Navigating engorgement
Engorgement typically occurs when milk “comes in”, around 3-5 days postpartum
From around 16 weeks pregnant until about 3-5 days postpartum you will be producing colostrum, the “first milk”. Colostrum is thick, sticky and yellowish in color. It is high in protein, antibodies, and has a laxative effect on baby, helping them to pass meconium (baby’s first poops). Milk “comes in” around days 3-5 postpartum, and colostrum will gradually become whiter and higher in volume as it transitions into mature breastmilk.
Engorgement can also occur anytime milk is not being removed effectively or frequently enough, or during the weaning process as milk supply adjusts.
What is engorgement?
When engorgement occurs, you may experience swollen, painful breasts. They are typically hard and may be hot to the touch. If you are within a week postpartum, this swelling is very common as mature breastmilk comes in. The increase in pressure is due to an increase in breastmilk as well as an increase in blood and lymph. This engorgement is worsened if baby or a breast pump is not removing milk efficiently (this is an important time to correct latching or pumping issues to make sure milk is being removed effectively by your baby).
How to treat engorgement
Treating engorgement includes reducing swelling and increasing the efficiency of milk removal.
ice, ice, ice to help reduce inflammation
you can also try taking an NSAID like ibuprofen to help with pain and inflammation
work on the efficiency of feedings or pumping if this is a problem
allow baby to breastfeed until they come off spontaneously
switch which side baby starts on each feeding
if you are experiencing latching issues this can affect milk removal - I would recommend working with a lactation consultant
if you are pumping I would recommend checking your flange size, as this can impact milk removal
lukewarm water in a basin can be used to encourage milk flow - fill a basin with lukewarm water, stand over it and dip your breasts in - you may see milk flow out of your breasts and into the basin as pressure is relieved
gentle hand expression or hand pumping may help relieve pressure
if baby is struggling to latch due to the tightness of your skin, consider reverse pressure softening or pumping/hand expressing just enough to relieve the pressure and soften your breast
to use reverese pressure softening:
place your fingertips against your breast, just outside your areola
press gently into the breast for 30-60 seconds
gently move your fingertips away from your nipple while still applying gentle pressure
repeat around your entire areola until the skin around your areola has softened enough for baby to latch
be sure to continue breastfeeding your newborn often, aiming for 10-12 feedings in 24 hours
if you are experiencing engorgement while weaning, consider slowing down the weaning process to allow your breasts to adjust to the decrease in milk removal, or remove just enough milk to relieve pressure without fully emptying your breasts
Engorgement should typically resolve in 24-48 hours. Consider reaching out to your medical provider or a lactation consultant if the engorgement is not resolving or you have any concerns about mastitis.
Resources:
WIC Breastfeeding Support: Engorgement
La Leche League GB: Engorged Breasts - Avoiding and Treating
