by Karen P. Roeske, RN, IBCLC
belliesbabiesbreasts.com

What is Engorgement?

Normal engorgement of the breasts typically occurs 3-5 days after birth. This fullness may be uncomfortable and your breasts may be warm and appear larger in size. The flow of milk will be normal. Discomfort varies from woman to woman but tends to be mild to moderate during this time. Normal engorgement slowly recedes over one to two days but may possibly last up to two weeks for some women.

Why Does it Happen?

Engorgement occurs as many hormonal changes are taking place in your body. Blood flow increases to the breast, which is triggered by a surge in prolactin. Prolactin is a hormone that stimulates development of the breast and controls milk synthesis. This is accompanied by an increase in milk volume. With the rapid increase in blood flow and milk volume, swelling occurs as blood vessels leak fluid into the surrounding breast tissue. This pressure and congestion also causes an obstruction in the flow of the lymphatic drainage of the breasts.

What Can I Do About It?

Treatment or prevention of severe engorgement is focused on decreasing swelling so the capillaries can bring oxytocin (a hormone your body makes) to the milk secreting cells and allow them to contract and release milk. The application of heat increases oxytocin uptake so your milk can be released. Cold compresses cause a constriction of the blood vessels, which decreases the swelling within the breast.

Feeding your baby or expressing milk along with warm and cold therapies work well during this time. Warmth is used prior to feedings and cold is used after feedings. A warm compress or a warm shower can work wonders by allowing your body to increase its uptake of oxytocin, which will allow your milk to let down and get to your baby.

Simple things can help you make it through this normal process of engorgement. First, the most important thing is feeding your baby. Breastfeed your baby within the first hour after birth. Skin to skin contact after birth is a great way to allow your baby access to your breasts. It is amazing that babies are born with the ability to seek and latch onto the breast. Correct latching techniques will allow your baby to transfer milk adequately. Babies who are latching correctly create a tugging sensation you will feel while they suckle.

Breastfeeding your baby should not hurt. If you feel a pinching sensation, pain, or if your nipples are not round after a feeding, then most likely the latch is not deep enough. Ask for assistance from a lactation consultant or other health care provider if you experience these indications that the latch may need to be deeper. They may recommend trying the cross cradle or football hold because these positions allow you the ability to gently support and guide your baby as they latch on. Continue frequent feedings on demand, or according to your baby's hunger cues. It is not necessary to restrict the frequency or length of the feedings.

Allow your baby to finish the first breast prior to offering the second breast. This allows the milk cells to release milk to the baby decreasing the distention of the cell and thus allowing the capillary blood to circulate around the cell. If the blood flow is compromised, then the vessels leak fluid into the surrounding space creating more swelling and the transfer of oxytocin is also decreased. Adequate blood flow around the cell brings oxytocin to the cell which causes the milk cells to contract and propel the milk down the ducts to your baby.

Second, pumping can be helpful in certain circumstances. If you have mild engorgement and are feeding your baby frequently with correct latching techniques, the engorgement should resolve on its own without pumping. Pumping is used when a baby isn't able to feed adequately at the breast. Pumping time recommendations vary depending on your situation. If you have significant engorgement that is preventing latch on, you may pump for a few minutes prior to a feeding to soften your breasts enough to allow your baby to latch. If breastfeeding is going well and your baby is able to latch and transfer milk, then pumping can potentially complicate matters by stimulating your breasts to make more milk, which can prolong the engorgement process.

Third, an interesting cold therapy is to use refrigerated cabbage leaves. These can be placed on your breasts in between feedings. Many mothers state that they notice a significant decrease in swelling and an increase in milk flow with use. Cabbage leaves have been noted to decrease milk supply, so be careful to use them only for a limited amount of time.

If your breasts are very painful and your milk flow is compromised, then you must seek help from an appropriate health care provider, such as a lactation consultant. The hospital or birthing center where you had your baby will often have one on staff, or you can ask your doctor, midwife or pediatrician for a referral. Severe engorgement can cause cessation of milk production if unresolved.

Works Cited

Humphrey, Sheila. The Nursing Mother's Herbal. Minneapolis, MN: Fairview Press, 2003: 142-152.

Mannel, Rebecca, and Martens, Patricia, eds. Core Curriculum for Lactation Consultant Practice. 2^nd Edition. Sudbury, MA: Jones and Bartlett Publishers, 2008: 637-640.

Riordan, Jan. ed. Breastfeeding and Human Lactation. 3rd Edition. Sudbury, MA: Jones and Bartlett Publishers, 2005:205-206.