Care Plan: Engorgement

Remember how sore and swollen your breasts were at the beginning of your pregnancy? Unfortunately, they might make a return appearance after your baby is born.

On Day 3 or 4 postpartum, when your mature milk comes in, your breasts might be extremely full, tight, painful and dripping milk. This is called engorgement. The change from colostrum to mature milk increases the flow of blood to your breasts, and the surrounding tissue starts to swell.

Not all women experience engorgement when their milk comes in. Some have milk that comes in more gradually, and their breasts just feel more heavy and full. If you do have engorged breasts, the best cure is good, thorough drainage. Make sure you offer both breasts to your baby at each feeding.

The good news is that engorgement doesn't last very long, just 1 or 2 days at the most. But take note: If you miss several feedings at a later stage, you could experience engorgement again.

What can I do to ease engorgement?

Place warm washcloths on your breasts before feedings, and cooler washcloths or even ice packs afterward. For hundreds of years, women have sworn by cabbage leaves. Although this treatment isn't scientifically proven, there seems to be something in cabbage that reduces fluid retention. Try refrigerating a green cabbage, stripping a few of the outer leaves and putting them against your breast, inside your bra. Leave the cabbage there for no more than 20 minutes. If your breasts are so full and hard that latching is difficult for your baby, apply pressure to the areola with your fingertips before feeding. Place your fingertips around the base of your nipple and press down on the areola for about 50 seconds. This should soften the areola enough so your baby can latch.

Should I pump during engorgement?

If nursing is going well and your baby is getting full feedings at the breast and draining them, the answer is no. But there are some exceptions.

If your breasts still feel hard and engorged after every feeding, and if your baby is small or sleepy, you might want to double pump both breasts at the same time for 10 minutes after a few daily feedings; try three spread throughout the day. This is also the case for babies with any level of jaundice, since that condition can make a baby sleepy.

Here's why you should pump in these situations: If your baby shows signs that she's dependent on your highly elevated flow to get full feedings, you don't want the supply to drop dramatically after the engorgement period.

Tips to Help with Engorgement

• The best way to cure engorgement is to breastfeed and aim for good drainage in each breast every time.
• Engorgement only lasts 1 or 2 days. After this period, your breasts will soften and adapt to your baby's feeding needs.
• You should only pump during engorgement if your baby is small and needs lower amounts of milk in the beginning or is very sleepy or jaundiced.
• While some women prefer not to wear a bra when they feel engorged, others find they need support from a well-fitted nursing bra. A seamless bra such as Bravado Designs’ Body Silk Seamless Nursing Bra molds to the body and provides support without feeling too tight.

Source: Heather Kelly is an International Board-Certified Lactation Consultant (IBCLC)