum breast engorgement is caused by the hormone changes in your body after delivery. The changes in hormones cause your breasts to start making a lot of milk. Extra blood flowing to the breasts add to the engorgement.

How long will it last?

Engorgement usually lasts just a few days until your body gets used to making and releasing milk. The swelling of your breasts makes it seem like you are making more milk than your baby needs. However, getting milk to flow is really the problem with engorgement, rather than making too much milk.

Once your baby is nursing well and your milk is flowing easily, there will be less swelling and firmness. Within a few days, your breasts adjust to your baby's appetite. Then you will most likely produce as much milk as your baby takes from your breasts. By the end of the first week after delivery, your breasts will have adjusted and will be much less engorged.

How can I take care of myself?

1. Prevention

   Nursing frequently day and night helps reduce breast engorgement. Plan to nurse your baby at least every 2 to 3 hours, even through the night, until the engorgement has improved. Feeding less often is OK at night. Don't allow more than one period of 5 hours to pass between feedings each night for the first month. Aim to feed your baby 8 to 12 times every 24 hours. Your newborn should nurse vigorously at least 10 minutes at each breast.

2. Managing fullness and discomfort

   Warm your breast just before nursing. Heat improves blood flow and helps your milk let-down. A warm shower just before feeding may help relieve engorgement. You can also cover the breasts with a warm washcloth and plastic diaper to keep the heat in.

   Support your breast with your hand and, if necessary, gently squeeze your thumb and index finger together to help make your nipple and areola (the colored area around the nipple) easier to grasp. Lightly tickle your baby's top lip with your nipple and wait until your baby's mouth opens wide. Then quickly pull her to your breast so she grasps both your nipple and as much of the underside of the areola as possible.

   Your baby should get a good, deep latch. Use the football hold or cross-cradle hold so that you have more control of the baby's head. With your hand, hold the back of the baby's head, his neck, and upper back and shoulders. Your fingers will be behind his ears. Lightly stroke your baby's upper lip with your nipple until he opens wide. Quickly move the baby onto your breast chin first, so that his chin and lower jaw touch the breast first. His head is tilted back slightly as he comes onto the breast. This results in an off-center latch, with his upper lip close to the top of the nipple, and the lower lip far from the base of the nipple. The baby will be able to strip the milk from the breast more effectively with his tongue and cause less pain.

   Gently massage and press on the firmer areas of your breast while your baby nurses to help empty and soften these areas.

   Put cool washcloths on your breasts between feedings to help relieve discomfort and reduce swelling.

   You can take an anti-inflammatory medicine like ibuprofen for discomfort. Very little of this medicine will get into your milk.

   Some breast-feeding experts recommend using cool cabbage leaves to treat uncomfortable breast engorgement. Many women who have tried cabbage leaves claim the treatment brings relief from discomfort and improves milk flow. (Cabbage has been used for centuries as a folk remedy for a wide variety of ailments.) Whether improvement results from the cool wraps or from a specific property in cabbage is not known. Here is how you can use cabbage leaves for engorgement:

   • Put thoroughly washed and dried, crisp, cold, green cabbage leaves over your engorged breasts. You can wear the leaves inside your bra or use them as compresses covered by a cool towel. You can cut holes in the leaves, if necessary, to allow the nipples to stay dry.
   • Leave the cabbage leaves in place for about 20 to 30 minutes or until they have wilted. Usually only one or two applications of the leaves are needed to soften the breasts and establish good milk flow. Longer periods of time have been used by women who are trying to dry up their milk.
      
3. Milk expression during engorgement

   Many women are afraid to pump or express milk while they are engorged because they think it will cause them to make even more milk. However, engorgement is really a problem of poor milk flow, rather too much milk.

   If your breasts are so full that it's hard for your baby to latch on correctly, you may want to pump or hand-express some milk before the feeding. Express enough to soften the nipple and areola so your baby can better grasp your breast.

   If your breasts are still uncomfortably full after feeding your baby, pump for a few minutes until your breasts are softer and your milk is flowing better. Reduce the firmness enough to relieve discomfort and produce obvious softening. Encourage your baby to nurse frequently to relieve breast fullness. Soon your baby will empty your breasts well at each feeding and you will no longer need to pump excess milk.

   Your baby's doctor can tell you if you need to feed your baby any expressed milk. If it is not necessary, the milk you express can be frozen for future use.

4. Unrelieved engorgement

   Unrelieved engorgement is considered to be a breast-feeding emergency because residual milk and sustained pressure on the milk-producing glands can rapidly decrease your milk supply. Thus, if your breasts are so full that your baby cannot latch on or if your baby is not nursing well after your milk has come in abundantly, you will need to get help with breast-feeding and perhaps rent an electric breast pump. Use the pump to express your milk at regular feeding times. Pumping your breasts will allow you to relieve uncomfortable fullness and to keep producing abundant milk. The pumped milk can be fed to your baby until he or she learns to breast-feed well. Your baby's doctor can refer you to a lactation consultant to assist with breast-feeding technique.

   To find where you can rent a pump, call Hollister at 1-800-323-4060; Medela, Inc., at 1-800-TELL-YOU (1-800-835-5968).

5. Relieving engorgement if you are formula feeding.

   "Dry-up" medicines are no longer given to women who choose to not to breast-feed. Uncomfortable engorgement usually gets better within 3 to 4 days. During this time, wear a bra that provides good support. Cold compresses and ice packs put on the breasts for short periods of time will give relief. You may also take ibuprofen to relieve the pain. Contact your health care provider if the pain is extremely sever.