When your milk comes in approximately 2-5 days after delivery, it is normal to notice your breasts are larger and heavier than usual for the first 24 hours. For this period, even when your breasts feel full and heavy, the areola and breasts should still be supple, milk should flow as usual and you should still be able to latch your baby with ease.

Engorgement is different- the breast skin is stretched and shiny and the breasts are sensitive and feel over full. Aside from the discomfort, engorgement can lead to other problems, such as difficulty latching and subsequent nipple pain and damage, blocked ducts and mastitis. If you notice symptoms of engorgement, get advice from your doctor, nurse or lactation consultant as with proper treatment, your symptoms should resolve quickly.

A lot of mothers experience engorgement in the early days after birth but it can also happen later in your breastfeeding journey when some feeds are missed.

Preventing Engorgement

  • Feed on demand, follow baby’s feeding cues and avoid feeding on a schedule. If your baby is sleepy in the early days, wake her to feed.
  • Start breastfeeding as soon as you can after delivery and feed often in the early days. It is normal for baby to feed ten times or more per 24 hour period in the early days.
  • Ensure baby is latched on well to help her drain the breast effectively. Ask your doctor, midwife or lactation consultant to check your latch if you have concerns.
  • Let baby finish the first breast before you offer the other side, and remember to switch sides at the next feed.
  • If baby is not feeding directly from the breast, express regularly.
  • Later on in the breastfeeding journey, if you are weaning baby try to do so gradually to prevent engorgement.

Treating Engorgement

  • Engorgement is caused by disruption of milk removal from the breast causing discomfort. The main principle of treating it is to remove enough milk to make the breast comfortable.
  • Feeding baby on demand will help to ease engorgement, aim to feed baby as regularly as she requires. Let her drain the first side before moving to the second. While feeding, allow the non feeding breast to drip milk if it does so. If baby does not want the second side, stimulating the let down reflex and then applying gentle pressure to the breast can help to remove enough milk to make you comfortable.
  • Before you feed baby, massaging the breast towards the nipple can help milk transfer.
  • If milk release is a problem, application of a warm compress a few minutes before feeding can help with this but be careful with using warmth in engorgement as it can increase swelling.
  • While baby is feeding, gentle breast massage or compressions can help.
  • Relatching baby a few minutes after beginning the feed can achieve a more effective latch.
  • Keep yourself comfortable by wearing a well fitting bra.
  • Cool compresses or chilled cabbage leaves can be soothing to the breasts between feedings.
  • Be mindful of using cabbage leaves as they can reduce milk supply.

Things NOT To Do

  • Do not restrict your fluid intake, this will not help and could make you ill. Continue to drink water as normal.
  • Be careful with using heat, this can increase swelling. Don’t use heat in between feeds and if you need it before feeding to help with milk release, just use it for a minute or two.
  • Engorged breast tissue is delicate and easily damaged. The ideal way to remove milk is to feed directly or to stimulate a let down and let milk flow freely. Hand expressing is another choice. Avoid using an electric pump in engorgement as it can cause damage to the breast and also cause or worsen swelling of the areola.
  • Do not over stimulate the breasts, e.g. massaging under a warm shower.

Watch Out For Signs Of Complications

If you have any symptoms or concerns, contact your doctor, midwife or lactation consultant for advice. Contact them urgently if you notice any symptoms of mastitis- inflamed, hot, red, tender areas in the breast, a temperature or flu like symptoms, or if you are having trouble latching baby or baby is unwell or not having as many wet/dirty nappies as you would expect or if you have any questions or concerns at all. Breastfeeding is a completely new skill and if you need help or support, don’t be afraid to ask for it.

You can find more detailed information in our more detailed engorgement article https://breast-assured.com/breast-engorgement/