We talk all the time about low milk supply, but what about when you have an abundance of milk. What about engorgement?
You had your baby a couple of days ago, and when you woke up this morning, you discovered you no longer have breasts.
You have two watermelons where your boobs once were.
They’re rock solid. They’re gigantic. And they HURT.
This is engorgement. Engorgement happens when your breasts are so full of milk that they’re painful. The pain may even stretch up into your armpits (because – fun fact! – your milk glands extend that far). This is very common for new parents when their milk first comes in around days 3-5 after birth and typically lasts 24-72 hours. Engorgement can also happen later if your baby goes longer than usual between feedings, you miss a nursing or pumping session, or baby starts sleeping longer stretches at night.
Often during severe engorgement, babies have difficulty latching to the breast because the usually-soft tissue of the areola is stretched so far that they can’t get a good “grip”. Or, baby feeds just fine but then your breasts are still very full and sore.
You may be tempted to pump if you’re engorged, but this can actually be counterproductive. The demand and supply process of milk production works against you here. If you express this extra milk, your body gets the message that it needs to keep making that much milk. Instead, feeding your baby on demand, at least as often as 10 times per 24 hours, and removing the least amount of additional milk possible is preferred. The exception to this, of course, is if baby is not latching or nursing well or you have chosen to exclusively pump; in that case, pump as often as you would normally be nursing.
In a day or two, your supply will begin to regulate and the engorgement will decrease. (If it doesn’t go away in 3 days, contact an IBCLC – International Board Certified Lactation Consultant – to rule out other causes of oversupply, which may include a tongue or lip tie, improper latch, or something else.)
So how do you get relief from engorgement?
Gentle massage from the nipple back toward the chest wall can help reduce some of the swelling around the areola and soften the tissues to help baby to latch on. Start with two fingers at the top of the areola (the round, flat part of the nipple), provide firm pressure, and stroke upward toward your shoulder 3-4 times. Move your fingers slightly clockwise on your areola and repeat. Do this until you’ve gone all the way around your areola.
If massage is not sufficient, you can use a similar intervention called Reverse Pressure Softening (RPS). To perform RPS, place your fingertips of both hands against either side of the base of your nipple where it meets the areola. Press directly back toward the chest wall for at least 60 seconds using firm pressure, though not enough to cause pain. The goal is to create a “pit” or depression in the edema (swelling) of the breast. Repeat with fingertips above and below the base of the nipple.
Utilizing gentle breast compressions and breast massage during breastfeeding can aid in the flow of milk and ease engorgement. You may find it necessary to unlatch your baby a few minutes into the feeding and relatch them once some of the initial tightness decreases. This can help them to get a better latch and transfer milk from the breast to belly more effectively.
Be sure to allow baby to fully finish at the breast before offering the other breast. If your baby refuses the second side or doesn’t complete an adequate feeding, hand express milk just to comfort.
If you’re having a difficult time getting the milk to come out of your engorged breasts, apply warm, moist heat for just a few minutes and use breast massage to encourage the milk to let down and flow.
Avoid heat and the stimulation of massage in between feedings while your breasts are engorged.
Though you don’t want to pump or express milk more than necessary, you do want to promote comfort. Hand expressing milk just to comfort, or pumping on a low setting for 5 minutes can help. You should gradually be able to express for shorter amounts of time, and then decrease the frequency of doing this between feeds altogether as your engorgement subsides and your milk supply regulates itself.
Use cold compresses to ease breast soreness. You can use a damp washcloth, an ice pack on top of a dry hand towel, or purchase gel pads that you freeze. Use for up to 20 minutes at a time.
Wear a well-fitting bra. You want something that is supportive, but not too tight. A sports bra a size or two larger than normal is effective. Wear breast pads to absorb any leaks.
Ask your provider about taking ibuprofen or a similar breastfeeding compatible pain reliever and anti-inflammatory.
Hydrate! Drink to thirst. This short-term engorgement is not going to be worsened by maintaining your fluid intake.
When to seek additional help
As mentioned above, if you are still experiencing engorgement after 3 days, please reach out to a Lactation Consultant. Other signs that you need additional help:
Baby is unable to latch or the latch is painful for longer than the first two minutes of a feeding.
You have symptoms of mastitis which include redness or red streaking on the breast, your breasts are painful and/or hot to the touch, you experience a fever greater than 100.6 degrees F, chills, body aches, or flu-like symptoms.
You have any additional questions.