Engorgement is when your breasts begin making larger volumes of milk on days 3-5 of your baby’s life, causing your breasts to feel fuller, warm, and sometimes tender. Engorgement generally lasts between 12-48 hours as your body adjusts in how much milk to make for your baby.  Your breasts may also leak and/or have lumps that develop in the breasts and armpits. This is caused both by the increase in milk and the extra blood and lymph fluid traveling to the area. Engorgement in the first several days is a normal part of the breastfeeding journey. Unrelieved engorgement is not.

Signs of Engorgement

• Breasts swell and the areola feels hard and tight like your chin instead of soft and elastic like your earlobe.
• Breast tenderness may occur with throbbing pain as well as a low-grade fever of 100 degrees or less.
• It may lead to flattened nipples which make it difficult for your baby to latch.

Preventing Engorgement

• Breastfeed baby early and often (at least every 2-3 hours from the start of one feeding to the start of the next feeding), or 8 – 12 times in 24 hours
• Breastfeed on the first side until your baby no longer wants to nurse, then offer the second side (start next feeding on this second side )
• If the second side is still uncomfortable after baby latches and feeds, it is ok to pump or hand express milk for 2-3 minutes to relieve discomfort
• Ensure correct latch and positioning. Listen for your baby swallowing to ensure they are moving the milk

Helping Baby Latch through Engorgement

• Express some milk first before latching baby, using either by hand expression or pumping (do not pump longer than 5 minutes)
• Apply moist heat before feedings to soften the breasts and encourage let-down
• Do some gentle breast massage before feeding, using circular motions with your fingertips around your breast
• Stand in the shower and let warm water run over your breasts
• Apply ice after feedings to help with swelling and any discomfort
• Take a non-Aspirin pain reliever such as Ibuprofen or Tylenol to help with discomfort and swelling

Treating Unrelieved or Significant Engorgement

• Apply cold to the breasts instead of heat. This helps reduce swelling.
• Lay on your back to help the excessive fluid in your breasts move away from the nipple.
• Use reverse pressure softening to help the extra fluid move away from your nipple. Place your thumbs on either side of the nipple, at the base. Apply gentle pressure back and upwards (towards your armpits) to help decrease swelling and allow the nipple to protrude. The following websites give more instruction.
  • https://kellymom.com/bf/concerns/mother/rev_pressure_soft_cotterman/
  • http://www.breastfeedingonline.com/rps.shtml#sthash.lDOCH0Ha.dpbs

When to Contact Your Healthcare Provider

• Baby is not able to latch or not making enough wet/dirty diapers
• Symptoms of mastitis such as breasts that are hard with red streaks, fever over 100.6, chills, body aches, and/or headache
• Pain in breasts that are not getting better