Although a miraculous journey for you and baby, breastfeeding can be a real challenge. Whether you are a new mom or not, delivering a baby is emotionally and physically exhausting! Now that your baby is here, your thoughts may have shifted to the process of breastfeeding.
As a lactation consultant, engorgement is a frequent topic amongst moms. Before diving into how to prevent it, let’s briefly go over the causes of breast engorgement.
What leads to breast engorgement?
First, you will experience breast fullness after your baby is born. Your breasts will feel heavy and firm. Initially, this will occur 3-5 days after delivery when your breast milk volume increases. Fullness will also happen over the first few months of breastfeeding, especially when your baby starts sleeping more at night. You may still be able to latch your baby, but it may take more attempts, and it might be more challenging to stay latched.
Fullness can progress to breast engorgement quickly. Engorgement occurs when your breasts become significantly enlarged and hardened from the increased breastmilk (that isn’t getting completely removed), water retention (edema), and inflammation. Your skin will feel stretched tight, and your breasts may be tender to the touch, even outright painful. At this point, you might find that you can’t latch baby deeply anymore, and milk doesn’t flow freely, which makes emptying the milk from your breasts almost impossible.
Breast engorgement prevention
Fortunately, engorgement is avoidable in most cases. Here are 3 ways to help prevent breast engorgement:
1) Breastfeed early and often.
Make sure to breastfeed your baby as soon as possible after birth. It is not unheard of for a baby to latch minutes after being born. In fact, there should be at least 8-10 feeds during the first 24 hrs of your newborn’s life. You can’t breastfeed too much so breastfeed as much as possible. Allow your baby to empty 1 breast completely before switching to the other, and don’t be afraid to wake your baby to feed.
2) Achieve a deep latch.
A shallow latch sits on the nipple instead of the edge of the areola. This is a common cause of engorgement. Your baby must latch deeply on the breast for the best milk removal. If you can’t latch your baby deeply, see a lactation consultant.
3) Learn and use the hand expression of breastmilk.
If your breasts start to feel full and tight, hand express a few drops to help soften the nipple and areola before trying to latch your baby. I recommend doing this for 1-2 minutes. It will help get a deeper latch and prevent the progression to engorgement. The reverse-pressure softening technique can also help.
Living with breast engorgement
Despite your best efforts, engorgement may happen – no shame or blame here! Here are 4 tips on how to live with breast engorgement:
1) Continue to feed or pump often.
You may be so uncomfortable that you don’t want anything, including your baby, touching your breasts. However, not removing any milk will only worsen your engorgement. If you can’t get your baby to latch after trying to soften your breast, or if your nipples are damaged and need rest, replace breastfeeding with full pump sessions every 2-3 hours (or 8-10 times in 24 hour period). Each pump session that is in place of a feed should last approximately 15-20 minutes on each breast. Make sure the suction is comfortable. If you are cringing or crying, the suction is too high.
2) Pump or hand express to comfort, then try to latch.
Your baby is the best milk-remover, so pumping to comfort should only be 1-5 minutes long to help relieve some pressure in your breast and soften the nipple/areola enough to allow baby to latch deeply. This pumping or hand expression is not meant to replace the feed or empty the breast, just soften. Pumping too much will increase milk production, making engorgement worse, so stick to only what is necessary.
3) Reverse-pressure softening.
If you received intravenous (IV) fluid during labor, such as with an epidural or induced labor, you most likely retained water. Therefore, your breasts may be waterlogged for the first 7-10 days after delivery. If this is the case, you’ll need to push the water in your breast tissue back and away from your nipple for your baby to latch well. Here’s how:
- Put 1 pointer finger, yours or a helper’s, flat on opposite sides of the nipple base (like at the 3 and 9 positions on a clock).
- Firmly press back toward your chest and hold for 5-10 seconds.
- Rotate the fingers 180 degrees (to 12 and 6 on a clock) and repeat the hold. Your nipple should stand out more than before.
- Latch your baby as quickly and deeply as possible because this is only a temporary movement of water.
4) Manage the inflammation.
Breast inflammation can put pressure on your milk ducts. Unfortunately, this added pressure can trap your milk and lead to more pressure and hardening. Adding heat can help your overall milk flow. Try one of the following:
- Wrap a warm (not hot) washcloth around your breast for a few minutes before latching.
- Add warm water over your breasts (as in the shower or in a basin/bath) while gently massaging down the breast with flat palms.
Also, a cool (not cold) cloth after or between feedings can soothe aching and pressure. A breastfeeding-safe anti-inflammatory, such as ibuprofen, can be helpful as well.
If not corrected, engorgement can lead to mastitis (infection of the milk duct), damage to breast tissue, and a decreased milk supply. Contact a board-certified lactation consultant if you need further help working through breast engorgement.