Do your breasts suddenly feel swollen, hot and painful? These symptoms may be signs that you have a more severe type of engorgement that may result in you having difficulty latching your baby if you are breastfeeding. Let’s find out more about engorgement and when to seek help.

Engorgement occurs when the breasts become overly full of milk along with an increased blood flow and the presence of lymphatic fluid between days 3 and 6 postpartum. Some engorgement is normal during this time, however, it can become problematic if the breasts become painful, tender, and hard. Your baby can have difficulty latching onto the breast due to taut skin and a flattened nipple. If not managed promptly, engorgement can lead to a decreased milk supply, mastitis, or a breast abscess. When treated, problematic engorgement should subside within 12 to 48 hours.

Spotting the signs of engorgement and being aware of effective relief methods can assist in preventing engorgement.

Is engorgement a normal process of lactation?

The normal fullness that many mothers feel during the first few days of nursing is due to the transition of colostrum to more mature breast milk. The surge in your lactating hormones, specifically prolactin, will result in your body producing more milk.

In addition, there is an increased flow of blood and lymph fluid to your breasts, which causes swelling and a feeling of fullness. As a result, your breast will feel warm, heavy and uncomfortable.  During this normal feeling of fullness, your areola (the surrounding darker pigmented skin) and nipples remain elastic and soft. Thus, your baby can still latch and breastfeed effectively. 

Engorgement is something more pronounced that this normal fullness.  Engorged breasts become hard, painful and hot. The skin to your breasts will appear red, tight and shiny. The pain may extend up to your armpit. Your areola becomes hard and your nipples become flat and taut. This will make it harder for your baby to latch on. 

What causes breast engorgement postpartum?

Some of the main causes of engorgement include:

  • Increased circulation. Increased blood and lymph circulation flow to the breasts cause swelling and tenderness.
  • As your milk “comes in”, your breasts will continue to produce milk, resulting in a feeling of fullness within the breasts. Ineffective emptying of the breasts is the primary reason why mothers experience postpartum engorgement. Nursing your baby long and often is the best way to relieve engorgement.
  • IV fluids during labor. Evidence has shown that women who needed IV fluids during labor and postpartum had higher levels of edema to the breasts postpartum. 

Does engorgement cause redness?

Redness to the skin on the breast is one of the typical signs of engorgement.  It is usually accompanied by pain and swelling that may extend up to the underarms. Engorged breasts are hard and hot. The areola and nipples can lose their elasticity and become harder for a baby to latch on. Sometimes, low-grade fever may also be present.

How long does engorgement last when milk first comes in?

Your breasts are more likely to get engorged during the first week, typically at around day 3 to 5 after giving birth. It usually lasts for one to two days if treated promptly. Engorgement that is not treated will usually subside within seven to ten days.

Can engorgement happen anytime?

The onset of the symptoms of engorgement usually occurs around day 3 after delivery. It has been found that first-time mothers can sometimes become engorged later than mothers who have had children before. Engorgement can happen at any time if most of the breast milk has not been removed from the breast. Engorgement may happen if:

  • You skipped one or more feedings.
  • It took you longer than usual to feed your baby.
  • You changed your feeding or pumping schedule.
  • Your baby is not nursing effectively.
  • Your baby is too sleepy to breastfeed.
  • Your baby is sick and this interferes with her normal feeding routine.

Other external factors may also make you more prone to engorgement. Some examples include:

  • Wearing tight-fitting bra
  • Wearing a poorly fitted baby sling

Can breast engorgement lead to mastitis?

Breast engorgement can lead to mastitis or infection of the breast tissues. When the breasts become engorged, milk and other fluids build up within the breast tissue. This can lead to severe swelling up to the point where the milk ducts become blocked potentially leading to mastitis.

If your breasts become uncomfortably engorged, consult your doctor if:

  • The symptoms do not subside after 24 to 48 hours.
  • You suddenly experience flu-like symptoms (temperature greater than 101 degrees Fahrenheit, body aches, and chills).
  • The symptoms become more severe.

These are possible indications of mastitis. Mastitis needs appropriate antibiotic treatment that can only be prescribed by a licensed doctor.

Can you breastfeed with engorged breasts?

If engorged it is imperative that you breastfeed your baby and drain the breasts as much as is possible. Engorgement is relieved when milk is effectively drained from the breast and the most effective way to do it is to nurse your baby frequently.

However, since engorgement comes with pain and swelling, it will become more challenging to initiate breastfeeding with your baby. Here are some expert’s tips on how to breastfeed with engorged breasts.

How to breastfeed with engorged breasts:

Remove your bra before you start breastfeeding.

This helps minimize obstruction to the milk flow. It can also make nursing more comfortable. Some mothers may prefer to leave their bra on and this is okay provided it does not contain underwiring. 

Gently massage your breasts.

This will help initiate your milk letdown. Gently massage your breasts starting from the chest wall towards the nipple prior to feeding. If the discomfort extends to your armpit, you can begin massaging under your arm down to your nipple.

Apply moist heat for a few minutes before you breastfeed.

The application of warmth will help your milk to flow, but will not help with swelling. Only apply heat before breastfeeding your baby. Apply for a short period of time as prolonged use could trigger more inflammation. Before application, make sure that the temperature is comfortable and won’t scald your skin.

Some ways to apply heat:

  • Take a warm shower over your back for a couple of minutes before nursing.
  • Submerge your breasts in a bowl or basin of warm water.
  • Apply a warm towel or warm compress over your breasts.
  • Add a few teaspoons of water to a clean diaper and heat it in the microwave. Wait for it to cool and place it over your breasts once tolerable.

Use reverse pressure softening

This technique is used to soften your nipples and areola so that your baby can latch on more effectively. Use your fingertips to hold and push in your nipple for around 1 to 3 minutes. This will relieve the pressure in your nipple and push back the excess fluids in your breast tissue.

Gently massage your breasts while nursing

A technique called therapeutic breast massage in lactation (TMBL) has been shown to reduce engorgement in nursing mothers and to help her effectively latch her baby. Here is a brief description of how it is performed. Before you begin the massage, apply a lubricant such as olive oil to prevent chaffing or friction to the skin which could cause pain and irritation.

  • This will help facilitate milk flow. Massage the breasts in gentle movements, particularly parts of the breast where there is more swelling and pain.
  • Begin the massage using your fingertips around the nipple and to the areola. This will soften the area to enable your infant to latch on effectively.
  • Gentle massage to this area can be used alongside reverse pressure softening at the beginning to further reduce swelling and soften the area.
  • Continue breast massage in gentle, stroking, or circular movements from the direction of the armpit towards the areola.
  • Once the areola is softened, the baby can latch and nurse while gentle massage continues.
  • During the massage as the swelling goes down and the breasts are softened, massage can be alternated with hand expression to facilitate drainage and resolution of milk stasis.

Should I pump to relieve engorgement?

If your baby is having difficulties latching or has only fed on one breast, expressing milk by hand or using a pump can help soften the breast tissue. Here are some tips when pumping.

  • Use gentle pressure only when pumping. Turn your pump to its lowest setting. High pressure from an electric pump could cause increased swelling and edema where the pump flange area is placed on the breast. This will further exacerbate the problem of engorgement. 
  • If your breasts still feel full after your baby has fed, you can pump again to remove any extra milk. This will give relief and prevents milk stasis. This can also prevent blocked milk ducts, mastitis or an abscess from forming.
  • Removing milk will help reduce swelling, protect your milk supply, and enables other fluids to drain into tissue.

Why do cabbage leaves help engorgement?

Their effectiveness has not been scientifically proven, however, cabbage leaves have been used for many years to relieve engorgement. Many mothers have sworn that cabbage leaves have provided relief and reduced pain from engorgement.

Cabbage leaves can be used either chilled or at room temperature and are used to help minimize pain and inflammation. A study carried out by Roberts, K., Reiter, M. et al (1995) showed that chilling the cabbages had no effect on their efficacy.

Cabbage leaves are also used by breastfeeding mothers with problems of oversupply and when weaning their baby. 

Aside from its soothing relief, cabbage leaves may also decrease your milk supply. To avoid this problem, remove after 20 minutes and apply no more than three times each day.  Discontinue when the engorgement has resolved.

Other ways to relieve engorgement

The juice jar method

This can be done to relieve pressure from your engorged breasts and bring out your nipples to facilitate a better latch. Here’s a brief description:

  • Get a clean and empty glass jar or bottle with the capacity of at least 1 liter. The rim should be at least 5 centimeters wide or more.
  • Pour hot water into the jar until it is nearly full.
  • Use a towel to protect your hand and carefully pour out all the water from the jar.
  • Get a cool washcloth and place it on the rim and the upper portion of the jar. This will cool down the portion that will be touching your breasts. Test the temperature using the skin on your inner arm.
  • Place the jar over the table and lean over to gently press your breast into the jar. Alternately, you can place it over a pillow on your lap and lean over the jar. 
  • Wait until the heat in the jar creates an airtight seal.
  • The jar will create a slow vacuum and express your milk as the temperature within the jar drops.
  • Sometimes, the temperature in the jar will go down too quickly and create a forceful vacuum. Break the suction immediately if you feel uncomfortable to avoid breast tissue damage. 

Fenugreek seeds

Fenugreek seeds are traditionally used to relieve breast discomfort and stimulate letdown. To use fenugreek for engorgement:

  • Steep a few ounces of fenugreek seeds in a cup of hot water.
  • Once the seeds cool down to a tolerable warmth, place them in a clean cloth and mash them.
  • The cloth with mashed seeds can be applied over the engorged breasts. Use it while it is still warm.

Cold compress

Cold compresses can help soothe the pain and relieve swelling. You can use it in between feedings for about 25 to 20 minutes. Some ways to do a cold compress are:

Cool washcloth

Get a clean washcloth and submerged it in cold water. Wring out the excess water and apply to your breast. Alternately, you can chill the clean washcloth in the fridge.

Gel packs

Hydrogel packs can be stored in the fridge to cool. It can be held directly or fit under your bra.

Ice packs

Place a thin towel or cloth over your breast and place the ice pack over it. 

Frozen vegetables

If you need something immediately, frozen vegetables can be an alternative to ice packs. Some mothers might prefer something malleable like frozen peas as they can mold better around the breasts.

Cold diaper

Add a few drops of water to a clean diaper until it is damp. Place it inside the refrigerator to cool. This can work as effectively as a gel pack. 

Positioning techniques

Trying different nursing positions can assist in alleviating the discomfort caused by engorgement. You may alternately nurse using the football hold, sitting, and lying down positions. If you also have problems with forceful milk ejection or oversupply, you can try the reclining position with your baby nursing on top of you. 

Medications

According to the AAP, occasionally taking acetaminophen (Tylenol) or ibuprofen (Motrin or Advil) is generally safe for breastfeeding mothers. Acetaminophen may work for pain relief, but using ibuprofen can be more helpful because aside from relieving pain, it also has anti-inflammatory properties. Even though both medications can be bought over-the-counter, it is always better to consult with your doctor before taking any medications while breastfeeding.

Engorgement can make breastfeeding difficult in the early weeks, but hang in there moms! With perseverance and some relief measures, symptoms will usually subside after a day or two. It shouldn’t be a reason to wean prematurely. If you can’t relieve the symptoms at home, never hesitate to call a lactation consultant or a doctor for help. 

References:

https://www.healthychildren.org/English/ages-stages/baby/breastfeeding/Pages/Engorgement.aspx
https://www.breastfeeding.asn.au/bf-info/common-concerns%E2%80%93mum/engorgement

Therapeutic Breast Massage in Lactation for the Management of Engorgement, Plugged Ducts, and Mastitis, K. A. Marinelli, Sara L. Gill, Ann M. Witt, Maya Bolman, et al Journal of Human Lactation, vol. 32, 1: pp. 123-131. , First Published December 7, 2015.

Reverse Pressure Softening: A Simple Tool to Prepare Areola for Easier Latching During Engorgement, K. Jean Cotterman, R, Journal of Human Lactation, vol. 20, 2: pp. 227-237. , First Published May 1, 2004

A comparison of Chilled and Room Temperature Cabbage Leaves in Treating Breast Engorgement Kathryn L. Roberts, Maureen Reiter, Diane Schuster, Journal of Human Lactation, vol. 11, 3: pp. 191-194. , First Published Sep 1, 1995.