Breast engorgement during breastfeeding: what causes it and how to relieve it

It's not unusual to get engorged, swollen breasts when you're breastfeeding. Here's the best expert advice on what's causing it, how to relieve the discomfort and what to do if engorgement means your baby can't latch on

engorgedbreasts

Engorged breasts are breasts that are swollen, mainly with milk but also with blood and fluid, and feel uncomfortable and heavy. Breast engorgement is fairly common in the very 1st week of your new-mum life but it can happen later on, too. It typically happens when:

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  • your milk ‘comes in’ (usually sometime between the 2nd and 5th day after the birth)
  • you’ve missed some breastfeeds
  • you’re expressing breastmilk (expressing stimulates your breasts to make more milk, so you will have excess supply if you express more than your baby actually needs)
  • you’re weaning your baby off the breast, especially if you’re doing so rapidly (your breasts need time to adjust to any reduction in the amount of milk your baby needs)

Are engorged breasts anything to worry about?

Not usually, says Justine Fieth, a postnatal doula and breastfeeding supporter who is on the Council of Directors of La Leche League UK, as the engorgement often passes quite quickly, especially if you take steps to relieve it (see How can I relieve engorged breasts?, below).

But, if the engorgement is very extensive or lasts for a while, it can sometimes lead to:

  • blocked ducts and mastitis
  • feeding problems for your baby

We know it sounds a bit counter-intuitive that having more milk in your breasts can make it harder for your baby to feed properly. But, as Justine explains:

Even if you feel as though you have lots of milk, engorgement can make it harder for your baby to latch on to your breast and feed well. Then, when milk isn’t removed from your breasts, you produce less milk. Treating engorgement gives your baby more milk now and helps protect milk production for when your baby is older
Justine Fieth, La Leche League

How can I relieve engorged breasts?

There are a number of simple things you can do to relieve engorged breasts, the most effective of which is breastfeeding your baby regularly. Here’s Justine’s list of top engorgement-relieving tips:

  • Breastfeed frequently. As a guide, in the first weeks, that means at least 8 to 12 times every 24 hours, including at night
  • Make sure your baby is latched on well. Check out our step-by-step guide to making sure you’ve got the right latch and see What do I do if my baby can’t latch on to my engorged breasts?, below.
  • Apply ice packs to your breasts between feeds. Literally stuff them down your bra for 15 to 20 minutes at a time to help reduce the swelling. Wrap them in a tea towel to protect your skin.
  • Try moist warmth before feeding. Put a warm wet towel on your breasts, take a warm shower or immerse your breasts in a bowl of warm water for about 2 minutes before a feed, to encourage your milk to flow well.  Then, express to comfort if your baby isn’t ready to feed.
  • Express (by hand or with a breast pump) a little after a feed if your breasts still feel very firm and full. Stop as soon as you feel comfortable. See our guide to expressing breastmilk.
  • Use gentle massage. Move from your chest wall towards the nipple area in a circular motion.
  • Wear a soft, supportive nursing bra. Avoid tight or underwired bras – and any tops that put pressure on specific areas of your breasts.
  • Put a (savoy) cabbage leaf in your bra. There is some evidence that this is soothing and relieving.1 Change leaves when they become wilted or after about 2 hours or (obviously) if you get any reaction or rash on your skin.

LadyTottington on our MadeForMums Chat forum swears by the ‘cabbage trick’: “Get yourself a nice savoy cabbage and chill it in the fridge. Then pop a couple of leaves inside your bra for about half an hour. You’ll find the shape of the leaves makes a pretty good fit! It feels weird and squirmy at first but, oh it works wonders!”

woman in shower

What can I do about the pain?

You can take some paracetamol or ibuprofen (at the recommended dose) to ease the pain. These are both safe to take while you’re breastfeeding but the NHS advice is to check with your midwife or GP first if you want to take ibuprofen.2

If 1 (or both) of your breasts becomes red, lumpy and inflamed and/or you get chills, a fever and feel flu-ey, do see your GP; you may have mastitis and, just in case that’s come hand-in-hand with an infection, you may need antibiotic treatment.

What do I do if my baby can’t latch on?

If your baby’s finding it hard to latch on to your suddenly different-sized breast, try changing your normal position or hold to a different one. We’ve got lots of ideas in our guide to breastfeeding positions.

It can also help to express (by hand or with a breast pump) a little milk before you start to feed, to soften your breast a little, and make it easier to latch on to.

You could also try a technique call reverse-pressure softening (see What is reverse-pressure softening?, below), which also helps to remove excess fluid from your breast prior to a feed.

What if my breasts are engorged because I’m stopping breastfeeding?

All of the tips for relieving engorgement (warmth, ice packs, cabbage leaves) will still help, as will taking an anti-inflammatory painkiller. You may also want to wear breast pads to mop up any leaks.

You may find you still feel full and uncomfortable for quite a few days after you’ve stopped breastfeeding, or expressing. Treating this fullness by expressing small amounts of milk every so often can help prevent it getting worse.

What is reverse pressure softening?

Reverse pressure softening is a technique that can help to make it easier for your baby to latch on if your breasts are swollen due to engorgement.

Here’s Justine’s guide to how to do it:
“Press all 5 fingertips of 1 hand around the base of your nipple. Apply gentle steady pressure for about a minute to leave a ring of small dimples on your areola. This softens the area around your nipple so your baby can draw it out well in their mouth.”

We also like this video (below) demonstrating reverse pressure softening, presented by Jessica Barton, an IBCLC-qualified lactation counsellor.

Reverse pressure softening technique for engorgement: VIDEO

About our expert Justine Fieth

Justine Fieth is a trained breastfeeding counsellor based in Cambridge, who is on the Council of Directors of  La Leche League GB. She is co-founder and trustee of the Cambridge Breastfeeding Alliance, and became a recognised post-natal doula in 2016. She is now part of Doula UK and Cambridgeshire Doulas. Justine has extensive experience in helping families with a wide-range of  breastfeeding issues, including breastfeeding babies with tongue-tie, twins, premature babies, and slow-weight gain babies.

References

1. The effectiveness of cabbage leaf application (treatment) on breast engorgement in breastfeeding women, Boh Boi Wong (primary reviewer). JBI Database of Systematic Reviews and Implementation Reports: Volume 8 – Issue 34 – p 1–21. DOI: 10.11124/jbisrir-2010-691
2. Breastfeeding and medicines. NHS online.

Pics: Getty

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