Engorgement 101 - Breastfeeding Challenges

Engorgement is an expected and incredibly common event in the first week after birth. Yet few mothers and lactating parents are prepared for it, much less know there are simple tips to prevent and treat it!

Engorgement occurs when your breasts/chest become swollen and painful. This typically occurs around 3-4 days postpartum. It signals that your milk is starting to change from colostrum (the first milk) to mature milk.

engorgement vs. not engorged

First, let’s address a common misconception: the pain and swelling of breast engorgement are NOT occurring just because your breasts are overly full with milk.  So getting milk out, in and of itself, won’t fix the discomfort! 

In reality, your breasts are having an increase in blood flow related to normal postpartum hormone shifts. This increase in blood flow causes swelling in the tissue around the milk-making glands. The swelling makes it hard for your baby to latch deeply enough - this causes nipple pain, trauma, and even wounds. The swelling can also make it hard for the milk to come out of the breast, leading to even more swelling - this can become a vicious cycle. I often call engorgement “stuck milk” as that is exactly what ends up happening.

Now that we know engorgement is common and expected and causes pain and difficulty with breast and chest feeding, let’s go over some simple things you can do to prevent and treat it.

So let’s talk about how to prevent and treat engorgement with these simple steps:

1. Feed your baby! 

Drain your milk as often as possible in the early weeks. If your baby won’t or can’t nurse directly, then hand express or pump every 2-3 hours.

2. Take your anti-inflammatory. 

If your physician or healthcare provider says it is ok for you to take a medicine like ibuprofen, then use it regularly during the first weeks postpartum. This helps pain and also decreases the inflammation in the breast that comes with engorgement.

3. Therapeutic lactation massage

This gentle technique is amazing. Do this at least every couple of hours as soon as the feeling of fullness and swelling begins. This can help to decrease the swelling, making it easier for the baby to latch and get milk out.

By barely stroking and tapping the breast or chest, you help move out the fluid that causes the swelling to build up. Beware - this is NOT a massage like you would do on your muscles - that type of vigorous massage can actually WORSEN the swelling! This is a gentle, barely touching the skin technique. 

This video by Maya Bolman, RN, IBCLC shows how to do the massage. 

4. Use gravity to help

Laying back at a 45 degree angle can help drain the fluid away from the breasts and chest while you do the gentle massage. 

5. Cold packs

Place frozen wet towels, ice packs, or even bags of frozen vegetables on and around your breasts or chest. Use a thin cloth between your skin and the ice to prevent damaging the skin. This helps to decrease the swelling.

6. Gentle heat

Warm compresses placed around the breast just before nursing or expressing milk can help your milk ‘let down’ or come out more easily. Be sure to test any heat on your cheek before placing it on your breast and chest skin - we don’t want a burn!

7. Wear a comfortable, supportive bra

Do not wear a super tight bra that compresses the breast and chest tissue. This can lead to blocked milk ducts and even infections in the breast. Even if you want to stop lactating, it is not a good idea to compress the breast tissue in this way.

8. Get help with latching your baby and/or expressing milk

Lactation may be natural, but that doesn’t mean it is easy. Pain with nursing or pumping is common but it is not normal and should NEVER be ignored. Seek help quickly if you are having any problems. There are many techniques a Lactation Consultant, Breastfeeding and Lactation Medicine physician or other lactation professionals can show you to help make things easier.

About the Author

Dr. Lindsay Moore-Ostbys, Internal Medicine and Pediatrics physician, cares for children and adults of all ages at Indy Direct Docs, her direct primary care medical practice in Indianapolis. She is also an IBCLC (a Lactation Consultant) and a Breastfeeding & Lactation Medicine physician. She offers care for lactation concerns, complex breastfeeding concerns, and 4th-trimester care in office, by video visit, and in-home to Indianapolis and the surrounding suburbs. If you need assistance or have questions about her practice you can call 317-964-0014 or go to https://www.indydirectdocs.com.