Breast engorgement

Breast engorgement is a problem that is common in the early days and weeks of breastfeeding. Once your baby is born, your breasts are given a signal to start full milk production. Blood flows to your breasts, and your milk usually comes in one to four days after the birth.

Offer a breastfeed day or night if your breasts become full and uncomfortable between feeds.

When your breasts start producing milk and your milk ‘comes in’, your breasts usually increase in size, feel heavier and warmer. Engorgement is when the breast tissue overfills with milk, blood and other fluids. This causes your breasts to feel very full, to become hard and painful and your nipples to appear flattened and tight.

Engorgement is usually temporary – eventually you will produce just as much milk as your baby needs.

Usually, the breast tissue is still soft enough for your baby to attach comfortably without causing trauma to the nipple or breast tissue.

Breast engorgement can be severe. It usually occurs if the baby is not feeding properly, so the milk builds up.

Breast engorgement can also occur at any time you are breastfeeding, especially when your baby’s feeding pattern changes and they feed less.

The best way to relieve this is to empty the breast, either by feeding your baby at the breast, or by expressing your milk.

Prevention

To reduce the chance of breast engorgement, you should:

• feed your baby often and on demand (not by the clock) from birth, with at least 8 to 12 feeds in the first 24 hours
• sleep in the same room as your baby
• avoid giving your baby any fluids other than breastmilk unless needed for a specific medical reason
• not limit your baby’s time at the breast.

Treatment

If you do get breast engorgement, you should empty your breasts regularly. You can also:

• wake your baby and offer a breastfeed day or night if your breasts become full and uncomfortable between feeds
• apply warm compresses to the breast, or have a warm shower before a feed, for comfort and to help the milk flow
• remove your bra before breastfeeding (and leave it off)
• if a bra is worn, ensure that it is not too tight (causing indentations)
• hand-express a little milk before feeding your baby, or try ‘reverse pressure softening’ (applying pressure around the nipples to push fluid back into the breasts)
• gently massage the breast in a downward motion from the chest wall toward the nipple while your baby is feeding
• use cold compresses after breastfeeding your baby. Some mothers find that it helps to put a chilled washed cabbage leaf over their breast.
• express milk after a feed, either by hand or with a breast pump, if your breasts still feel full.

Sometimes, if the engorgement does not improve, a complete ‘pump out’ with an electric pump may be necessary to relieve the milk pressure that is causing increased blood and fluid within the breast tissue (ask your lactation consultant or doctor for help).

If you are still uncomfortable, ask your doctor for appropriate pain relief.

For help with breast engorgement prevention and treatment, contact a health professional, including your doctor, lactation consultant or breastfeeding counsellor, child health nurse, or call Pregnancy Birth and Baby on 1800 882 436.

Sources: Australian Breastfeeding Association(Breastfeeding: breast and nipple care - engorgement) , Raising Children Network(Oversupply of breast milk and engorgement) , Women’s and Children’s Health Network(Engorgement – very full breasts)