Engorgement

Moms ask “How will I know if I’ve become engorged?”  If engorgement occurs, you will be the first to know.  Moms may experience symptoms from firmness, with mild discomfort, to full blown rock hard swelling and pain.  Some women never experience any engorgement and sail through this transitional time when their body is adding milk producing breast tissue.  Most women do, however, experience some discomfort, so prevention and proper treatment is very important. Typically, initial symptoms may be mild.  They may include a tightening of the skin, followed by warmth and some fullness. Severe engorgement may include very tight, shiny red skin, rock hard breasts, swelling up to your collar bone and under your arms, a headache, and a slight fever.  Most people think that their breasts are completely filled with milk, but this is not the case.  The tissue swelling that occurs is due to the increased blood supply to the breast, the increase of milk producing tissue and production of milk.  This is when your body begins producing the transitional, then mature milk and the colostrum phase is ending.  At the first sign of breast changes, which usually begins between day 3 and day 5 for first time mother, and between day 2 and 4 for second + time mothers, we suggest that you start doing the following prevention and treatment techniques.  Remember this can last 48 to 72 hours and it may take for the swelling to decrease. 

1. Use very warm water and a gentle massaging of the breast tissue to help with the milk flow.  Do this for 10 minutes before a feeding. You can take a shower, lean into a bowl of water or even wet two disposable diapers and put them in the microwave until they get very warm.  Be cautious not to get them too hot.  Start out with just 10 or 15 seconds and see how hot they get.

2. Feed the baby as often as he or she wants.  If the baby is too sleepy and it has been close to 3 hours since the last feeding, undress the baby, change the diaper, or gently wipe down the baby’s face with a wet cloth.  Avoid use of the pump if the baby can latch and feed well.  We want to let the baby do the programming and not create an over supply problem.

3. Apply ice packs across the entire breast area for 15 to 20 minutes after a feeding.  Frozen bags of vegetables wrapped in a blanket work well. Another trick is to open up a disposable diaper and put ice in it.  The plastic keeps it nice and cold.

4. For severe swelling, you can try using cabbage leaves.  Peel off two leaves of cold green cabbage and pound down the stalk.  You can even cut out a small circle for the nipple to fit through so it is not rubbing against the leaf. Place one leaf on each breast.  Do this after a feeding until the leaf wilts.  Cabbage contains aspirin like qualities that reduce the tissue swelling and estrogen like compounds that help to regulate milk supply.  Typically, we only use this for 12 hours, due to the possibility of decreasing the milk supply.

5. If you are in a lot of discomfort and are not allergic to aspirin, ask your health care provider if you can take Advil, Motrin, or Ibuprofen to relieve the pain and help reduce the inflammation.

Problems:

         Baby can not latch because the breast and/or areola are swollen and hard.  First try pumping for a few minutes after doing the heat

         treatment for 10 minutes.  Then try and latch the baby.

If the baby still refuses give some of the pumped milk to help with the calming and raise the blood sugars.  Then try and latch the

baby to the softer breast and areola.

If the baby can not latch and you have been trying for more than 10 minutes.  Stop!  Calm the baby, pump for 10-15 minutes and

feed the baby pumped milk. You can use an eye dropper, medicine syringe, medicine cup, or bottle.  If you use a bottle, try using

the slowest flowing nipple and pace the feeding.  Alternate the bottle, and your finger, in the baby’s mouth so the baby gets plenty

of sucking time and has to work harder on the bottle instead of having a continuous flow.

If the baby refuses to breastfeed during this time do not panic.  Most babies go back to the breast within a few days.  Keep your

supply going by pumping 8 – 10 times in 24 hours for 10 to 15 minutes using a double pump or 10 minutes on each side using

a single pump.  Letting your breast stay engorged and not removing the milk if the baby is refusing to latch will signal your body to

stop production.  Continue using the hot and cold treatment for 48 to 72 hours or until the swelling and discomfort is gone.

What happens if I get engorged again after this initial time?  Most women never experience this type of engorgement again unless they suddenly decide to wean or they skip several feedings in a row.  If this occurs, using the hot and cold treatment is still suggested along with feeding the baby as often as possible.  If you are weaning, drop one feeding at a time and wait about 3 to 4 days before dropping the next to avoid discomfort.

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