When your baby is born, the first milk it receives isn’t that white mature milk. The first milk is colostrum; a thick, creamy, yellow liquid. Liquid gold. It really is “gold”. It’s packed with essential nutrients for the first few days of baby’s life [source]. It’s what baby gets from breastfeeding for about the first 3-5 days.
During this time, mom’s breasts are soft. After that, mature milk starts to “come in” leaving the breast feeling fuller and tender. If you’re “lucky”, you may go up a cup size or two :). This occurrence is known as engorgement.
Some women experience a mild engorgement while others have it more severely. Some women never experience engorgement at all. Mine wasn’t mild. Nobody warned me how difficult it could be breastfeeding with engorgement. I can only assume they probably never experienced it the way I did. Wait…now I think of it, no one ever told me about engorgement…period!
I learnt about engorgement the day after I returned from the hospital with my brand new baby girl after spending 5 days there.
What is engorgement?
The Journal of Nursing Education and Practice describes engorgement as “the painful swelling of the breasts associated with the sudden increase in milk volume, vascular congestion, and edema during the first two weeks after birth” [source]. It occurs when there is a buildup of breastmilk during the breastfeeding period.
Signs of Engorgement
Breastfeeding with engorged breasts can be very uncomfortable if not dealt with appropriately. These are some signs that you may be experiencing engorgement:
- Swollen, hard, painful breasts. It’s not just a full feeling but when you touch them, they feel like rocks. Depending on how bad it is, you may even feel or see lots of lumps. During my engorgement period, it was difficult for me to even lift my hand without feeling pain in my breasts and under my armpit. Yes, my swelling was not just confined to my breasts.
- Flattened nipples. This doesn’t necessarily occur immediately, but as the milk builds up the nipples begin to flatten and the areola becomes hard. Sometimes you may see lumps in the areola too. I figure it’s because the milk has nowhere to go. This impacts baby’s ability to latch on properly for a good feed. In my case, I felt my nipples pulling and they were shiny. This made my pain worse.
- Low grade fever. This is a temperature above 37◦C but less than 39◦C. Not everyone experiences this. My temperature stayed normal for the duration of my engorgement.
Can I prevent engorgement?
I remember just sitting in bed crying and feeling guilty for allowing myself to become engorged even though I wasn’t sure if it was necessarily my fault. I questioned myself about what I could have done, if anything, to prevent this painful experience. Somethings are just out of our control but from my research there are some things which can be done to prevent engorgement or at least reduce it’s duration.
- Try to nurse baby as soon as possible after birth. I get it. This isn’t everyone’s reality. It definitely wasn’t mine. If you don’t get the chance until hours later, you can try some hand expression.
- Nurse your baby often. As tiring as this may be, it’s necessary to keep your breasts from becoming overly full because you skipped a feeding or went too long between feedings. So feed whenever your baby shows hunger cues.
- Forget the time. I’m sure there may be people in your ear telling you to feed for a certain amount of time. Forget that! Let your baby lead. If he wants to feed for 6 minutes or 30 minutes, let him. He controls his intake not the clock.
- Empty one breast before switching. Although your breasts are never fully “empty”, they are a lot less full when most of the milk is removed. Have baby nurse at one breast until his sucking slows or stops completely and your breast is soft.
- Make sure baby’s latch is good. The deeper the latch, the more effectively milk is removed.
How can I relieve it?
If you find yourself engorged before you had the chance to try to prevent it, I’ve got some tips to help you that worked for me. You may not need to do all depending on the severity of your engorgement.
- Despite the pain, continue nurse your baby from your engorged breast(s) frequently. Even if your baby is asleep, wake him to nurse. Looking back, I made this mistake in the first few days of my daughter’s life. The day she was born, I let her sleep for hours without waking her to feed. Some other days, I allowed her to sleep more than 4 hours without waking her. I believe that this contributed to my milk backing up.
- Apply heat before a nursing session. Heat causes milk to flow which is needed when your baby is feeding. I used a warm washcloth before and during each nursing session. Sometimes because the pain was so bad and I really wanted the milk out, I would boil my washcloths. I don’t recommend this though because I got a few burns because of it.It also helps to stand in a hit shower. The steam from the water would stimulate milk flow. Excessive heat is not good, however. This can actually make engorgement worse. I only applied heat for up to 10 minutes at a time.
- Massage your breasts. If you’re not a fan of heat, massages work well too. Sometimes before I finished my massages, milk would be pouring out. They key is to massage from under the arms and go in the direction of the nipple. It’s like you’re pulling milk towards your nipple to be expressed. You can also massage your breast while baby is feeding.
- Use a cold compress. Heat encourages milk flow but a cold compress helps with swelling and inflammation. In between feedings, use a cold compress for about 15-20 minutes at a time. I used bags of crushed ice or a frozen saline bag. Some people use frozen peas or cabbage leaves. There are some really cool cold packs that fit nicely in your bra as well.
- Use reverse pressure softening. If your nipples become flat and taut, reverse softening pushes the milk back so that your baby can latch better. This video helped me figure out how to do the reverse pressure softening.
Should I seek medical help?
If left untreated, engorgement can reduce milk supply or even worse, lead to mastitis and plugged milk ducts. If your temperature rises above 38◦C or your breasts are red and extremely painful, you should seek medical help immediately. If you try treating your engorgement at home and it doesn’t get better, speak to a lactation consultant or your doctor.
Engorgement, while common, doesn’t need to stop you from breastfeeding. The key is to keep milk flowing. The more effectively milk is removed, the better for you and the shorter your engorgement period.
Have any of you mamas experienced engorgement? How was that time for you? Share in the comments below :).