Relieving and Treating Engorged Breasts

By Barbara Wilson-Clay

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For the first few days after giving birth, a new mother’s breasts remain soft. They will produce colostrum. Colostrum, the first milk, is available in just the right amount, and is rich in immune factors that protect newborns. Sometime during the next few days, the breasts will become full, firm, warm, and perhaps tender. When this occurs, people say: “the milk is coming in!” The scientific term for this event is: engorgement. Engorgement is normal, and lasts for various periods of time depending on the individual woman. Some women experience only a day or so of mild, easy-to-manage engorgement. For other women, engorgement may be more intense, and can last from several days to two weeks.

Some women seem to bring in a larger early milk supply. Others seem to experience more breast swelling. For these women and their babies, the engorgement period may seem more difficult. The breasts will adjust over time, eventually making exactly the right amount of milk for the baby.  

It is the baby’s job to help the mother through engorgement by removing milk. If the baby is not latching properly or feeding frequently enough, the breasts may become overly full. This reduces the elasticity of the breasts and nipples. When the breasts are too firm, some babies cannot grasp enough tissue to latch on well. They may suck overly hard trying to pull in the breast tissue. This can lead to sore nipples. If poor latch results in poor emptying of the milk, the build-up can cause breast engorgement to become severe. The breasts may redden and become painful. Mothers may sometime develop a low-grade fever. (Fever may also signal infection, so at the first sign, call the doctor.)

Along with making mothers feel ill, severe engorgement may interfere with milk production. The milk pooling in engorged breasts releases chemical signals that tell the body to decrease milk production. If unrelieved, prolonged engorgement can contribute to insufficient milk supply or begin the weaning process.
 
 
Prevention:
  • Begin breastfeeding as soon as possible after the birth, to give the baby time to learn to breastfeed before the breasts become full and firm.
  • Unless medically indicated, avoid early use of bottles and pacifiers while the baby is learning to breastfeed.
  • Once the milk comes in, breastfeed at least 8 times in 24 hours to prevent over fullness.
  • Ask for help from the hospital lactation consultant so that latch-on problems are solved as soon as possible.
  • Any time a feeding is missed, use hand expression or a breast pump to remove the milk.
  • Always wean gradually  
 
Treatment:
  • Use moist heat on the breasts for a few minutes, or take a brief hot shower before breastfeeding. This may help the milk begin to flow. Note: Use of heat for extended periods of time (over 5 minutes) may make swelling worse.
  • Use cold compresses for 10 minutes after feedings to reduce swelling.
  • Gently massage and compress the breast when the baby pauses between sucks. This may help drain the breast, leaving less milk behind.
  • Ask your health care professional about medications such as ibuprofen to reduce pain and inflammation.
  • A well-fitted, supportive nursing bra makes some women feel better. Others prefer to go bra-less during engorgement.
  • Gentle breast massage and relaxation techniques may help improve milk flow and reduce engorgement.
  • Hand expression or brief use of a breast pump may help soften the nipple and areola so that the baby can get a better latch.
  • Some women find that a single use of a breast pump to soften severely engorged breasts diminishes painful inflammation. They then return to frequent breastfeeding as the main way to manage engorgement.
  • Pumping, hand expressing, or nursing to comfort prevents the negative consequences of retained milk. Relieving the milk pressure will not make engorgement worse. 
  • If the baby is premature or complications interfere with breastfeeding, a hospital grade pump can help the mother through engorgement until her baby can breastfeed.
  • Fever higher than 101° F or severe pain may signal a breast infection. Call your medical care provider for advice if this occurs. 
 
References:
 
Fetherston C: Mastitis in lactating women: physiology or pathology? Breastfeeding Review 2001, 9(1):5-12.
Humenick S and Hill P: Breast engorgement: patterns and selected outcomes, J Hum Lact 1994, 10(2):79-86.
 
Lawrence R: Breastfeeding: A Guide for the Medical Profession 6th ed. Elsevier Mosby:Philadelphia,PA. 2005.
 
Neville M: Anatomy and Physiology of Lactations, in Ped Clin N America 2001, 48(1):13-34.
 
Snowden H, Renfrew M, Woolridge M: Treatments for breast engorgement during lactation (Cochrane Review). In: The Cochrane Library, Issue 4, 2003. Chichester, UK; John Wiley & Sons, Ltd.
 
Successful Breastfeeding 3rd ed. Royal College of Midwives, Churchill Livingston, London, 2002.

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